Introduction

Poor dental health impacts not just on the individual’s health but also their wellbeing and that of their family. Children who have toothache or who need treatment may have pain, infections and difficulties with eating, sleeping and socialising. A quarter of 5 year-olds have tooth decay when they start school. Children who have toothache or who need treatment may have to be absent from school and parents may also have to take time off work to take their children to a dentist or to hospital. Oral health is therefore an important aspect of a child’s overall health status and of their school readiness.

Oral health is seen as a marker of wider health and social care issues including poor nutrition and obesity. The relationship between obesity, deprivation and dental caries is unclear. Despite this, it is likely that interventions that reduce sugar intake have the potential to impact both conditions at the population level because deprivation and high intakes of free-sugars are known risk factors for both dental caries and for obesity.

Evidence shows that poor oral health may also be indicative of dental neglect and wider safeguarding issues. Dental neglect is defined as ‘the persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development’ [1].

Data Overview

Every 2 years the National Dental Epidemiology Programme (NDEP) conduct a survey in order to collect oral health information of 5 year olds who attend mainstream, state-funded schools across England. This most recent (2021/22) survey was delayed from 2020 to 2021 by the COVID-19 pandemic. It was carried out as part of the OHID NDEP. The aim of the survey was to measure the prevalence and severity of dentinal caries among 5 year old children within each lower-tier local authority. This was to provide information to local authorities, the NHS and other partners on the oral health of children in their local areas and to highlight any inequalities.

The prevalence and severity of disease at age five can be used as a proxy indicator for the impact of early years services and programmes to improve parenting, weaning and feeding of very young children.

Visually obvious dental decay refers to dental decay extending to the dentine layer which can be detected by visual observation alone. The latest data reveals that the percentage of 5 year old children in Oldham with visually obvious dental decay (39.5%) is significantly higher than the England average of 23.7% and has been consistently across all surveys conducted. With the exception of 2016/17, where the rate dipped, Oldham's rate has also remained above the Greater Manchester average (figure 1). Rates across all areas have improved. Oldham's 2021/22 rate is 3rd highest across Greater Manchester, behind Bolton and Rochdale. Oldham's rate is more than double the highest performing Local Authority in Greater Manchester (Stockport at 17.5%) (figure 2).

Figure 1: Percentage of 5 year olds with visually obvious dental decay trend
Source: Dental Public Health Epidemiology Programme for England

Figure 2: Percentage of 5 year olds with visually obvious dental decay across Greater Manchester
Source: Dental Public Health Epidemiology Programme for England

DMFT refers to the severity of tooth decay in children based on the mean number of teeth per child sampled which were either actively decayed or had been filled or extracted decayed/missing/filled teeth.

Oldham's mean dmft is significantly higher than the averages for the North West and England despite improvements since the 2014/15 survey. On average, children in Oldham have 1.9 decayed, missing or filled teeth at age 5, higher than the regional rate of 1.19 and more than twice as high as the England rate of 0.8 (figure 3). Oldham has the highest rate across Greater Manchester. The only Greater Manchester authority with a rate below the England rate is Stockport, with an average of 0.68 (figure 4).

Figure 3: Mean dmft 5 year old trend
Source: Dental Public Health Epidemiology Programme for England

Figure 4: Mean dmft 5 year olds across Greater Manchester
Source: Dental Public Health Epidemiology Programme for England

Public Health England (now OHID) have conducted two dental health surveys with three year olds; the first in 2012/13 and the latest in 2019/20. Little changed between the 2012/13 and 2019/20 results regionally and nationally, with slight reductions in rate. Oldham has seen substantial improvements between the two surveys, almost halving the rate of three year olds with visually obvious dental decay. Despite this improvement, the rate for Oldham still sits significantly above the North West and England averages (figure 5). Oldham's rate is 3rd highest across Greater Manchester (figure 6).

Figure 5: Percentage of three year olds with visually obvious dental decay trend
Source: Dental Public Health Epidemiology Programme for England

Figure 6: Percentage of three year olds with visually obvious dental decay across Greater Manchester
Source: Dental Public Health Epidemiology Programme for England

According to the 2019/20 dental survey results Oldham 3 year olds have 0.66 decayed, missing or filled teeth on average. This is higher than the North West rate of 0.42 and the England rate of 0.31. Whilst the regional and national rate saw slight improvements between the 2013/13 and 2019/20 surveys (11% and 14% respectively), Oldham's improvement was much more substantial, with a decrease of 39% (figure 7). Oldham's rate is second highest across Greater Manchester, behind Manchester. Oldham's rate is more than double the three best performing Local Authorities in Greater Manchester (Bury, Stockport & Trafford) (figure 8).

Figure 7: DMFT in 3 year olds trend
Source: Dental Public Health Epidemiology Programme for England

Figure 8: DMFT in 3 year olds across Greater Manchester
Source: Dental Public Health Epidemiology Programme for England

Hospital admission rates for dental caries in children aged 0-5 years is similar in Oldham compared to Greater Manchester (figures 9 and 10), however is significantly higher than the England average. All areas have experienced similar improvements in rate over the period shown in figure 9 (around 35%). Much of the improvement occurred between 2017/18-2019/20 and the most recent data period (2018/19-2020/21).

Figure 9: Hospital admissions for dental caries in children aged 0 to 5 years trend
Source: Hospital Episode Statistics (HES)

Figure 10: Hospital admissions for dental caries in children aged 0 to 5 years across Greater Manchester
Source: Hospital Episode Statistics (HES)

Further Information & Resources

NHS Information - Children's Teeth
NHS advice on children's dental health

NHS Dental Statistics
Dental reports contain data on dental activity, including COT and UDA, clinical treatments, dental workforce, and the number of patients seen. The data is shown at regional, local authority (LA) and sub-ICB location (SICBL) level. As of 2022/23, this report is published annually, with a dashboard available.

National Dental Epidemiology Programme - Oral Health Survey of 5 year olds
This survey takes place every 2 years in order to collect oral health information of 5 year olds who attend mainstream, state-funded schools across England. The aim of the survey was to measure the prevalence and severity of dentinal caries among 5 year old children within each lower-tier local authority. This was to provide information to local authorities, the NHS and other partners on the oral health of children in their local areas and to highlight any inequalities.

OHID Child & Maternal Health Data Profile
Additional information and data relating to children's dental health

References

[1] Health matters: child dental health
https://www.gov.uk/government/publications/health-matters-child-dental-health/health-matters-child-dental-health



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