{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:25:23Z","timestamp":1783074323816,"version":"3.54.6"},"reference-count":21,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,5,11]],"date-time":"2016-05-11T00:00:00Z","timestamp":1462924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100010763","name":"National Health Care Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100010763","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Comm Dent Oral Epid"],"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Untreated dental caries is the most prevalent medical condition worldwide, with considerable variations in prevalence between regions and countries. The care index (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>) and the restorative index (<jats:styled-content style=\"fixed-case\">RI<\/jats:styled-content>) are generally used to make comparisons between and within countries of levels of care delivered. However, several methodological challenges can be identified that limit the interpretation and comparison of these indices. The objective of this manuscript was to evaluate these challenges and to provide solutions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Five challenges were identified: (i) the comparability of <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">RI<\/jats:styled-content>, (ii) the use of multiple definitions of <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">RI<\/jats:styled-content>, (iii) <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">RI<\/jats:styled-content> measured for surfaces or teeth, (iv) the skewness of F\/D(M)F (restored teeth or surfaces as a fraction of the total number of decayed, (missing), and filled teeth or surfaces), and (v) the relationship between <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> RI<\/jats:styled-content> and D(M)F. Time\u2010series data were obtained \u2013 for people aged 25\u201344 years with low socioeconomic status \u2013 from four cross\u2010sectional studies performed in 1995, 2002, 2007 and 2013 in the Netherlands, and those data were subjected to descriptive analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The analyses showed that the choice of index and definition had a major impact on the results, which varied in terms of absolute size and trends. Moreover, <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">RI<\/jats:styled-content> are expressed as mean scores, but the distributions of F\/<jats:styled-content style=\"fixed-case\">DMF<\/jats:styled-content> and F\/<jats:styled-content style=\"fixed-case\">DF<\/jats:styled-content> were highly skewed. <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">RI<\/jats:styled-content> may therefore mask groups of individuals who still need care. The proportion of individuals receiving most restorative care was much higher in the group with low levels of caries than in the groups with more caries. This implies that, when the need for care decreases over time, the restorative care indices can be expected to increase, even though there may be no improvement in the amount of care delivered.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We argue that epidemiological studies of oral health in the future should clarify the definitions used to describe the care delivered and investigate subgroups of F\/<jats:styled-content style=\"fixed-case\">DMF<\/jats:styled-content> or F\/<jats:styled-content style=\"fixed-case\">DF<\/jats:styled-content> in categories based on the extent of caries. These figures could be used to monitor changes in treatment provision and to highlight inequalities in the provision of care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cdoe.12238","type":"journal-article","created":{"date-parts":[[2016,5,11]],"date-time":"2016-05-11T13:49:02Z","timestamp":1462974542000},"page":"485-492","source":"Crossref","is-referenced-by-count":3,"title":["The amount of care delivered: challenges of indices in oral health studies"],"prefix":"10.1111","volume":"44","author":[{"given":"Paula","family":"van Dommelen","sequence":"first","affiliation":[{"name":"Department of Child Health TNO Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemarie A.","family":"Schuller","sequence":"additional","affiliation":[{"name":"Department of Child Health TNO Leiden The Netherlands"},{"name":"Center for Dentistry and Oral Hygiene in Groningen University Medical Center Groningen Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,5,11]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034515573272"},{"key":"e_1_2_7_3_1","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1016\/S0140-6736(12)61729-2","article-title":"Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990\u20102010: a systematic analysis for the Global Burden of Disease Study","volume":"380","author":"Vos T","year":"2010","journal-title":"Lancet"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034513490168"},{"key":"e_1_2_7_5_1","unstructured":"vanKalsbeek H. 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