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  1. 1. Board Meeting 05 10 10 Open Session Item 7.1b Grampian Adult Dental Health Survey Summary Report – Final Draft August 2010Report prepared by:Ray Watkins, Consultant in Dental Public Health, NHS GrampianData Analysis:Dr. Tatiana Macfarlane, Senior Research Fellow, University of AberdeenDr. Sriyani Ranasinghe, Honorary Research Fellow, University of AberdeenMr Neil Katecha (cancer knowledge), Undergraduate student, University of AberdeenProject Group and Editorial Team:Claudia Cunningham, Senior Dental Officer, NHS GrampianIain Bovaird, Senior Dental Officer, NHS GrampianRochelle Morgan, Specialist Analyst, NHS GrampianTatiana Macfarlane, Senior Research Fellow, University of AberdeenKirstin Rhodes, PA to the Consultant in Dental Public HealthSampling and data management:Val Angus, Data Manager, University of AberdeenFiona Chaloner, Software Engineer, University of AberdeenKatie Wilde, Analyst Programmer, University of AberdeenMichal Kawecki (pilot study), Undergraduate Student, University of Aberdeen
  2. 2. CONTENTSSummary of main findings........................................................................................................................... 11. How was the survey conducted?......................................................................................................42. What was the response rate? ..........................................................................................................43. Who responded? ............................................................................................................................44. What was the condition of the natural dentition? ............................................................................55. How does this compare to the previous study in 1993 study? ........................................................56. Do most adults in Grampian have enough teeth for normal functions? ...........................................67. What is the relationship between total tooth loss and deprivation? .................................................88. What is the level of oral health improvement over the last 30 years in Scotland and Grampian?....89. How do people access their dental services? . ...............................................................................910. How satisfied were the patients with their dental service? ............................................................1011. What did patients feel about the location of their dental services? ................................................1112. Do people with disabilities have equal access to dental services? ...............................................1213. What are people doing to maintain their own oral health (self care)? .......................................... 1214. How do people use and rate emergency dental services? ............................................................1315. What are people’s attitudes and views of their dental health and visiting the dentist? How does this affect their care? .....................................................................................................................1315. What were people’s general health behaviours and knowledge of mouth cancer? .......................14 2
  3. 3. 17. How does oral health impact on people’s quality of life? ...............................................................15Conclusions ...............................................................................................................................................16 3
  4. 4. SUMMARY OF MAIN FINDINGSThe Purpose of the SurveyThe purpose of the survey was to provide information on the current state of adults’ teeth and oralhealth in Grampian. Overall 3,353 people participated in the survey, which was an adjustedparticipation rate of 58%. The highest response rate was in the 55-64yrs category (68.2%) and thelowest response was in the youngest age group 25-34yrs (47.2%).Oral Health and Impact on Quality of LifeThe results showed that Grampian has reached the target set by the Scottish Government of ‘lessthan 10% of adults to have no teeth remaining by 2010’. In Grampian 9.1% of adults over the age of16 have no remaining teeth. This is a significant improvement from the 1993 Grampian oral healthsurvey when 22.9% of adults had over the age of 16 had no remaining teeth. Again, this is a furtherimprovement on the results of the 1972 Scottish survey which revealed that almost half (46%) ofScottish adults had no teeth remaining.The Oral Health Impact Profile, used to assess the impact of oral health on quality of life, showedthat the largest impact on health from oral diseases was pain, with 29.8% recording pain wheneating occasionally, often or very often and 25.4% recording painful aching in the mouthoccasionally, often or very often over the last 12 months.Oral Health Behaviours96% of respondents brush their teeth regularly (once or more per day). 95% of those who weardentures regularly clean their dentures. However only 13.3% of people floss their teeth daily and24.1% floss every few days.Access to Dental Services45.4% of respondents were in regular NHS dental care however the results also revealed thatGrampian has the highest level of private dental care in Scotland with 37.9% of the populationunder private care. However results show that 16.8% of the population are unable to get any dentalcare at all.Patient Satisfaction with Current Service93% of respondents who claimed to be under regular NHS dental care were either ‘satisfied’ or‘very satisfied’ with their current service. 75% of those who are unable to get any dental careclaimed to be either ‘dissatisfied’ or ‘very dissatisfied’ with their current service. 17.3% of those whoare under private care claimed to be either ‘dissatisfied’ or ‘very dissatisfied’ with their currentservice. 4
  5. 5. 1. How was the survey conducted?The Grampian Adult Dental Health Survey was conducted in Grampian between October 2009 andJanuary 2010. The only other such study in Grampian was conducted in 1993 and involved 2,626participants.The study consisted of a postal questionnaire. A random sample of 6,000 adults aged 25 years andover was chosen from the Community Health Index (CHI) database. The sample wasrepresentative of the three Community Health Partnership (CHP) and Local Authority areas thatconstitute Grampian. The largest CHP area (Aberdeenshire) was divided into two diverse groups togive data on four areas within Grampian i.e. Moray, North Aberdeenshire, South Aberdeenshire andAberdeen City. The sample was further stratified by age (25-34yrs; 35-44yrs; 45-54yrs; 55-64yrs;65-74yrs and 75+yr) and sex. NHS Grampian had recently undertaken a youth and young peoplelifestyle survey and therefore 16-24 yr olds were not sampled.The study was comprised of questionnaire consisting of 51 questions on oral health, dental healthbehaviour, dental services utilization, mouth cancer knowledge and quality of life.Every effort was made to increase participation. A press release was published, resulting in radioand newspaper interviews. Non-respondents after first two weeks were sent a reminder postcard, afurther full questionnaire after another two weeks, which followed by a final short questionnaireconsisting of 10 key questions in the case of non-response.2. What was the response rate?Overall 3,353 (56%) of adults participated in the survey, of whom 3,022 completed the fullquestionnaire and 331 completed the short questionnaire. Following removal of surveys returned bythe post office as undeliverable, deceased and participants who were unable to complete thesurvey due to disability, there was an adjusted participation rate of 58%. In addition, 23 adults partlycompleted the questionnaire i.e. only provided some information such as presence of dentures,dentist location etc.3. Who responded?The geographic spread of the response was fairly even across Grampian with the highest responsein Moray (26.3%) and the lowest response in South Aberdeenshire (23.9%). In terms of agedistribution, the highest response rate was in the 55-64yrs category (68.2%) and the lowestresponse was in the youngest age group 25-34yrs (47.2%). Some elderly people with no teeth didnot feel the survey was relevant to them and sent the questionnaire back unanswered. The femaleresponse rate (61.6%) was higher than the male response (54.4%). The response from the fourgeographic areas and the urban/rural divide was fairly similar. Analysis of participation by SIMDquintile (Scottish Index of Multiple Deprivation 2009) showed the lowest response rate was in themost deprived category (quintile 1, 44.4%) and the highest response rate was in quintile 4 (60.4%)and quintile 5 (60.1%). 5
  6. 6. 4. What was the condition of the natural dentition?Adults can have up to 32 adult teeth but some of them are lost over time. Scotland has a longtradition of poor oral health and unfortunately a major indicator used to measure and monitor oralhealth is the number and percentage of people who have “no natural teeth remaining”. This index ofdental health (disease) is acutely illustrated when considering the first Scottish survey of oral healthin 1972 when 44% of adults aged over 16 years had no teeth remaining. The corollary of this is thatonly 54% of adults had any remaining natural teeth and 64% of adults in Scotland needed denturesto eat and speak.Previous oral health studies in Grampian, Scotland and the UK used all adults including those aged16-24yrs as the base for their research. This study used a sample of adults aged 25 years andover. In order to compare this survey with previous surveys, an adjusted value was calculated thatgave an adjusted total for the percentage of all adults in Grampian with total tooth loss. The numberof adults with total tooth loss aged 16-24yrs was assumed to be zero. In the previous Grampianstudy in 1993, one person aged 16-24yrs had lost all their natural teeth. It was consideredreasonable to base the adjusted total tooth loss for all adults over the age of 16 on the premise thatnone of the 16 to 24 year olds had lost all their teeth.Table 1: Age-adjusted (Grampian population in CHI database) comparisons of the number of adults in Grampian with no remaining teeth Adjusted percentage of Adjusted percentage of adults over 16 yrs of age adults over 16 yrs with with no remaining teeth some remaining teeth All adults over 16 yrs 9.1% 90.9% Male 8.0% 92% Female 10.4% 89.6% Aberdeen City 10.4% 89.6% North Aberdeenshire 9.7% 90.3% South Aberdeenshire 7.0% 93% Moray 9.2% 90.8%5. How do these results compare with the previous study in 1993?In the 1993 survey 22.9% of adults aged over 16 years in Grampian had no remaining teeth. Therehas therefore been a 56.5% reduction in people with no teeth remaining i.e. a decrease from 22.9%of people with no teeth remaining to 9.1% of people with no teeth in 2010. 6
  7. 7. Table 2: Percentage of people with some natural teeth by age group 1993/2010 Age group Number and % with Percentage with Percentage with no natural teeth some natural teeth some natural teeth 2010 remaining 2010 remaining 1993 25-34yrs 3 (0.6%) 99.4% 98% 35-44yrs 7 (1.0%) 99% 94.1% 45-54yrs 30 (5.8%) 94.2% 79% 55-64yrs 70 (11.8%) 88.2% 54% 65-74yrs 131 (23.6%) 76.4% 39.1% 75+ 176 (40.6%) 59.4% 22.3%The percentage of adults with no natural teeth increases considerably with age. This relates toprevious disease and patterns and treatment patterns - in the past dentists tended to extract largenumbers of teeth (sometimes up to 20) at one time often using general anaesthesia. There were anestimated 200,000 general anaesthetics per year for such adult extractions recorded in 1960s. Thiswas common practice as late as the 1970s. Thus total tooth loss increases considerably withpeople who were adults in the 1960s and 1970s. The present survey shows that over 40% of adultsin Grampian aged over 75 years have no remaining teeth. The largest improvement in those whohave retained their natural teeth compared to the 1993 survey are in the 55-74yr age group i.e.people who have had a National Health Dental Service for most of their adult life.6. Do most adults in Grampian have enough teeth for normal functions including eating, chewing, smiling and talking?The survey recorded that the average number of teeth in an adult over 25 years of age was 23(22.79) teeth. Many adults have some unerupted or missing teeth such as wisdom teeth and it maybe considered that 28 (excluding 4 wisdom teeth) as opposed to 32 should be the expected numberof teeth present.When considering the natural dentition, many dentists believe that it is necessary to have at least20 teeth to perform normal functions such as eating and chewing food, for speaking and to maintaina reasonable aesthetic. Graph 1 illustrates the proportion in each age group that achieve this“reasonable” level and compares the data to the1993 survey.The graph illustrates that whilst 94.4% of adults aged 25-34yrs in Grampian have enough teeth fornormal functions, this declines sharply with age and only 15.7 % of those over 75 years have 20 ormore teeth. People with less than 20 teeth usually require dentures or other artificial toothreplacements e.g. dental implants or bridges. 7
  8. 8. Graph 1 Percentage of adults by age group with 20 or more natural teeth 1993 and 2010 100 90 80 70 60 50 40 30 20 10 0 25-34yrs 35-44yrs 45-54 yrs 55-64 yrs 65-74 yrs 75 yrs 1993 20+ teeth 89.3 75.2 47.9 24.9 13.1 2.1 2010 20+ teeth 94.4 89.5 74.4 56.3 30.7 15.7Artificial replacement of teethThe traditional loss of teeth in Scotland has led to a reliance on plastic replacement of teeth i.e.dentures. In 1972 very few people in Scotland had mouths unaffected by dental disease and 64%of the adults needed dentures of some type. These were either part dentures replacing somemissing teeth or full dentures which are upper and lower dentures replacing all the teeth each jaw.Full dentures are described as Full/Full or F/F.In Scotland in 1972, 64% of the population had some type of denture, 44% of these had fullreplacement (F/F). In Grampian in 1993, 48.8% of the population had some type of denture, 22% ofthese had full replacement (F/F). In Grampian in 2010, 32.8% of the population had some type ofdenture, 9.1% of these had full replacement (F/F).A further indication of replacement was recorded in 1993 with about 4% of people having a dentalbridge replacing lost teeth, this rose to 6.8% by 2010. A recent development has been the use ofimplants to support crowns, bridges or dentures and in this survey 4.9% of adults had dentalimplants.It was concerning that of the people who wear dentures, 29.8% had the same dentures for over 10years. 10 years is considered to be the maximum life expectancy of a denture.7. What is the relationship between total tooth loss and deprivation? 8
  9. 9. There is a clear relationship between socio-economic deprivation and tooth loss with *22.3% ofadults in the most deprived quintile (quintile 1) with no remaining teeth. In contrast, only *10.2% ofpeople in the most affluent group (quintile 5) had no remaining teeth.8. What is the level of oral health improvement over the last 30 years in Scotland and Grampian?In 1972, almost half (46%) of Scottish adults (over 16 years) had no teeth remaining, having lost all32 teeth. Successive Scottish administrations and the current Scottish Government have set targetsfor improving the oral health of the population. The present target for adults “less than 10% of adultsover 16 years of age to have no teeth remaining by 2010” has been achieved by Grampian as awhole as well as in each of the CHP areas. Graph 2: Number of people with no teeth by age group. Comparison of results for 1972 (Scotland), 1993 (Grampian) and 2010 (Grampian) 100 90 80 Percentage with no teeth 70 60 Scotland 1972 50 Grampian 1993 Grampian 2010 40 30 20 10 0 25-34yrs 35-44yrs 45-54yrs 55-64yrs 65-74yrs 75yrs+ Scotland 1972 13 35 54 78 86 89 Grampian 1993 2 5.9 21 46 60 77.7 Grampian 2010 0.6 1 5.8 11.8 23.6 40.6Whilst the above graph illustrates a clear improvement in people with no teeth, a new indicator isrequired for oral health which would reflect improvements in oral health rather than lack of teeth andthe effect of dental disease.(*these figures are not comparable with the age-adjusted figures presented earlier and are reported directlyfrom the statistics with no age adjustments. They therefore give a higher than anticipated result than if theywere balanced to represent all adults over the age of 16)9. How do people access their dental services?Grampian has had problems with access to NHS dental services with over 30,000 people on awaiting list for regular NHS care at the time of this survey. The results of the survey show 16.8% of 9
  10. 10. the population in Grampian are unable to access any regular dental care. A further 37.8% have access to Private dental care only. A considerable number of those in Private care expressed dissatisfaction with their Private dental service primarily on the grounds of cost. The youngest and the oldest age groups have the poorest access to any dental care. Graph 3: Service providers of dental care by age group in Grampian 100% 90% 80% 70% 60%Percentage NHS regular care 50% Private regular care No care or NHS emergency care 40% 30% 20% 10% 0% 25-34yrs 35-44yrs 45-54yrs 55-64yrs 65-74yrs 75yrs+ Total NHS regular care 45.1 47.5 45.7 44.1 44 45.2 45.4 Private regular care 35 38.8 39.8 42.5 38.1 30.3 37.9 No care or NHS emergency care 19.8 13.7 14.5 13.5 17.9 24.5 16.8 Table 3: Distribution of dental care in Grampian by service type Frequency Percent Percent NHS registered regular care 1,206 38.7% Regular NHS care NHS registered with some Private care 208 6.7% 45.4% NHS emergency only 161 5.2% Private plan e.g. Denplan 375 12.0% Regular Private care Private care 804 25.8% 37.8% Unable to get any dental care 363 11.6% There is considerable variation across Grampian in access to dental care: • The highest level of NHS registered regular care is in North Aberdeenshire (62.3%) 10
  11. 11. • The lowest level of NHS registered regular care is in Moray (34.1%) • The highest level of Private care is in Moray (46.3%) • The lowest level of Private care is in North Aberdeenshire (23.1%)There was also considerable variation in terms of age groups: • The highest level of NHS registered regular care was in the 35-44 age group (47.5%) • The highest level of Private care was in the 55-64 age group (42.6%)10. How satisfied were the patients with their dental service?The majority of respondents stated that they were either “satisfied” or “very satisfied” with theircurrent service. The main reasons for dissatisfaction were the cost of services, mainly related to thePrivate sector. Table 4: Satisfaction with dental services Frequency Percent Very satisfied 1,131 38.2% Satisfied 1,240 41.8% Dissatisfied 340 11.5% Very dissatisfied 252 8.5% Table 5: Satisfaction with dental services by service type Very satisfied Satisfied Dissatisfied Very dissatisfied NHS 728 (52.1%) 571 (40.9%) 78 (5.6%) 19 (1.4%) Private 380 (32.6%) 583 (50.1%) 170 (14.6%) 31 (2.7%) Unable to get 18 (4.7%) 77 (20.3%) 87 (23%) 197 (52%) regular care Total 1,126 (38.3%) 1,231 (41.9%) 335 (11.4%) 247 (8.4%)When respondents were asked to comment on why they were dissatisfied with their current service,the main recorded dissatisfaction concerned the Private sector with several hundred commentsrelated to the cost of Private services. A further question asked independently of their views ofdental services as shown in Table 7 below. Indications are that a sizable proportion of people whoaccess Private care find it expensive and only access Private care because of the lack of availableNHS care. As the Private: NHS ratio is presently 37.8%: 45.4% i.e. fairly equal proportions, servicedevelopment becomes challenging for the NHS and a very large risk for Private dental suppliersbecause there is little motivation for people to join Private dental care systems except lack of NHS. Table 6: Comments related to dental services 11
  12. 12. Frequency PercentI have difficulty getting time off work 200 6.6%I have difficulty getting an appointment that suits me 285 9.4 %My dentist does not offer evening appointments 520 17.2%I have not found a dentist I like 74 2.4%I cannot get dental treatment under the NHS 859 28.4%I cannot get a Private dentist 57 1.9%I find NHS treatment costly 175 5.8%I find Private treatment costly 1008 33.4%Respondents were asked whether they had tried to get a routine NHS dentist appointment in thelast two years: • 47.3% of people had tried to get an NHS appointment in the last two years • Of the people who had tried to get an appointment, the majority 71.1% were successful in getting an NHS appointment.11. What did patients feel about the location of their dental services?A high level of satisfaction was recorded with the distribution/location of dental services, even forthose in rural areas. Access to NHS care remained the main issue rather than location/distributionof dental services.Respondents were asked what time or distance they felt was acceptable to travel for dentalservices. The average maximum time was 38.5 minutes (SD 24.7) or 15 miles (SD13). • The majority (90%) of people felt that the distance they currently travel to their dentist is acceptable. • Travel duration by CHP or rural and urban sampled populations showed little variation. A major exception was the rural remote sector where 30 mins or less travel distance was only recorded by 64% of people. In this remote and rural sector 93% recorded travel time within 1 hour, even in the remotest locations. • The majority (53.3%) of respondents preferred their dentist to be located close to their home with only 6.4% stating that they preferred their dentist to be located close to their place of work. 40.4% said that they did not mind either way.12. Do people with disabilities have equal access to dental services? • Only a small number of respondents (n = 126, 4.4%) stated that they had a disability that required their dentist to make special arrangements for their visit. 12
  13. 13. • Of the disabilities recorded, the largest number were heart diseases (26.2%). Physical disability was much lower at 9.5% (n=12) and 5.6% (n=7) recorded having learning difficulties. A number of people identified anxiety as a disability, with 15.1% (n=19) requiring dental care under sedation due to anxiety. • A number of people stated that they require home visits but did not stipulate why. • 59.3% (n=51) of those who had a disability stated that their local dentist was able to provide for their needs. • However 14% (n=12)of respondents stated that their dentist is unable to meet their needs so they do not receive any dental care at all. This was a small but concerning problem.13. What are people doing to maintain their own oral health (self care)? • Toothbrushing has become a universal habit, with a similar attention to care paid to dentures. • 96% of people brush their teeth regularly (once or more per day) with 95% regularly cleaning their dentures. • Only 13.3% of people floss their teeth daily and 24.1% floss once every few days. • Mouth rinsing with a mouthwash was surprisingly popular with 25.1% rinsing daily and 19.3% rinsing once every few days. • It was very concerning that 49.4% of people who wear dentures do not leave their dentures out at night. Table 7: Last routine check-up received Grampian Grampian1 2010 993 Less than one year 66.9% 58% 1-2 years ago 9.9% 14% 2-5 years ago 5.7% 11% 5-10 years ago 6.8% 17% over 5 years I have not been to a dentist for over 10 years 10.6% 13
  14. 14. 14. How did people use and rate emergency dental services? • 22.6% of people needed urgent dental care in the last two years. • The majority (66%) received urgent care from their regular dentist. • Of the people that received urgent care in the last two years, 81% received both advice and an appointment.Whilst satisfaction levels with emergency care were high the main issue was the access toinformation regarding emergency services. 38.1% reporting that their dentist had not advised themof who to contact in an emergency. Only 23% said that they were fully informed of who to contactin an emergency out of hours.15. What are people’s attitudes and views of their dental health and visiting the dentist? How does this affect their care?This section reviewed people’s attitudes to oral health and dental services. • 57.7% recorded their main use of dental services was for a routine check-up. • Anxiety still seems to be a problem, with 29.4% of people feeling anxious about attending the dentist and 7.9% of people being scared of attending the dentist. This however is an improvement on the 1993 survey. • Respondents were asked how they would rate the information they receive from their dentist regarding procedures, self care etc. 78.4% reported that the information they receive is either “good” or “excellent”, however 21.4% stated that the information they receive is either “poor” or ”very poor”. • Gum disease remains prevalent with 24.8% of people reporting bleeding gums while eating or brushing their teeth. • 23% of people reported having a tooth extracted in the last two years. Whilst the majority of these were single extractions (70.9%), there were some (4.1%) who had over five recent extractions. • The main reason for extraction was dental decay (62.9%). Accidental damage (8.9%) was the second most common reason for extractions followed by gum disease (7.8%). • Respondents were asked to rate their own oral health and 66% responded either “good” or “excellent”. • 28.2% of people said that they thought they would need treatment if they were to visit the dentist tomorrow. 14
  15. 15. • A number of people recorded that they felt they had obvious problems such as dental decay and gum disease. However a concerning number recorded swelling, infection, ulcers, blisters and white patches as indicated in the table below. NHS Grampian would recommend that many of these types of lesion should be investigated urgently. Table 8: Abnormalities observed in the mouth Frequency Percent Obvious holes in teeth (decay) 445 14.7% Gum disease 220 7.3% Ulcers / blisters / raw areas 171 5.7% White or red patches 76 2.5% Swelling or infection 86 2.8% Other 281 9.3%16. What were people’s general health behaviours and knowledge of mouth cancer?Head and neck cancer is the sixth most common cancer in Scotland. Oral cancer accounts foran estimated 40% of head and neck cancers (circa 450 new cases per year). Early diagnosis canmake a substantial difference to the outcome. Participants were asked about their awareness of thecauses of mouth cancer as previous studies showed poor understanding and knowledge in thisarea. • Knowledge of mouth cancer was good (81%), almost on a par with other well know cancers like lung cancer (87.3%) and breast cancer (88.1%). • There were small variations in knowledge between the different age groups however the 75+ age group (potentially those at highest risk) had the least knowledge with only 67.7% having heard of mouth cancer. • Respondents were asked to identify from a list what they thought were risk factors for mouth cancer. The majority (84.2%) correctly identified smoking as a risk factor. A smaller proportion (58.8%) correctly identified heavy alcohol consumption as a risk factor. However a high percentage (60%) identified poor dental hygiene as a risk but currently there is no evidence to support such a statement.Smoking and Alcohol UseThe main factors related to oral cancer i.e. smoking and alcohol were recorded as part of thesurvey. Current smokers and participants who consumed alcohol every day were more likely to 15
  16. 16. report awareness of mouth cancer. They were also more likely to respectively identify smoking andheavy alcohol consumption as risk factors for mouth cancer. Table 9: Smoking prevalence in Grampian Percent I currently smoke or have stopped smoking within last 12 months 19.3% I used to smoke but stopped smoking over 12 months ago 27.2% I have never smoked 53.5% Table 10: Alcohol use in Grampian Percent I drink alcohol almost every day 10.9% I drink alcohol once or twice a week 35.7% I drink alcohol less than once a week 34.6% I do not drink alcohol 18.8%17. How does oral health impact on people’s quality of life?OHIP (Oral Health Impact Profile) is a set of 14 questions used to assess the impact of oral healthon quality of life. Initial analysis reviewed the impact of oral health on the quality of life of communitygroups by establishing a mean score for each group. • There was a clear relationship between deprivation and OHIP score, with those in the most deprived quintile 1 (mean 11.5) experiencing a lower quality of life due to poor oral health compared with those in Quintile 5 (mean 5.2) • Geographic / community variation was less pronounced with the largest impact on quality of life in Aberdeen City (mean 7.3). The lowest impact was in South Aberdeenshire (mean 5.4). • The largest recorded differential between groups was in relationship to care pathways (Table 12). Those who are under Private care had the least impact (mean 4.9) compared with those who are unable to get any dental care (mean 11.8) who had the greatest impact on their quality or life due to poor oral health. Table 11: Comparison of the OHIP mean scores for NHS, Private and those unable to get regular dental care Total OHIP-14 Valid Mean Standard Minimum Maximum number 16
  17. 17. score DeviationNHS 1,247 5.4 7.7 0 52Private 1,019 4.9 6.6 0 43Unable to get regular care 418 11.8 11.7 0 56Comparison of individuals’ quality of lifeThe largest impact on quality of life was related directly to the disease process i.e. pain. 29.8%recorded pain when eating occasionally, often or very often and 25.4% recorded painful aching inthe mouth occasionally, often or very often over the last 12 months. This correlates closely with theearlier statistic that 22.6% of people needed urgent dental care in the last two years.The second most often recorded factor affecting quality of life was related to psychological issues.23.3% of people felt self conscious about the appearance of their teeth (4.3% felt this way ‘veryoften’), 15.6 %, reported feeling tense/stressful and 15.4% recorded feeling embarrassed.Graph 4: Selection of responses to quality of life questions (Oral Health Impact Assessment) illustrating the most and least common factors impacting on quality of life 0.4 14 Unable to function 2 0.2 10. Embarrassed 11.7 2.8 2.9 9. Difficulty relaxing 7.8 1.6 0.9 6 Tense 10.5 2.6 2.5 5. Self conscious 15.2 4.8 4.3 4. Uncomfortable to eat 23.6 4.8 2.4 3. Painful aching mouth 20.6 3.5 1.3 0 5 10 15 20 25 30 35 % Percentage Occasional Fairly often OftenCONCLUSIONSData will be discussed with our partners to enable us to focus our efforts in the areas of greatestneed. The results provide a baseline for future evaluation of our Dental Action Plan and will enableus to monitor trends. 17
  18. 18. Requests for the full report can be emailed to: 18