Skewed distributions--new outcome measures

Area of Science:

• Dental epidemiology
• Public health research
• Biostatistics

Background:

• The decayed, missing, or filled teeth (DMF) index, a traditional measure for caries, exhibits highly skewed distributions in children and young adults.
• Existing research on skewed DMF data primarily addresses statistical analysis properties, sample size, and subject selection for clinical trials.

Purpose of the Study:

• To examine epidemiologic studies and their aims to identify measurement issues with skewed DMF index data.
• To propose novel outcome measures for improving caries epidemiology.

Main Methods:

• Analysis of the full range of epidemiologic studies and their constitutive interests (description, documentation, explanation, prediction, evaluation, advocacy, experimentation).
• Identification of measurement problems associated with skewed DMF index data within these contexts.

Main Results:

• Skewed DMF index data presents significant measurement challenges across various epidemiologic study aims.
• The study highlights the need for 'new' outcome measures beyond simple prevalence or incidence.

Conclusions:

• The development of 'new' outcome measures is crucial for advancing caries epidemiology.
• Proposed measures include caries severity grading, refined prevalence/extent/severity variants, combined case definitions, and weighted DMF components.
• Further research questions are identified to codify the use of these new measures in caries epidemiology.