MDent, Faculty of Haelth Sciences, University of the Witwatersrand

The aim of this thesis is to describe the development of oral health and possible associations with socioeconomic and socio-behavioural factors, in an adult population over a period of 30 years. A further aim is to describe attitudes to, and demands of dental care, and the impact of oral conditions on quality of life. The study sample consisted of 787-1158 individuals, aged between 35-85 years, randomly selected from Dalarna’s population register in 1982, 2002, 2007 and 2012. The studies were carried out in 1983, 2003, 2008 and 2013, and the participants responded to a questionnaire and a clinical examination of oral status. There has been a substantial improvement in oral status in regard to the mean number of teeth, intact teeth, and less removable dentures over this period of 30 years. The proportion of individuals with alveolar bone loss decreased significantly between 1983 and 2008, but increased significantly between 2008 and 2013. Smoking was the overall strongest factor associated with alveolar bone loss, after adjustment for socioeconomic and socio-behaviour factors, age and number of teeth. Calculus, visible on radiographs, increased significantly between 2003 and 2013. The proportion of individuals with manifest caries declined significantly between 1983 and 2008, but seems to level out between 2008 and 2013. Socioeconomic and socio-behaviour factors were significantly associated with manifest caries. Preventive treatment, meeting the same caregiver as on previous visits, and information about treatment cost was reported to a significantly lower degree as important in 2013, compared with 2003 and 2008, and booking time for treatment was reported as more difficult in 2013, compared with earlier years. Regular recalls was reported as less important in 2013, compared with 2008. A third of the respondents reported oral impact on daily performance and irregular dental visits, limited economy for dental care, less than 20 remaining teeth, manifest caries and temporomandibular disorder were significantly associated with oral impact on daily performance.