Child Dental Health in the United Kingdom
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Barbara Chadwick School of Dentistry Cardiff University
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Child Dental Health in the United Kingdom
- 1. Child Dental Health in the United Kingdom Barbara Chadwick chadwickbl@Cardiff.ac.uk School of Dentistry Yr Ysgol Ddeintyddiaeth
- 2. My brief To set the scene for the Mouth Matters: Dental Health and Child Welfare Symposium Review normal dental development Explain how dental caries (decay) is measured Review the epidemiology of dental caries Within the national context of dental disease consider when dental caries is a manifestation of dental neglect Identify how population based preventive approaches School of Dentistry Yr Ysgol Ddeintyddiaeth
- 3. Why worry? The effect of a relatively common chronic disease, severe dental caries, affects young childrens’ growth and well-being. Treating dental caries in pre-school children would increase growth rates and the quality of life of millions of children. Severe untreated dental caries is common in pre-school children in many countries. Children with severe caries weighed less than controls, and after treatment of decayed teeth there was more rapid weight gain and improvements in their quality of life. This may be due to dietary intake improving because pain affected the quantity and variety of food eaten, and second, chronic inflammation from caries related pulpitis and abscesses is known to suppress growth through a metabolic pathway and to reduce haemoglobin as a result of depressed erythrocyte production. School of Dentistry Yr Ysgol Ddeintyddiaeth
- 4. School of Dentistry Yr Ysgol Ddeintyddiaeth
- 5. In an Ideal World… 6 months 5 years 12 years School of Dentistry Yr Ysgol Ddeintyddiaeth
- 6. The Primary Dentition • 20 teeth • Development commences at 7 weeks IU • Eruption begins at about 6 months • Dentition complete at about 2½ years Primary = deciduous, first or milk teeth School of Dentistry Yr Ysgol Ddeintyddiaeth
- 7. Mixed Dentition 6 – 13 Years 6 years (+/- 1 year) • Lower primary incisors loosen and are replaced by permanent incisors • 1st permanent molars erupt, there is no primary predecessor • Many parents think they are baby teeth School of Dentistry Yr Ysgol Ddeintyddiaeth
- 8. The Permanent Dentition • 28 teeth • Development begins at 20 weeks IU • Eruption begins at about 6 years • Dentition complete at about 13 years Permanent = second or adult teeth School of Dentistry Yr Ysgol Ddeintyddiaeth
- 9. In Reality Things Can Go Wrong Main dental problems: • Dental caries (decay) • Dental trauma (broken teeth) • Dirty mouths and sore gums (plaque) School of Dentistry Yr Ysgol Ddeintyddiaeth
- 10. Tooth • susceptible surface Diet (sugar substrate) • amount • frequency • type Bacteria in biofilm Time Caries Caries Aetiology School of Dentistry Yr Ysgol Ddeintyddiaeth
- 11. Selwitz et al. (2007) Dental Caries; Lancet. 369:51-59 School of Dentistry Yr Ysgol Ddeintyddiaeth
- 12. Dental Caries • Dental caries is preventable with plaque control using a fluoride toothpaste and limiting sugar containing food and drinks to meal times. • Is any decay in a mouth therefore a sign of neglect? School of Dentistry Yr Ysgol Ddeintyddiaeth
- 13. 2 children – would you say either of these was dental neglect? 18 months old, all 4 primary incisors show enamel decay 4 years old dental decay in 16 of 20 primary teeth School of Dentistry Yr Ysgol Ddeintyddiaeth
- 14. And now? Family fail to attend, present in pain 10 months later This child is under regular review – the family have made changes to diet and brushing habits, all decay is hard and arrested and there has been no new disease since they presented. His younger brother is decay free School of Dentistry Yr Ysgol Ddeintyddiaeth
- 15. Measuring Caries – dmf Index decay = d missing = m (extracted) filled = f (restored) School of Dentistry Yr Ysgol Ddeintyddiaeth DMFT – permanent teeth; dmft – primary teeth
- 16. Some decay is obvious – some you have to look for…. dmft = 0 dmft= 10 dmft = 2 dmft = 6 School of Dentistry Yr Ysgol Ddeintyddiaeth Visual decay into dentine d3 level
- 17. Epidemiology of dental decay Over the past 40 years dental caries prevalence has fallen in the UK - attributed to the introduction of fluoridated toothpaste. It still affects almost half of UK children and adolescents and more than 55% of adults. The improvements ceased in the primary dentitions of younger children in the early 1980s There has been an increasing polarisation with more of the disease occurring in a smaller proportion of the population. School of Dentistry Yr Ysgol Ddeintyddiaeth
- 18. Statistics - child dental health status Decennial UK ONS Child Dental Health surveys NHS Dental Epidemiology Programme (previously known as the “BASCD” surveys) School of Dentistry Yr Ysgol Ddeintyddiaeth
- 19. Decennial Child Dental Health Surveys Every ten years since 1973, across the UK Measures changes in oral health; provides information on children’s experiences of dental care and treatment and their oral hygiene questionnaires; visual examination of teeth by a trained and calibrated dentist Data generally available at country and region level 2013 survey just taken place; outputs not available at time of submitting slides School of Dentistry Yr Ysgol Ddeintyddiaeth
- 20. Mean decayed, missing and filled permanent or primary teeth (DMFT or dmft) for UK children, 1983-2003 School of Dentistry Yr Ysgol Ddeintyddiaeth 1983 1993 2003+ 5 year olds - dmft 1.8 1.7 1.6 12 year olds - DMFT 3.1 1.4 0.8 15 yr olds - DMFT 5.9 2.5 1.6 0 1 2 3 4 5 6 7 meanDMFT/dmft Source: Decennial CDH surveys
- 21. Mean decayed, missing and filled permanent or primary teeth (DMFT or dmft) for children in WALES, 1983-2003 School of Dentistry Yr Ysgol Ddeintyddiaeth Source: Decennial CDH surveys 1983 1993 2003+ 5 year olds - dmft 2.6 1.8 1.9 12 year olds - DMFT 3.3 1.5 1.0 15 yr olds - DMFT 6.7 2.9 2.0 0 1 2 3 4 5 6 7 8 meanDMFT/dmft
- 22. NHS Dental Epidemiology Programme BASCD coordinated surveys of child dental health commenced 1985/86 2006/07 organisational change – devolution, NHS HA reorganisation NHS Dental Epidemiology Programme England: Dental Observatory, NWPHO Scotland: National Dental Inspection Programme, Northern Ireland: programme has stalled recently Wales: Welsh Oral Health Information Unit with PHW regional coordinator Complement the decennial CDHS Provide local smaller area level data, e.g. UAs, USOAs Consent issues School of Dentistry Yr Ysgol Ddeintyddiaeth
- 23. Mean d3mft and %s of children with caries experience, 5 year olds - reported by CDHSs and National Dental Epidemiology Programme over time, England School of Dentistry Yr Ysgol Ddeintyddiaeth 0% 10% 20% 30% 40% 50% 60% 70% 80% 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 1973 CDHS 1983 CDHS 1992 1993 CDHS 1994 1996 1998 2000 2002 2003 CDHS 2004 2006 2008 2012 Proportionofchildrenwithcariesexperience Meand3mft Mean d3mft % children with caries experience Notes: The scale of data collection years is not uniform. Surveys involving positive consent are shown checked bars for severity and with dashed line for prevalence Positive consent
- 24. 24 year trend in the % of Primary 1 Scottish Children with obvious decay experience School of Dentistry Yr Ysgol Ddeintyddiaeth
- 25. DENTAL NEGLECT? = % with 2 or more dmft, 5 or more, 10 or more? School of Dentistry Yr Ysgol Ddeintyddiaeth 0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 16 17 18 20 Numberofchildren Number of teeth affected Distribution of dmft - 5 year olds 2011-12 30.3% 12.7% 1.6%
- 26. Who has the disease? School of Dentistry Yr Ysgol Ddeintyddiaeth 1.16 1.56 1.77 2.04 2.65 0.0 1.0 2.0 3.0 4.0 5.0 Least deprived Second least deprived Middle deprived Second most deprived Most deprived Meandmft Welsh Index of Multiple Deprivation 2008 - Quintiles 2020 Target WALES mean dmft %dmft>0 Least deprived 1.16 34.5 Second least deprived 1.56 41.3 Middle deprived 1.77 44.1 Second most deprived 2.04 49.2 Most deprived 2.65 57.6 All within area 1.98 47.6 Ratio - most deprived: middle deprived 1.50 1.31 Revised targets Reduce the ratio of the most deprived: middle deprived
- 27. School of Dentistry Yr Ysgol Ddeintyddiaeth How do we prevent caries? • We have evidence based national guidance which gives recommendations on: – Toothbrushing – Fluoride toothpaste – Fissure Sealants – Dietary investigation and advice – Professional fluoride application
- 28. ChildSmile School of Dentistry Yr Ysgol Ddeintyddiaeth
- 30. ChildSmile School of Dentistry Yr Ysgol Ddeintyddiaeth
- 31. Impact of Childsmile School of Dentistry Yr Ysgol Ddeintyddiaeth
Editor's Notes
- My brief today is to …… That’s not easy to do in 15 minutes – so forgive me if I skim over a few slides quite quickly – am happy to share the presentation should you need any of the detail.
- May delete this one
- The standard model
- A more usefull context – individual and societal factors play a part
- It has been suggested that any decay is a sign of neglect because it is preventable .......however
- To determine how much decay there is in the UK one needs to understand how we measure it
- There is a positive association between prevalence of dental caries and deprivation Those most at risk come from the most deprived socio-economic groups. DENTAL CARIES IS A PREVENTABLE DISEASE
- In terms of counting the burden of oral disease in children there are 2 main sources of information: READ FROM SLIDE
- The UK Child Dental Health surveys have reported improvements in children’s caries experience during the years previous to 1983; this is thought to be mainly due to the widespread use of fluoride toothpaste. However, since 1993 the rate of improvement in the dental health of UK 12 and 15 year olds has markedly decreased and the oral health of 5 year olds has plateaued since 1983.
- This is a similar graph to the previous one but for WALES. Since 1993 the rate of improvement in the dental health of 12 and 15 year olds has markedly decreased BUT the oral health of Welsh 5 year olds has worsened.
- The British Association for the Study of Community Dentistry (BASCD) initiated the co-ordination of locally based surveys of child dental health in 1985/86. Since 2007, as a result of devolution and NHS health authority reorganisation, the programme is now co-ordinated by the NHS and has been renamed as the NHS Dental Epidemiology Programme. However, BASCD still has an advisory role in the programme delivery. The Dental Observatory based at the North West Public Health Observatory co-ordinates the programme for England. In Scotland there is a National Dental Inspection Programme which is coordinated by a multi-agency Dental Epidemiological Committee. The Welsh Oral Health Information Unit is responsible (together with the PHW regional co-ordinator – Mr Nigel Monaghan) for coordinating the programme in Wales. Consent issues In 2007 we moved from using passive consent to positive consent for our surveys of Welsh five year olds. We are aware that this has had an impact upon the types of children taking part and the overall dmft index – we are currently trying to quantify this.
- As each constituent country has their own survey programme there is less opportunity to present UK data in the same year. Here’s a slide presenting data relating to English 5 year olds.
- Here’s another highlighting prevalence of decay experience in Scottish 5 year olds.
- Lets consider the Wales survey data for 5 year olds in 2011/12 So from a dental caries perspective what is the cut off for dental neglect? The 30% of 5 year olds with 2 or more dmft? The 13% of 5 year olds with 5 or more dmft? Or the 2% of 5 year olds with 10 or more dmft?
- D2S attempts to address the child poverty targets associated with child dental health. So by 2020 the experience of the most deprived fifth (as measured at baseline 2007/8) reflects the experience of the middle fifth (as measured in 2007/8).
- D2S is based upon ChildSmile in Scotland – and Child Smile has reported some promising results. Macpherson LMD et al. – Authors aimed to assess the association between the roll–out of the national nursery toothbrushing program and a reduction in dental decay in five–year–old children in a Scotland–wide population study. The result improved when one outlying Health Board was excluded (correlation = –0.90; –0.97, –0.70; p < 0.0001). An improvement in the dental health of five–year–olds was detected and is associated with the uptake of nursery toothbrushing
- Macpherson LMD et al. – Authors aimed to assess the association between the roll–out of the national nursery toothbrushing program and a reduction in dental decay in five–year–old children in a Scotland–wide population study. READ A dramatic decline in caries of 5 year old children, in Scotland in the past decade during a time when nursery tooth brushing programmes were being developed and rolled out in every Health Board across Scotland. Moreover, an absolute corresponding reduction in absolute inequalities between dental caries rates in the most compared with the least deprived communities was observed.
- Astonishing results, almost certainly largely due to community based prevention, in support of general dentists