The Scottish Health Survey 2011: Volume 1 - Adults

CHAPTER 2 DENTAL HEALTH

Lisa Rutherford

SUMMARY

• In 2011, 90% of all adults aged 16 and over had some natural teeth (91% of men and 89% of women).
• Between 1995 and 2003 the percentage of men aged 16-64 with all false teeth fell from 9% to 5% (the corresponding figures for women were 13% and 7%). Since 2008, the proportion reporting no natural teeth has remained stable (3-4% of men and 4-5% of women).
• There was a strong association between area deprivation and prevalence of natural teeth. Those living in the most deprived SIMD quintile were the least likely to have some natural teeth (83% compared with 94% of those in the least deprived quintile).
• Similarly, men and women living in the 15% most deprived areas of Scotland were more likely than those living elsewhere to have no natural teeth (18% compared with 10%).
• Almost all (96%) adults with teeth said they brush them daily with fluoride toothpaste.
• Four in ten adults reported using a mouth-wash daily, though women were more likely than men to do this (45% compared with 36%).
• A quarter (26%) of adults with teeth said they used dental floss daily, with women twice as likely as men to report doing so (33% versus 17%).
• One in five (22%) of people said they restrict their sugar intake to improve their dental health. 16-24 year olds and those aged 75 and over were least likely to say that they took this action daily.

2.1 INTRODUCTION

To address Scotland's poor oral health record and increase access to dental health services, the then Scottish Executive published An Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland¹ in 2005. This laid out a series of national dental health and dental service targets, including the aim that by 2010 90% of all adults in Scotland, and 65% of adults aged between 55 and 74 years, would possess some natural teeth. The dental health chapter in the 2008 Scottish Health Survey (SHeS) report² noted that the separate target for adults in the 55-74 age group had already been met.

The introductions to the three previous dental health chapters in the 2008, 2009, and 2010 (SHeS) reports^2,3,4 outlined the recent policy context in this area, much of which focuses on improving children's oral health, especially among those in the most deprived areas. The key initiatives highlighted were:

• The opening of a new dental school in Aberdeen in 2008, and steps to attract more dentists to work in Scotland.
• Two NHS HEAT targets⁵ relating to child dental health (one on NHS dentist registration rates for 3-5 year olds by 2010/11, and one on fluoride varnish applications for 3-4 year olds by March 2014).
• The Childsmile national oral health improvement programme for children in Scotland.
• The introduction of free dental checks for adults.

The HEAT target for 80% of 3-5 year old children to be registered with an NHS dentist by 2010/11 was surpassed (88% were registered).⁶ The annual report from NHS Scotland's Chief Executive also highlighted a number of recent developments in the field of dental health.⁷ For example, the expansion of rural dental services through the opening of new premises in Stornoway (Isle of Lewis) which provides services to patients as well as training for student dentists and uses IT links to larger practices to support this. There are now 17 dental outreach centres where senior student dentists can gain experience of working in a primary care setting. These deliver treatment to patients in rural areas and other places with a high demand for such services, many of whom are not registered with a dentist.

The origins of poor adult oral health often lie in childhood, hence the focus on children's teeth outlined above. A target for 60% of primary 1 children to be free of dental decay by 2010 was achieved nationally, and locally in 12 health board areas. However, stark differences by area deprivation persist: 45% of primary 1 children in the 10% most deprived areas had no decay compared with 82% in the 10% least deprived areas.

This chapter provides the 2011 figures for the reported prevalence of natural teeth in adults. Reflecting the concerns noted above about inequalities in oral health, the prevalence of natural teeth is also shown by the Scottish Index of Multiple Deprivation (SIMD). The chapter then reports details of steps adults say they take to improve their oral health. There was not space to cover all aspects of dental health within this chapter so supplementary web tables are being published at the same time as this report.

2.2 METHODS AND DEFINITIONS OF MEASUREMENT

In 1995, 1998 and 2003 SHeS included similar questions about the number of natural teeth people have, but there has been a notable change to the wording that affects the data presented here. The three surveys conducted prior to 2008 asked participants whether they had their own teeth. From 2008 onwards people were asked how many natural teeth they had. Consequently, it is only possible to compare the people in 1995-2003 who said they had all false teeth with the proportion from 2008 onwards who said they had no natural teeth. In addition, the definition of false teeth used in 1995 was not the same as in 1998 and 2003. In 1998 and 2003 participants were asked to count caps and crowns as natural teeth but there was no such instruction in 1995. Although the question format from 2008 onwards is very different, it attempts to measure the same underlying concept (having no teeth) and might therefore be functionally equivalent. However, as there is no way of quantifying this, the comparison over time between 1995-2003 and 2008 onwards needs to be treated with caution.

The dental health chapters in the 2008² and 2009³ SHeS reports outlined the full range of adult dental health questions included in the survey. Questions focusing on dental health are asked every year while questions about dental services, and actions to improve oral health, were only asked in 2009 and 2011.

2.3 DENTAL HEALTH

2.3.1 Trends in prevalence of natural teeth since 1995, by age and sex

Figures for the prevalence of natural teeth are presented in Figure 2A and Table 2.1 for 1995 onwards. Changes to the sample composition in the first three surveys mean that the discussion of 1995-2011 figures presented here is based only on those aged 16 to 64. Figures from 2003 onwards, based on adults aged 16 and over, are also presented in Table 2.1.

As noted in the previous section, some of the data reported here are based on previous survey years when the questions about natural teeth were slightly different. Table 2.1 and Figure 2A present the proportion of adults aged 16-64 with all false teeth in 1995, 1998 and 2003, and the proportion with no natural teeth from 2008 onwards. The results for the last four years have been very similar, with just 3%-4% of men and 4%-5% of women aged 16-64 reporting that they had no natural teeth. Figure 2A, Table 2.1

The 2005 Action Plan target was that by 2010 90% of all adults in Scotland, and 65% of adults aged 55-74, would possess some natural teeth.¹ The 2010⁴ SHeS report noted that the proportion of all adults possessing some natural teeth was just short of the target in 2010 (89%). As shown in Table 2.1, the target was met in 2011 with 90% of all adults reporting some natural teeth. The figure for men remained unchanged from 2010 (91%), and the proportion for women increased by one percentage point (from 88% to 89%).

The target for 65% of adults aged 55-74 to possess some natural teeth by 2010 was comfortably met by 2008 (78%). The increase to 81% in 2011 (82% of men and 80% of women), was largely driven by an increase in prevalence among women of this age (from 75% in 2008 to 80% in 2011) (data not shown). Table 2.1

2.3.2 Number of natural teeth and % with no natural teeth, 2008-11, (age-standardised) by Scottish Index of Multiple Deprivation (SIMD)

Two measures of SIMD are being used throughout this report. The first - which uses quintiles - enables comparisons to be drawn between the most and least deprived 20% of areas and the three intermediate quintiles. The second contrasts the most deprived 15% of areas with the 85% least deprived. The Scottish Health Survey was designed to provide robust data for the SIMD 15% areas after four years of data had been collected and combined (2008-2011). The figures discussed below are based on these combined data. To ensure that the comparisons presented by SIMD are not confounded by the different age profiles of the sub-groups, the data have been age-standardised (age-standardisation is described in the Glossary). On the whole, the differences between observed and age-standardised percentages are small. Therefore, the percentages and means presented are the standardised ones only.

As Figure 2B illustrates, there was a significant association between area deprivation (measured in quintiles) and the number of teeth people had. The proportion of adults with some natural teeth declined from 94% in the least deprived quintile to 83% in the most deprived, while there was a threefold increase (from 6% to 17%) in the proportion with no teeth at all between the least and most deprived.

The decrease in prevalence of any natural teeth by increasing deprivation followed a linear pattern for both sexes, although was slightly more pronounced for women. 94% of women and 95% of men in the least deprived quintile had some natural teeth compared with 80% and 86%, respectively, in the most deprived quintile.

This pattern was also evident when prevalence among those living in the 15% most deprived areas of Scotland was compared with those living elsewhere. 15% of men and 20% of women in the 15% most deprived areas had no natural teeth compared with 8% and 12%, respectively, living in the rest of Scotland. Figure 2B, Table 2.2

2.3.3 Actions taken to improve dental health

This section reports various actions people said they took daily to improve their dental health and is based on data collected in 2011. The figures presented in Table 2.3 are based on all adults with some natural teeth. Note that this includes some people who have a combination of natural teeth and dentures.

Not surprisingly, brushing teeth with fluoride toothpaste was the most common action mentioned, with almost all (96%) adults with some natural teeth doing this daily. The next most common action reported was using a mouth rinse, but this lagged some way behind fluoride toothpaste use with four in ten adults with teeth doing this. Even fewer (26%), said they used dental floss daily, while 22% said they restricted their intake of sugary foods and drinks. Only 2% said they did not take any of the daily actions listed.

Men and women were equally likely to brush their teeth with fluoride toothpaste daily (95% and 97%, respectively), and similar proportions also reported restricting their intake of sugary foods (20% and 24%, respectively). In contrast, women were twice as likely as men to report using dental floss every day (33% compared with 17%) and were also more likely to use mouth rinse (45% compared with 36%).

There were some notable differences across the age groups for some of the actions. For example, use of mouth rinse was highest among those aged 25-34 (49%) and declined with age thereafter to 26% for those aged 75 and over. Adults in the youngest and oldest age groups were the least likely to report restricting their sugar intake (12%). Actions to care for dentures increased sharply with age, as would be expected given their low use among younger people. Table 2.3