Adult Dental Health
The Adult Dental Health Survey has been carried out every decade since 1968. It measures tooth retention, numbers of natural teeth, sound and untreated teeth and also the periodontal (gum) health of the adult population. Nationally across all of the indicators of oral health and disease there has been a continual improvement in adults' dental health. Overall however, only 10% of people across the UK and in the North East have excellent oral health and almost a third had obvious decay in the crowns/roots of their teeth. 75% of adults say that they clean their teeth twice per day with a further 23% saying they clean once per day. Only 2% of the England population claim to brush less than once per day and 1% said that they never clean their teeth.
One of the basic measures of oral health is how many teeth are retained throughout a lifetime. The number of adults retaining teeth into old age is increasing. In 2009, 94% of people in England had at least one natural tooth. For people in the North East 92% had at least one natural tooth.
Across the whole adult population of adults aged 65 and under just over half a million are edentate (have no natural teeth). This is a small group but they present unique demands on the dental service. The proportion of adults with no teeth has fallen from 28% in 1978 to 6% in 2009.
Generally the more teeth a person retains the better their oral health and function will be. Twenty-one teeth are generally considered adequate. In 2009 86% of the population of the UK had at least 21 teeth compared to 82% in the North East. This was the lowest rate between all the England Strategic Health Authorities at the time.
Tooth decay, tooth wear and tooth trauma all cause irreversible damage to teeth. If the population are retaining sound and untreated teeth then this indicates a good potential for good oral health in the future. The average number of sound and untreated teeth per adult is 17.9 across the UK but the north east average is just lower at 17.8%.
Good oral health isn't just about teeth but also depends on the health of the gums and bone that support them (periodontal tissues). Across the UK only 17% of people had very healthy gum tissues. This was higher in the North East at 18%.
A new survey was undertaken in 2013 to assess caries in 3-year-olds as it was recognised that there was evidence of decay, even at this early age. This survey gives an indication of the decay rates in this age group but results should be interpreted with caution as only those three-year-olds that attended nursery/playgroup settings and whose parents provided positive consent were examined.
In England 12% of 3-year-old children had decay in one or more of their teeth. In Gateshead this was 13.7%. This is concerning especially as the water in Gateshead is fluoridated to optimal levels.
Early childhood dental decay is an aggressive form of dental disease found in very young children and is usually associated with long term bottle use containing sugar-sweetened drinks. Feeding of sugar-sweetened drinks also contributes to other public health issues such as childhood obesity. Early childhood decay affects around 4% of 3-year-old children in England but in Gateshead affects 3%.
The number of children with dental abscesses (sepsis) was also assessed. In England 0.3% of three-year-olds had sepsis but in Gateshead the numbers were 3%. This is worryingly high and shows that there is a lot of untreated decay in these young children despite there being adequate dental provision.
Children at five-years-old will usually have 20 teeth and some of these are decayed before they even attend school. The last survey of 5-year-olds was carried out in 2014/15 and showed that In Gateshead 76% of 5-year-old children were free from dental decay. This is similar to the England average of 75% [Chart - 5 year old children free from dental decay]. The average number of teeth that were decayed or had been filled or extracted in 5 year olds in Gateshead was 0.65 compared with the England average of 0.84 [Chart - Number of decayed, missing or filled teeth at age 5]. An earlier survey from 2011/12 showed that only 2.7% of children had teeth that had decayed into pulp compared with 4.4% across England.
The 2011/12 survey also showed that Gateshead has good numbers of school aged children accessing dental care. This is shown by the fact that in Gateshead 16.1% of decayed teeth had been filled whereas the average for England was just 11.2%. The number of 5-year-old children who have had one or more teeth extracted in Gateshead was 3%. This was just below the England Average of 3.1%. This is of particular concern as extraction of teeth in this age group is generally carried out in hospital under a general anaesthetic. Although a simple procedure it does carry real risk for the child and impacts on family life for example parents requiring time off work.
The number of 5-year-olds with dental abscesses in Gateshead was below the England Average at 1.2 % compared to 1.7% for England.
Although the survey showed that there have been decreasing levels of decay there is a wide variation across the country and between different life circumstances for example, the most deprived communities have the highest levels of decay. This is true for Gateshead as five-year-old children with decay varied from 9% in Whickham South and Sunniside to 47% in Felling ward.
Tooth decay by ward:
|Ward||% of children aged 5 years with dental decay|
|Chopwell & Rowlands Gill||20%|
|Crawcrook & Greenside||22%|
|Dunston & Teams||27%|
|Dunston Hill & Whickham East||20%|
|Lobley Hill & Bensham||33%|
|Pelaw & Heworth||20%|
|Ryton, Crookhill & Stella||19%|
|Wardley & Leam Lane||25%|
|Whickham South & Sunniside||9%|
|Windy Nook & Whitehills||29%|
|Winlaton & High Spen||14%|
The last dental survey of 12 year old children was carried out in 2008/2009. The survey showed that in England 33.4% of 12 year olds had one or more decayed teeth. Gateshead was just below this at 31.8%.
The number of decayed teeth that were filled in Gateshead was 47% the same as the England Average. While this is equal to the England average this still leaves 53% of decayed teeth untreated which is concerning. There may also be issues for some vulnerable groups due to cultural issues or language barriers.
The North East had the highest level of access to Dental services in England in March 2013 but despite this there is still significant treatment need amongst the population. Barriers to accessing dental care mainly centre on dental anxiety, cost of treatment and the attributes of the dental practice.
In Gateshead there is good access for school aged children with 65% of them having seen an NHS dentist in a two year period. There is however a decline amongst young adults (although females are better than males probably due to better health seeking behaviours). In later life there is some improvement in access but for most age groups less than 50% saw a dentist within a given 2 year period. There is a further decline at age 70 years.
Access varies against Gateshead with 59% of people having seen a dentist in Ryton, Crookhill and Stella compared to 36% in Bridges. Efforts therefore should be made to improve access especially in certain communities and for families.
General Anaesthetic Rates
Extractions in children are often carried out under general anaesthetic. Although a simple procedure it does carry risk for the child. In 2013/2014 261 Gateshead children aged 0-19 (0.6% of the population) were treated under General Anaesthetic for the removal of teeth. The majority of these would be due to dental caries. This number is high for a fluoridated area and on par with non-fluoridated areas with much higher caries rates such as Middlesbrough (0.7%). Other fluoridated areas in the North East have much lower General Anaesthetic rates for children for example Hartlepool (0.2%), Sunderland (0.3%) and County Durham (0.3%).
Oral cancer rates may be affected by high risk behaviours such as smoking and drinking large quantities of alcohol. Gateshead has oral cancer rates similar to both the national and North East averages. The general trend nationally and regionally is upwards. In Gateshead the trend over recent years has been downwards (although large confidence intervals make it difficult to draw definitive conclusions) so that it is now very close to the national rate [Chart - Oral cancer registrations].
 Adult Dental Health Survey 2009, HSCIC (HSCIC website)
 Dental Public Health Epidemiology programme. Oral Health survey of three-year-old children 2013. A report on the prevalence and severity of dental decay. (NWPH website)
 Local Authority Dental Health Profile, National Dental Epidemiology Programme for England, Oral Health Survey of 5 Year Old Children, 2011/12 (NWPH website / Oral Health Profile website)
 Local Authority Dental Health Profile, National Dental Epidemiology Programme for England, Oral Health Survey of 5 Year Old Children, 2011/12 (NWPH website)
 PHE National dental epidemiology programme for England: oral health survey of five-year-old children 2012. A report on the prevalence and severity of dental decay
 Child Dental Health Survey 2011/2012. Locality supplement for Gateshead Council, PHE
 Dental Public Health Epidemiology programme. Oral Health survey of 12-year-old children 2008/2009. (NWPH website)
 HSCIC, NHS Dental Statistics for England: Third Quarterly report, 2012/2013 (HSCIC website)
 Access to NHS Dental Services 2012/13. PHE - Gateshead Council and Cumbria, Northumberland, Tyne and Wear
 Admission to hospital for extraction of one or more decayed primary or permanent teeth among 0-19 year olds, PHE Dental Public Health Intelligence Programme, 2011/2012 (NWPH website)
 Oral cancer registrations, London Knowledge and Intelligence Team based on data from the National Cancer Registration Service's cancer registration system ENCORE, 2015-17 (Local Tobacco Control Profiles for England website)