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Within: Oral Health

Related to: Oral Health of AdultsDeprivation and Oral Health Children and Young People, Ill Health and Disability, Diet and Malnutrition, NHS Health Checks, Patient Experience, Older People, Child Health and Wellbeing Survey

Key Facts:

  • The prevalence of tooth decay in 5 year olds in B&NES in 2015 was lower than that of England.
  • Around 15% of children in B&NES have experience of tooth decay with each child having around 3 affected teeth.  Most disease in these children is untreated at 5-years-old.
  • Children with special needs with decay tend to have more affected teeth.

Why oral health matters in children

For children, tooth decay has both physical and psychological effects. 1 These include pain, infections, poor nutrition, loss of sleep and days off school.  It can also growth and weight gain in very young children 2 and can contribute to school readiness. 3 The Public Health Outcomes Framework and the Children and Young People’s Health Outcomes Framework include tooth decay in 5 year old children as an outcome indicator.

How oral health of children is monitored

Information on trends in oral disease in children is available from two main sources: the national decennial children’s dental health survey and Public Health England co-ordinated local surveys. 5 year olds are most regularly surveyed, usually every two years. 

It is important to bear in mind that surveys generally underestimate levels of disease, particularly the early stages of tooth decay as it is more difficult to spot decay in a school environment than in a clinical environment with good lighting, radiographs, etc4

The major oral condition affecting children in the UK is tooth decay. This is usually measured using the dmft index. This shows the number of decayed, missing and filled teeth (dmft).

Oral health inequalities in children 

Certain groups of children are at greater risk of oral diseases (Figure 1). These tend to be children who are already vulnerable or disadvantaged in other ways, such as living in poverty.  At a national level, children from the most deprived backgrounds are more likely to experience dental problems and need urgent treatment at dental practices than those living in affluent areas.  They are also most likely to need dental treatment e.g. fillings and extractions and less likely to attend regularly for routine examinations.  Similarly, children with learning difficulties are more likely to have poor oral hygiene, untreated dental caries and more extractions than the general population. 5 A similar picture is seen in other groups of vulnerable children.

Children who are at higher risk of oral diseases include vulnerable families, looked after children, young carers, teenage mothers, individuals in youth offending services and children in inpatient settings. 

 

Figure 1: Some of the groups of children who are at higher risk of oral diseases

Unusually however, in B&NES there is no clear relationship between deprivation and tooth decay.  

What does the data say?

5 year old children6

Prevalence of tooth decay 7

The prevalence of tooth decay in five-year-olds in B&NES is lower than that of England.  In 2015, 15% of 5 year olds in B&NES had tooth decay compared to a quarter (25%) in England. 

The prevalence of tooth decay in five-year-olds in B&NES is significantly lower than the South West as a whole. 

Figure 2: The proportion of five-year-olds with tooth decay experience, by local authority in the South West (d3mft >0) in 2015 8

When considering changes in prevalence of tooth decay in B&NES over time, there have been apparent improvements between 2011/12 and 2014/15.  These are not however, statistically significant.

Severity of tooth decay9

In B&NES many children have no decay at all whilst a minority of children experience will have between 2 and 4 teeth affected on average (Figure 3).

Figure 3:  Mean number of teeth affected by tooth decay (d3mft) in five-year-olds with decay experience (d3mft > 0) in 2015 10

In B&NES there has been no statistically significant changes in the severity of tooth decay (i.e. in the number of teeth affected) between 2011/12 and 2014/15.  This picture is replicated across most of the South West. 

The dmft index is made up of the number of decayed, missing and filled teeth.  The ‘missing’ and ‘filled’ portions indicate how much of the tooth decay has been treated.  The ‘decayed’ portion shows how much decay is untreated (and therefore represents unmet need).

In 5 year olds in B&NES, the proportion of affected teeth that are decayed is much greater than the proportion which is missing or filled. This means that a large proportion of decay is untreated in this age group.

Surveys at local, regional and national level consistently show that the majority of decayed teeth in 5 year olds are untreated.  This could indicate that these children are not visiting the dentist.  It could also indicate that children are accessing dental care but are not receiving treatment.   There is debate in the dental profession as to the value of treating disease in young children as filling these teeth may not improve the long term health outcome.  This issue is currently being researched.

Figure 4: Mean number of teeth affected by decay in 5 year olds, by local authority in the South West, showing how much decay is decayed, missing or filled. 11

3 year old children12

In their early years, children can experience a specific type of tooth decay, known as Early Childhood Caries (ECC).  This is an aggressive form of decay that affects upper front teeth (incisors) and can cause rapid and extensive tooth destruction. It is associated with long term bottle use with sugar-sweetened drinks, especially when these are given overnight or for long periods of the day. For the first time, a survey on the oral health of 3 year olds was carried out in 2013. The results of the survey can be found here however, they do not include data for Bath and North East Somerset. In the South West 3% of 3-year-olds had ECC compared with 3.9% of 3-year-olds in England.  The number of teeth affected was less than one tooth per child in both England and the South West.

Children with special needs13

Children with special needs aged 12 and 5-years olds were surveyed for the first time in 2014.  The number of children examined was relatively small so there is no robust estimate at upper tier local authority level.  In this survey, prevalence of tooth decay, at a national level, was 22% for five-year-olds and 29% for 12-year-olds with special needs.  Five-year-olds with decay had between 3 and 4 affected teeth that were decayed, missing or filled, 12-year-olds had between 2 and 3 affected teeth. For both 5-year-olds and 12-year-old children attending special needs schools overall severity and prevalence was lower than for children attending mainstream schools but those who had decay had it more severely with more teeth being affected on average.

Hospital admissions for dental extractions in children and young people (0-19 years)

14

Such procedures expose children to small, but significant risks of life-threatening complications for an essentially, entirely preventable disease. 

In 2012/13, 236 (0.6%) children and young people aged 0-19 years in B&NES had teeth extracted under a general anaesthetic due to dental decay, slightly higher than in the South West and England, both with 0.5%.  The highest proportion of children and young people who had teeth extracted under a general anaesthetic due to dental decay in B&NES in 2012/13 were those aged 5-9 with 1.5% (133 children).

It is important to note that this dataset does not include those extractions carried out by community dental services, which thus means the figures are likely to be an underestimation.

What does the community say?

The Child Health and Wellbeing Survey15

The Secondary School Wellbeing Survey is carried out alongside a Primary School Wellbeing Survey every two years. These surveys have been carried out in 2011, 2013 and 2015. They have been developed by Bath and North East Somerset Council (B&NES), in partnership with the Schools Health Education Unit (SHEU). The Secondary School survey asks B&NES pupils in Year 8 (12 and 13 years old) and Year 10 (14 and 15 years old) and the Primary School Survey asks B&NES pupils in Year 4 (8 and 9 years old) and Year 6 (10 and 11 years old ). The surveys are about a wide range of issues, including teeth cleaning and visits to the dentist. 

The purpose of the surveys are to acquire data that can be used to inform decisions, at both a local authority and school level, to improve the wellbeing of pupils in B&NES. It is also used in the classroom as the stimulus for discussion with young people. 

The survey is undoubtedly extremely valuable in helping to understand the issues that affect the health and wellbeing of young people locally. However, it has its limitations and it is important to bear these in mind when interpreting the results.

Firstly, the survey is not statistically representative of all Year 4, Year 6, Year 8 and Year 10 pupils as not all schools participated, nor was a random sample selected.

The pupils that completed the survey were those in schools that choose to participate and who were present on the day of the survey. Therefore, it excluded pupils that were not in school on the day of the survey due to illness or exclusion, and in a small number of schools, those that were not able do the survey due to restricted access to computers.

Due to the fact the survey was for school pupils in Year 4, Year 6, Year 8 and Year 10 in B&NES, it excluded children resident in B&NES who go to schools outside B&NES. Therefore, the survey included some children not resident in B&NES.

The survey was designed as an anonymous survey. Names and other personal identifiable information were not collected. Therefore, pupils cannot be identified. Furthermore, due to safeguarding and ethical issues the survey was unable to ask very sensitive personal questions.

Oral health questions

The Child Health and Wellbeing Survey carried out in 2015 and 2013 asked the following questions about oral health:

  • How many times did you clean your teeth yesterday?
  • How long ago did you last visit the dentist?

Teeth cleaning - When the pupils were asked - How many times did you clean your teeth yesterday? :
  • In 2015 2% of the B&NES Year 4 and 6 pupils responded that they did not clean their teeth at all on the day before the survey, this was a increase compared to 2013 when it was 1%.
  • Only 1% of the B&NES Year 4 and 6 pupils responded that they did not clean their teeth at all on the day before the survey.
  • In both 2013 and 2015 only 1% of the B&NES Year 8 and 10 pupils responded that they did not clean their teeth at all on the day before the survey.
  • In 2015 80% of the Year 4 and 6 pupils responded that they cleaned their teeth at least twice on the day before the survey, this was a decrease compared to 2013 when it was 85%.
  • In 2015 77%  of the Year 8 and 10 pupils responded that they cleaned their teeth at least twice on the day before the survey, this was a decrease compared to 2013 when it was 85%.

Visit to the dentist - When the pupils were asked  - How long ago did you last visit the dentist?:

  • In 2015 83% of Year 4 and 6 pupils responded that they had visited the dentist in the past 6 months. This question was not asked in 2013.
  • In 2015 89% of Year 8 and 10 pupils responded that they had visited the dentist in the past 6 months, a decrease compared to 2013 when it was 91%

For more information and results from the Child Health and Wellbeing Survey see the Child Health and Wellbeing Survey section.

What can realistically change?

Oral health of 5 year old children in Bristol, North Somerset, Somerset, South Gloucestershire, Wiltshire and Gloucester report 16

The recommendations made in the Oral health of 5 year old children in Bristol, North Somerset, Somerset, South Gloucestershire, Wiltshire and Gloucester report are:

  • On-going commissioning of dental epidemiological surveys by local authorities as part of their statutory requirements is necessary to monitor oral health and progress.
  • Priorities should continue to be driven by knowledge of local populations and careful assessment of needs and evidence-based practice.
  • Areas with children with high levels of tooth decay should be identified and preventive services should be targeted to these locations using the principles of proportionate universalism.
  • Local authorities should work towards improving oral health and reducing  oral health inequalities through the commissioning of evidence-based oral and general health promotion programmes.
  • NHS England commissioners should ensure equitable access and distribution of resources to reduce inequalities in access to care. Distance, inconvenience and cost should be considered to avoid barriers to care.