DENTAL EPIDEMIOLOGY

It is a well known fact that in Western Societies dental decay is most prevalent in people living in areas of deprivation with the statistics speaking for themselves. A measure of deprivation commonly used in recent years is from data relating to free school meal children.

The Nuffield Trust has published a remarkable Report  “Root Causes” in which a dataset (P14) shows that in 20 out of 25 Regional Health Authorities in England, the majority of hospital admissions in the U14 age group are related to dental problems. It also reports large numbers of dental patients attending doctor’s surgeries where there are no NHS payments to worry about. There is a clear trend from 2016 of a considerable increase in spending on private dental treatment but little researach exists that relates to the loss of NHS supply side services in deprived areas.

It is tiresome to read of a constant improvement in the dental health of the population being attributed solely to the NHS, with significant courses of treatment in recent years being supplied in private practice. Based upon economic grounds alone the private sector services will be concentrated within wealthier families and it is a certainty the loss of NHS dental services will hit the poorest hardest. It is not difficult to predict in 5 years time the state of young children’s teeth from deprived areas in the UK will be far worse than today in the absence of urgent remedial treatment. Nowhere is the term “levelling up” more appropriate than in the provision of free NHS Dental Services for children in deprived areas.

The epidemiology of dental disease in children tells its own story and the Oral Health Survey (OHS) of Children’s Teeth 2013 (6) is an indictment of NHS failure. The Executive Summary begins with the statement “In 2013, nearly a half (46%) of 15 year olds and one third (34%) of 12 year olds had “obvious decay experience in their permanent teeth” whilst in 5 year olds the percentage affected by obvious decay experience in their primary teeth was 31% and the number of teeth affected with any such decay was 3.0 (20% of the deciduous teeth). The longer the teeth remain within an acid environment, their progressive destruction will be a certainty in the absence of preventive measures. This Survey confirms that dental decay more than doubles in children whose families are on low incomes and entitled to free school meals. The jargon that provides the “science” in the latest National Diet and Nutrition Survey (NDNS)(7)  “Analysis by equivalised income quintile showed some evidence of income differences in diet and nutrient intake with those in lower income quintiles tending to have poorer diets, particularly with respect to fruit and vegetable consumption” is extraordinary. Any newly qualified Dental Graduate would have arrived at the same conclusions without wasting vast sums of Taxpayer money on a National Survey many decades ago. Even so, the basis of these National Surveys depends upon parental consent which necessarily skews the resuts and almost certainly undermines the data.

Public Health England launched the Children’s Oral Health Improvement Programme Board in 2016 with a wide range of partners and stakeholders, with the aim to improve the oral health of all children and reduce the oral health gap for disadvantaged children. “The collective ambition of the Board is to see every child growing up free from tooth decay as part of the ambition for every child having the best start in life. Preventing tooth decay also fits in with the government’s childhood obesity strategy and work on healt inequalities and social justice”.

In the days of the NHS General Dental Services (GDS), it was possible to monitor the dynamics of the dental health of the nation.Today special Surveys need to be carried out at 3/5 year intervals as separately funded Surveys that suffer from recording only periods of history where illness trends are often well entrenched requiring costly intervention. It can be argued that an NHS Preventive Dental Care Programme from birth would be far more cost effective than the wholescale ad hoc subsidy encouraging ineffective restorative dentistry.