child dental health in the united kingdom

Child Dental Health in the United Kingdom

Barbara [email protected]

School of DentistryYr Ysgol Ddeintyddiaeth

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


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.


In an Ideal World…

6 months

5 years

12 years


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


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


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


In Reality Things Can Go Wrong

Main dental problems:• Dental caries (decay)

• Dental trauma (broken teeth)

• Dirty mouths and sore gums (plaque)


Tooth•susceptible

surface

Diet (sugar substrate)• amount• frequency • type

Bacteria in biofilm

TimeCaries

Caries Aetiology


Selwitz et al. (2007) Dental Caries; Lancet. 369:51-59School of DentistryYr Ysgol Ddeintyddiaeth

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?


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


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


Measuring Caries – dmf Index

decay = d

missing = m(extracted)

filled = f(restored)


DMFT – permanent teeth; dmft – primary teeth

Some decay is obvious – some you have to look for….

dmft = 0 dmft= 10 dmft = 2 dmft = 6


Visual decay into dentine d3 level

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.


Statistics - child dental health status

Decennial UK ONS Child Dental Health surveys

NHS Dental Epidemiology Programme(previously known as the “BASCD” surveys)


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


Mean decayed, missing and filled permanent or primary teeth (DMFT or dmft) for UK children, 1983-2003


1983 1993 2003+5 year olds - dmft 1.8 1.7 1.612 year olds - DMFT 3.1 1.4 0.815 yr olds - DMFT 5.9 2.5 1.6

0

1

2

3

4

5

6

7

mea

n D

MFT

/dm

ft

Source: Decennial CDH surveys

Mean decayed, missing and filled permanent or primary teeth (DMFT or dmft) for children in WALES, 1983-2003


Source: Decennial CDH surveys

1983 1993 2003+5 year olds - dmft 2.6 1.8 1.912 year olds - DMFT 3.3 1.5 1.015 yr olds - DMFT 6.7 2.9 2.0

0

1

2

3

4

5

6

7

8

mea

n D

MFT

/dm

ft

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 issuesSchool of DentistryYr Ysgol Ddeintyddiaeth

Mean d3mft and %s of children with caries experience, 5 year olds - reported by CDHSs and National Dental

Epidemiology Programme over time, England


1973 CDHS

1983 CDHS

1992 1993 CDHS

1994 1996 1998 2000 2002 2003 CDHS

2004 2006 2008 20120

0.5

1

1.5

2

2.5

3

3.5

4

4.5

0%

10%

20%

30%

40%

50%

60%

70%

80%

Mean d3mft% children with caries experience

Mea

n d3

mft

Prop

ortio

n of

child

ren

with

carie

s exp

erie

nce

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 year trend in the % of Primary 1 Scottish Children with obvious decay experience


DENTAL NEGLECT?= % with 2 or more dmft, 5 or more, 10 or more?


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

Num

ber o

f chi

ldre

n

Number of teeth affected

Distribution of dmft - 5 year olds 2011-12

30.3%

12.7%

1.6%

Who has the disease?


1.16

1.561.77

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

Me

an

dm

ft

Welsh Index of Multiple Deprivation 2008 - Quintiles

2020 Target

WALES

mean dmft %dmft>0Least deprived 1.16 34.5Second least deprived 1.56 41.3

Middle deprived 1.77 44.1Second 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 targetsReduce the ratio of the most deprived: middle deprived


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

ChildSmile


Impact of Childsmile


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