Oral health of children and young people

Introduction

There are two major oral diseases: tooth decay and gum (periodontal) diseases – both are largely preventable.

The primary cause of decay is frequent exposure of teeth to sugars, most commonly through eating and drinking sugary snacks and drinks.

Sugars are also contributory factors to other issues of public health concern in children, for example, childhood obesity and development of Type II diabetes later in life. Improvements in dental decay levels can also give early indication of the success, or otherwise, of interventions aimed at very young children such as those designed to improve parenting, children’s weight or overall health or diet.

There are wide ranging costs at individual and societal level:

• physically, poor oral health leads to pain, inability to bite, chew and swallow, not only does this narrow the food choices a person can make, but poor diet and nutrition continues the cycle of dental decay, poor oral health may also be viewed as the most acute presentation of future chronic health problems such as coronary heart disease, diabetes, obesity, rheumatoid arthritis, and adverse pregnancy outcomes
• psychological impact includes limiting social function with a reduced willingness to smile, speak and interact socially, leading to absence from school in children and young people and from work in adults caring for affected children

Tooth decay was the most common reason for hospital admissions in children aged five to nine years old in 2012 to 13. Dental treatment under general anaesthesia (GA), presents a small but real risk of life-threatening complications for children and is both physically and psychologically traumatic for young children. Good oral health can reduce the nearly 5% of healthcare expenditure on treating oral problems.

Key inequalities and risk factors

Survey data shows that oral health has improved over time but there remain disparities within the population:

• deprivation – variation in dental decay was evident at the local authority level and the severity of decay was related to level of deprivation, children who were from lower income families (eligible for free school meals) are more likely (21%) to have oral disease than other children of the same age (11%).
• ethnicity – Chinese, Eastern European and Asian groups are more at risk from dental decay, have higher levels of obvious decay (particularly incisor /front teeth decay) and lose more teeth than all other ethnic groups
• gender – although declining, teenage boys are more prone than girls to dental trauma related to injuries in the home and school environment which primarily affect incisors
• learning disabilities – fewer children have experience of decay, but those who have tend to have decay more severely, with more teeth affected than mainstream educated children, children with learning disabilities have poorer oral health leading to extractions when compared to the general population and levels of decay, untreated decay and substantial plaque are higher in older children with behavioural or social disabilities compared to mainstream peers

Facts, figures and trends

Children aged 5

The Public Health England Oral health survey of five-year-old children 2015 is a survey of five-year-old children who attended mainstream, state-funded schools across England during the 2014/15 academic year. All 152 upper tier local authorities, including Bracknell Forest, and 111,500 children took part.

The 2015 results found that:

• 75.2% of 5-year-old children in England participating in the survey had no experience of obvious dental decay (an increase from 69.1% in 2008 and 72.1% in 2012)
• 24.7% of children showed some experience of obvious decay

Reviewing previous survey data, the Public Health England Oral health survey of five-year-old children 2015 reports a difference in prevalence of severity of decay:

• during the 1992 to 2006 series of surveys there was little change
• data from the 2008 to 2015 series show a significant reduction in severity of decay

The following factors may contribute to reduced levels of decay:

• increased levels of fluoride in toothpaste from very low levels, such as 250ppm or 440ppm, up to at least 1,000ppm
• increased focus on prevention in general dental practice accouting for an almost seven-fold increase in dentists’ prescriptions for fluoride-based products between 2007 and 2014
• wide dissemination of the messages about twice daily brushing and spitting out after brushing instead of rinsing

Severity of decay

The average number of decayed, missing or filled (DMF) teeth in 5 year olds (including the 75.2% who were decay free) was 0.8 DMF for Bracknell Forest which was the same as the England figure. The figure of 0.6 DMF for the south east was the lowest regional figure.

The chart below shows that among the 24.7% of children with obvious decay, the average number of DMF teeth was 3.4 and the figure for Bracknell Forest was slightly higher at 3.5. At age 5, children normally have 20 primary teeth, meaning that nearly 1/5th were missing.

The percentage of children with incisor caries is also the same as the England figure.

Young people

Older children will have developed their permanent teeth and ongoing care is essential to avoid tooth decay and loss in later life.

Since 1973, a survey has been carried out every ten years into the dental health of 5, 8, 12 and 15 year old children in England, Wales, and Northern Ireland. The most recent survey (2013) was published in March 2015 by the Health and Social Care Information Centre (NHS Digital). The 2013 survey found that:

• 46% of 15 year olds and a third (34%) of 12 year olds had “obvious decay experience” in their permanent teeth. This was a reduction from 2003, when the comparable figures were 56% and 43% respectively
• the proportions of children with some untreated decay into dentine in permanent teeth have also reduced, from 32% to 21% of 15 year olds and from 29% to 19% of 12 year olds
• a quarter (26%) of the 15 year olds who were eligible for free school meals had severe or extensive tooth decay, compared to 12% of 15 year olds who were not eligible for free school meals

Previous surveys looked in more detail at children attending special schools (2013/14), three year olds (2013) 5 year olds (2011/12) and 12 year olds (2008/09). Statistics prepared by the Berkshire Public Health Team show the mean number of DMF in Bracknell Forest for children aged 3, 5 and 12 compared to England as follows:

Impact on health and wellbeing is measured against different problems related to the condition of the teeth and mouth including physical difficulty in eating, speaking clearly, cleaning teeth, doing homework, and emotional difficulties such as relaxing (including sleeping), smiling, laughing and showing teeth without being embarrassed, enjoying being with people, and generally feeling different (e.g. being more impatient, irritated, easily upset):

• overall, 58% of 12 year olds and 45% of 15 year olds reported that their daily life had been affected by problems with their teeth and mouth in the past 3 months
• a fifth of 12 and 15 year olds (22% and 19% respectively) reported experiencing difficulty eating in the past 3 months
• more than a third (35%) of 12 year olds and more than a quarter (28%) of 15 year olds reported being embarrassed to smile or laugh due to the condition of their teeth
• more than a third (35%) of the parents of 15 year olds reported that their child’s oral health had impacted on family life in the last 6 months; 23% of the parents of 15 year olds took time off work because of their child’s oral health in that period

Young people with learning disabilities

The Clinical Guidelines and Integrated Care Pathways for the Oral Health Care of People with Learning Disabilities 2012 state that physical, mental and cognitive ability affect a person’s ability to identify and express need, seek out dental services or co-operate with treatment and therefore carry out effective oral hygiene.

Parents/carers face challenges in providing a recommended healthy and nutritional diet for an individual with eating or drinking difficulties and young people cannot always make informed choices about healthy eating. High calorie food supplements, sugar based liquid medication and laxatives can also increase the risk of dental caries.

Prevention, care and support

Visiting the dentist

NHS Dentist Statistics for England 2014/15 show the number of children seen has increased by 2.5% since March 2006.  According to the Child Dental Health Survey, 88% of those aged 5 and 94% of those aged 8 visited the dentist for a check-up in 2014/15.  The number of children seen by an NHS dentist in the 12 months up to 31 March 2015 was 6.9 million. This equates to 60.0% of the child population. However, despite an actual rise in the number of children seen, as a percentage of the population, the number of children seen has fallen 0.7 percentage points.

Dental treatments

Dental activity is measured through the number of courses of treatment delivered.

The Department of Health’s Delivering Better Oral Health toolkit, first published in 2007, advocates the use of fluoride to improve dental health.  The increase in the application of fluoride varnish treatment for children continued with 3.4 million delivered during 2014/15 making it the most frequent treatment for children.  This represents a 24.6% (676,448) increase in treatments from 2013/14 and an increase of 11.3% to 1.2 million prescriptions in 2014 for fluoride prescriptions.

There was also an increase of 3.5% in scale and polish treatments to 989,851 in 2014/15.

Costs

There has been an almost seven-fold increase in dentists’ prescriptions for fluoride-based products between 2007 and 2014. Dental treatment is a significant cost, with the NHS in England spending £3.4 billion per year on dental care (with an estimated additional £2.3 billion on private dental care). However, fluoride varnish treatment is a significant preventative measure that can be delivered by dental nurses, not just dentists, thereby freeing up capacity in dentist surgeries.

Hospital admissions for dental caries in children aged 1-4 in Bracknell Forest was too small to be reported but the rate over the three year period 2012/13 to 14/15 for the south east was 165.3 children per 100,000, lower than the 322 figure for England as a whole.

Lifestyle habits

Decreasing sugar intake and maintaining a well-balanced diet, and ensuring proper oral hygiene are recommended by the World Health Organisation (accessed 22 June 2016) to reduce oral health risk factors.

The Child Dental Health Survey 2013 summary reported that older children were more aware of good dental health and hygiene. Regular tooth brushing improves oral health.  More than three quarters of older children reported brushing their teeth twice a day or more often (77% of 12 year olds and 81% of 15 year olds). Yet, despite this levels of gum inflammation, plaque and calculus (hardened plaque) were higher in children aged 8 and 12 compared to those aged 5 and 15.

Sugar remains an ongoing risk particularly to lower income families. A minority of older children (16% of 12 year olds and 14% of 15 year olds) reported consuming sugary drinks four or more times a day, putting them at increased risk of developing dental caries. However, children from lower income families (measure by free school meal uptake) consumed sugary drinks four or more times a day (26% of 12 year olds; 26% of 15 year olds).  Sugary sports drinks, drunk socially, are posing an emerging issue according to 2016 research: sports drinks are attractive because of their sweet taste, low price, and availability, with most parents and children not aware that sports drinks are not intended for consumption by children or of the high levels of sugar.

The Public Health England child diet factsheet (2015) sets out government guidelines to limit children’s intake of ‘free sugars’ to a maximum of 5% of total dietary energy which would represent a 50% reduction in the recommended intake. However, data quoted from the National Diet and Nutrition Survey shows that maximum sugar intake is exceeded significantly by both boys and girls.

A short video suitable for younger children is available on the council’s YouTube channel to help promote good oral hygiene:

YouTube video link

Changes to outcome measurement

The Public Health England Oral health survey of five-year-old children 2015  reported significant variance regionally by severity of dental decay and also amongst specific ethnic groups.  A measure showing children with incisor caries (front teeth) in therefore planned to tackle this specific problem which is related to long term use of a baby bottle and sugared drinks. The existing indicator measure of tooth decay in children aged 5 (accessed 23 June 2016) will be changed in the Public Health Outcomes Framework to report children who are free of obvious decay using a revised data set.

Want to know more?

Child diet factsheet (Public Health England, 2015) – reports and analyses food energy benefits and levels of consumption of sugars, fats, salt, fruit, vegetables and fish oils for better health in children and young people.

Clinical Guidelines and Integrated Care Pathways for the Oral Health Care of People with Learning Disabilities (Faculty of Dental Surgery, The Royal College of Surgeons of England, 2001 updated 2012) – guidance based on a systematic review of literature and experience of affected individuals and families and groups involved in their wider support.

Delivering Better Oral Health toolkit (Public Health England, 2014) – guidance designed for dental professional to support the drive for greater emphasis on prevention and reduction of inequalities by the giving of advice, provision of support to change behaviour and application of evidence-informed actions.

Local authorities improving oral health: commissioning better oral health for children and young people (Public Health England). An evidence-informed toolkit for local authorities to support the commissioning of dental health services, setting out practice examples, integrating dental health into other children and young people’s services and desiging services for best outcomes.

National Diet and Nutrition Survey: results from Years 1 to 4 (combined) of the rolling programme for 2008 and 2009 to 2011 and 2012 (Public Health England) – survey data which assesses the diet, nutrient intake and nutritional status of the general population in the UK.

Oral health: approaches for local authorities and their partners to improve the oral health of their communities (NICE, 2014) – guidance on undertaking oral health needs assessments, developing a local strategy on oral health and delivering community-based interventions and activities.

Oral health survey of five-year-old children 2015 (Public Health England, 2015) – report and associated tables present the results of standardised dental examinations of 5-year-old children who attended mainstream, state-funded schools across England during the 2014/15 academic year.

Cite this page:

Bracknell Forest Council. (2016). JSNA – Childhood Oral Health. Available at: jsna.bracknell-forest.gov.uk/developing-well/children-and-young-peoples-health/oral-health (Accessed: dd Mmmm yyyy)

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