Causality in Dentistry

Dr Sergio Uribe
sergio.uribe @ gmail.com
Objectives
at the end of class, the student may

articulate the concept of causality to recognize the different causal models to

identify types of causal state the Hill criteria of causation set forth the conc
ept of confounding variables to estimate risk of tetrachoric tables
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sergio.uribe @ gmail.com
Causality

Cause: A causal factor is an event if its operation alters the frequency of the
event
A A A
B B C
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B C D
Classical Epidemiology
Time
Place
Person
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Causal factors
Biological factors
-
age, sex, race, weight, size, genetic composition, nutritional status, immune st
atus
Psychological factors
-
self-esteem, behavior pattern, lifestyle, stress response
Factors related to the social and cultural environment
-
global warming, pollution, demographic, lifestyle, physical activity during leis
ure time, membership of a social network, access to basic services, overcrowding
, drug addiction, alcoholism
Economic factors
-
socioeconomic status, occupational status, educational level, poverty
Workplace
-
accident at work, employment, loss of employment, access to social security, job
stress, noise pollution, workplace conditions
Political factors
-
wars, embargoes, external debt, globalization and invasion
Factors related to the physical environment
-
geology, climate, natural causes, chemical causes, presence of vectors, deforest
ation sergio.uribe @ gmail.com
Role of variable
Association
Independent Independent Independent Dependent
Effect modifier
Confusion
Dependent
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Dependent
Variable Types
Quantitative (continuous) Qualitative (Discrete)
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Causal models
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Establishing causation
group of subjects divided into two similar groups apply to a group putative fact
or to measure the frequency in both groups compare frequencies
Rest 52 107 patients with TB
14 + 21
17
52 streptomycin + rest
4 + 13
38
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Causality
DeStefano et al. BMJ. 1993 Mar 13; 306 (6879) :688-91.
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Causal model of dental caries
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Causal model of dental caries
Litt et al Public Health Rep. 1995 Sep-Oct, 110 (5) :607-17
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sergio.uribe @ gmail.com
Hill criteria
1) Strength of association as measured by appropriate statistical indices. 2) Co
nsistency among different observers in different places, times and circumstances
. 3) Specificity of the causes. 4) Time. 5) Biological gradient in the dose-resp
onse relationship. 6) Biological plausibility. 7) Consistency with other knowled
ge. 8) experimental evidence. 9) Analogy with other causal relationships.
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Measurement of disease

Normal
- - -
statistical criterion standard diagnostic threshold prevalence incidence forecas
t

Basic measures of disease

- -
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Relationship between P and R Prevalence = Incidence x Duration
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Measures of Association
• Useful for assessing the existence of a relationship between exposure to a spe
cific risk factor and disease status • Relative risk (risk ratio) (RR) - used in
cohort studies. Reason for attack rates in exposed and unexposed groups.
- RR = 1 rate in both groups - RR> 1 the above is possible that disease nás - RR
<1 the above is no more likely to get sick
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Risk estimation
Smoking Implant failure present absent present absent 75 100 565 225
Smoke
Implant failure absent present absent present ab cd
Absolute risk Relative risk
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Risks

Absolute Risk Relative Risk Risk Risk Attributable Attributable%

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As measured risks epidemiology

Determine rates of disease by person, place and time - Absolute Risk (incidence,
prevalence) to identify risk factors for the disease - relative risk (or odds r
atio) develop ways for the prevention of disease - Risk / attributable fraction

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Attributable Risk
Risk
35 30 25 20 15 10 5 0 A B
Excess risk
RA =
Risk between the positive risk factor on the negative risk to the risk factor
Risk factor
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Attributable fraction
FA =
Risk among positive risk factor
-
Risk among negative risk factor
Risk among positive risk factor
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X 100%
Confusion
Cafe
?
Periodontal Diseases
Cafe
Periodontal Diseases
Smoking
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sergio.uribe @ gmail.com