Scottish Health Survey 2012 - volume 1: main report

2 Dental Health

Tracey Hughes

Summary

• In 2012 nine in ten adults (aged 16 and above) in Scotland had some natural teeth.
• Men were significantly more likely than women to have at least some natural teeth (91% compared with 88%).
• Since 1995, there has been a steady decline in the proportion of 16 to 64 year olds with no natural teeth. One in ten (11%) had all false teeth in 1995; by 2012 this had more than halved (4%). The decline has been particularly pronounced for women (from 13% in 1995 to 4% in 2012).
• The proportion of adults (aged 16 and over) with some natural teeth has not changed significantly since 2008 (88% in 2008 and 90% in 2012).
• In 2012, 28% of adults reported experiencing bleeding gums in the previous month; 23% experienced it occasionally while 5% said that it happened often.
• Experience of gum bleeding declined with age, decreasing from 29% of men and 26% of women aged 16-24 to 8% of those aged 75 and over.
• In 2012, around one in seven (13%) adults (12% of men and 13% of women) reported experiencing toothache in the previous month. Toothache prevalence declined by age for both men and women.
• Twelve percent of adults reported that they often or occasionally had difficulty in chewing food (13% of men and 11% of women).

2.1 Introduction

To address Scotland's poor oral health record and increase access to dental health services, An Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland^[37] (the Action Plan) was published by the Scottish Executive in 2005. The Action Plan laid out a series of national dental health and dental service targets, including the aim, that by 2010, 90% of adults in Scotland, and 65% of adults aged between 55 and 74 years, would possess some natural teeth. The dental health chapter in the 2011 Scottish Health Survey (SHeS) annual report^[38] noted that the target for all adults had been met for the first time in 2011; the separate target for adults in the 55 to 74 age group had already been met in 2008^[39].

Each year, in addition to presenting the most up-to-date data on dental health, the SHeS annual report also provides a broad overview of the recent policy developments and initiatives in the area. Recent dental health initiatives of relevance have included:

• The opening of a new dental school in Aberdeen in 2008, and steps to attract more dentists to work in Scotland.
• Two NHS HEAT targets^[40] relating to child dental health - one on increasing NHS dentist registration rates for 3 to 5 year olds by 2010/11 (the 80% target has now been surpassed, with 88% registered), and one on fluoride varnish applications for 3 to 4 year olds by March 2014^[41].
• The Childsmile national oral health improvement programme for children in Scotland^[42].
• The introduction of free dental checks for adults.
• The 2005 Action Plan^[37]37 recognised the links to inequalities, the problems with access to services, and that poor dental health in adults often has its origins in childhood.

There have also been more recent policy developments in the field of dental health. In May 2012, the Scottish Government published the National oral health improvement strategy for priority groups: frail older people, people with special care needs and those who are homeless^[43] which is a preventive strategy aimed at vulnerable adults. A new core national preventive programme, Smile, builds upon the established Childsmile programme for children, in providing access to oral health care regardless of life circumstances. Two training guides for those working with frail older people in care homes and with homeless people have now also been published^[44].

This chapter presents up-to-date figures for a selection of the dental health questions included on SHeS each year. The trend in natural teeth prevalence among adults in Scotland has been updated and is presented here (allowing monitoring of the related Action Plan target). The relationship between prevalence of natural teeth and age and sex is also explored. The chapter concludes by examining prevalence, in 2012, of a number of specific dental health problems among those with natural teeth, such as gum bleeding, toothache and difficulties chewing.

Since 2008, more detailed questions on dental services have been asked in alternating years of the survey (2009, 2011 and 2013). Updated data for these questions are likely to be included in the 2013 SHeS annual report.

2.2 Methods And Definitions

Two changes to the SHeS dental health questions have implications for the time series data presented here. In 1995, 1998 and 2003 participants were asked if they had their own teeth but were not asked how many of their own teeth they had. From 2008 onwards, participants were asked how many natural teeth they had. Consequently, it is only possible to compare people in the period 1995 to 2003 who said they had all false teeth with people 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 that used 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.

While the question on natural teeth prevalence used since 2008 is very different to that used in earlier years, it attempts to measure the same underlying concept - having no natural teeth - and might therefore be considered as functionally equivalent. As there is no way of verifying this, however, the comparison over time between 1995-2003 and 2008 onwards should be interpreted with caution.

2.3 Dental Health

2.3.1 Trends in prevalence of natural teeth since 1995

The trend in natural teeth prevalence for adults in Scotland is presented in Figure 2A and Table 2.1 from 1995 onwards. As a result of changes to the sample composition in 2003, figures presented here for the first two survey years (1995 and 1998) are based on those aged 16 to 64 only. Figures for 16 to 64 year olds and for all adults (aged 16 and over) are presented for 2003 onwards.

As noted in Section 2.2, some of the data presented are from earlier years of the survey when the question on presence of natural teeth had slightly different wording. In Table 2.1, the proportion of adults aged 16-64 with all false teeth are presented for 1995, 1998 and 2003, and, for 2008 onwards, the proportions with no natural teeth are shown.

Over the years there has been a steady decline in the proportion of 16 to 64 year olds with no natural teeth. In 1995, one in ten (11%) reported that they had all false teeth and, by 2008, just 4% reported that they had no natural teeth. Since 2008, the proportion of adults with no natural teeth has remained steady at between 3% and 5% (4% in 2012). The decline has been more pronounced for women than for men, declining from 13% in 1995 to 4% in 2012 (the equivalent figures for men were 9% in 1995 and 4% in 2012).

The proportion of adults (aged 16 and above) reporting that they had no natural teeth has fluctuated between 10% and 12% (10% in 2012) since 2008. The 2005 Action Plan³⁷ set out the aim that 90% of all adults living in Scotland would possess some natural teeth by 2010. This target was met in 2011³⁸ and prevalence remained unchanged in 2012 (90%). Prevalence trends have, however, followed slightly different patterns for men and women. In 2012, nine in ten men (91%) possessed some natural teeth, a level which has remained unchanged since 2008. For women, in 2012, the proportion with some natural teeth was 88%, just short of the Action Plan target of 90%. There has, however, been a slight rise in prevalence among women since 2008 when 86% had some natural teeth. Figure 2A, Table 2.1

Figure 2A Proportion of adults aged 16-64 with all false teeth (1995-2003)/no natural teeth (2008-2012), by sex

2.3.2 Number of natural teeth and prevalence of no natural teeth, 2012, by age and sex

The proportion of adults (aged 16 and over) with some natural teeth in 2012 is presented in Table 2.2 by age and sex. As already noted (see Table 2.1), in 2012, 90% of adults in Scotland reported that they had some natural teeth. The proportion of men with some natural teeth was significantly higher than the level for women (91% compared with 88%).

Prevalence also varied by age, with the proportion of adults with natural teeth generally decreasing as age increased. In 2012, the percentage of 16 to 44 year olds with some natural teeth was between 99% and 100%; thereafter, the proportion declined, dropping to 54% for those aged 75 and over. Age-related prevalence patterns were slightly different for men and women. While similar proportions of men and women reported having natural teeth at age 65-74 (74% and 71% respectively) by age 75 and over, women were significantly less likely than men to have some natural teeth (51% and 60% respectively). Table 2.2

2.3.3 Dental health problems, 2012, by age and sex

In 2012, bleeding gums was the most widely reported dental health problem for adults aged 16 and above (28%). When asked whether it was a problem they experienced occasionally or often, most described it as an occasional problem (23%, compared with 5% who experienced it often).

Men and women were equally likely to report bleeding gums as a problem (29% and 28% respectively) and the frequency with which they experienced it was also similar (24% of men and 23% of women experienced it occasionally compared with the 5% who experienced it often).

In 2012, around one in seven (13%) adults (12% of men and 13% of women) reported experiencing toothache in the last month, while a similar proportion reported that they often or occasionally had difficulty in chewing (12% of all adults, 13% of men and 11% of women).

While men and women's experience of dental health problems was very similar, experience of gum-bleeding and toothache did vary noticeably by age. On the whole, gum bleeding and toothache incidence decreased with age, a pattern which can, in large part, be explained by the decline in the presence of natural teeth over the life course (as seen in Table 2.2).

For gum bleeding (occasional or often), the age-related pattern was similar for men and women, with prevalence decreasing from 29% of men and 26% of women aged 16-24 to 8% of those aged 75 and over.

For toothache, the pattern by age was slightly different for men and women. For men, toothache prevalence fluctuated between 10% and 17% among 16 to 44 year olds and dropped to between 6% and 8% for those aged 55 and over. For women, prevalence among those aged 16-24 was high, with a quarter (24%) experiencing toothache in the last month. Prevalence dropped to 15% among 25-34 year old women and then declined steadily to 6% of women aged 75 and over. Table 2.3

Table list

Table 2.1 Number of natural teeth and % with no natural teeth, 1995 to 2012, by age and sex

Table 2.2 Number of natural teeth and % with no natural teeth, 2012, by age and sex

Table 2.3 Dental health problems, 2012, by age and sex

Table 2.1 Number of natural teeth and % with no natural teeth, 1995 to 2012, by age and sex

Aged 16 and over	1995 to 2012
False teeth / number of natural teeth	1995	1998	2003	2008	2009	2010	2011	2012
	%	%	%	%	%	%	%	%
Men
All own teeth
16 - 64	69	73	76	n/a	n/a	n/a	n/a	n/a
16+	n/a	n/a	67	n/a	n/a	n/a	n/a	n/a
All false teeth
16 - 64	9	8	5	n/a	n/a	n/a	n/a	n/a
16+	n/a	n/a	12	n/a	n/a	n/a	n/a	n/a
No natural teeth
16 - 64	n/a	n/a	n/a	4	4	4	3	4
16+	n/a	n/a	n/a	9	9	9	9	9
Fewer than 10
16 - 64	n/a	n/a	n/a	4	3	3	3	3
16+	n/a	n/a	n/a	6	6	5	5	5
Between 10 and 19
16 - 64	n/a	n/a	n/a	11	11	11	11	12
16+	n/a	n/a	n/a	13	12	13	13	13
20 or more
16 - 64	n/a	n/a	n/a	82	82	82	83	82
16+	n/a	n/a	n/a	72	72	73	73	72
All with teeth
16 - 64	n/a	n/a	n/a	96	96	96	97	96
16+	n/a	n/a	n/a	91	91	91	91	91
Women
All own teeth
16 - 64	66	70	75	n/a	n/a	n/a	n/a	n/a
16+	n/a	n/a	62	n/a	n/a	n/a	n/a	n/a
All false teeth
16 - 64	13	11	7	n/a	n/a	n/a	n/a	n/a
16+	n/a	n/a	18	n/a	n/a	n/a	n/a	n/a
No natural teeth
16 - 64	n/a	n/a	n/a	5	5	5	4	4
16+	n/a	n/a	n/a	14	14	13	11	12
Fewer than 10
16 - 64	n/a	n/a	n/a	3	3	3	3	4
16+	n/a	n/a	n/a	5	4	5	6	6
Between 10 and 19
16 - 64	n/a	n/a	n/a	9	10	8	8	7
16+	n/a	n/a	n/a	11	12	11	11	10
20 or more
16 - 64	n/a	n/a	n/a	83	82	84	85	85
16+	n/a	n/a	n/a	70	70	72	72	73
All with teeth
16 - 64	n/a	n/a	n/a	95	95	95	96	96
16+	n/a	n/a	n/a	86	86	87	89	88
All adults
All own teeth
16 - 64	68	72	75	n/a	n/a	n/a	n/a	n/a
16+	n/a	n/a	64	n/a	n/a	n/a	n/a	n/a
All false teeth
16 - 64	11	9	6	n/a	n/a	n/a	n/a	n/a
16+	n/a	n/a	15	n/a	n/a	n/a	n/a	n/a
No natural teeth
16 - 64	n/a	n/a	n/a	4	5	4	3	4
16+	n/a	n/a	n/a	12	12	11	10	10
Fewer than 10
16 - 64	n/a	n/a	n/a	4	3	3	3	3
16+	n/a	n/a	n/a	5	5	5	5	6
Between 10 and 19
16 - 64	n/a	n/a	n/a	11	10	10	10	9
16+	n/a	n/a	n/a	12	12	12	12	11
20 or more
16 - 64	n/a	n/a	n/a	82	82	83	84	83
16+	n/a	n/a	n/a	71	71	72	73	73
All with teeth
16 - 64	n/a	n/a	n/a	96	95	96	97	96
16+	n/a	n/a	n/a	88	88	89	90	90
Bases (weighted):
Men 16 - 64	3902	3950	3169	2537	2940	2824	2944	1885
Men 16+	n/a	n/a	3833	3083	3585	3450	3598	2309
Women 16 - 64	3998	3989	3318	2632	3060	2938	3063	1950
Women 16+	n/a	n/a	4276	3362	3917	3762	3924	2500
All adults 16 - 64	7900	7939	6487	5169	6001	5762	6007	3836
All 16+	n/a	n/a	8109	6445	7502	7212	7522	4809
Bases (unweighted):
Men 16 - 64	3524	3364	2756	2078	2398	2287	2416	1517
Men 16+	n/a	n/a	3589	2835	3276	3104	3270	2126
Women 16 - 64	4408	4212	3451	2687	3206	3073	3172	1970
Women 16+	n/a	n/a	4522	3608	4234	4114	4252	2684
All adults 16 - 64	7932	7576	6207	4765	5604	5360	5588	3487
All 16+	n/a	n/a	8111	6443	7510	7218	7522	4810

Table 2.2 Number of natural teeth and % with no natural teeth, 2012, by age and sex

Aged 16 and over	2012
False teeth / number of natural teeth	Age							Total
	16-24	25-34	35-44	45-54	55-64	65-74	75+
	%	%	%	%	%	%	%	%
Men
No natural teeth	1	0	1	3	13	26	40	9
Fewer than 10	-	1	4	5	6	16	15	5
Between 10 and 19	0	4	10	19	22	22	22	13
20 or more	99	95	86	72	58	36	23	72
All with teeth	99	100	99	97	87	74	60	91
Women
No natural teeth	1	0	1	3	15	29	49	12
Fewer than 10	-	0	2	6	10	12	16	6
Between 10 and 19	2	2	6	10	16	21	13	10
20 or more	98	97	91	82	60	38	22	73
All with teeth	99	100	99	97	85	71	51	88
All adults
No natural teeth	1	0	1	3	14	27	46	10
Fewer than 10	-	0	3	5	8	14	15	6
Between 10 and 19	1	3	8	14	19	22	17	11
20 or more	98	96	88	77	59	37	22	73
All with teeth	99	100	99	97	86	73	54	90
Bases (weighted):
Men	339	383	380	420	362	251	173	2309
Women	324	376	414	454	382	287	263	2500
All adults	663	760	795	874	744	539	435	4809
Bases (unweighted):
Men	170	228	346	409	364	385	224	2126
Women	227	329	474	498	442	388	326	2684
All adults	397	557	820	907	806	773	550	4810

Table 2.3 Dental health problems, 2012, by age and sex

Aged 16 and over	2012
Self-assessed dental health	Age							Total
	16-24	25-34	35-44	45-54	55-64	65-74	75+
	%	%	%	%	%	%	%	%
Men
Toothache
Yes	15	17	10	16	8	7	6	12
No	84	82	89	80	78	67	54	79
No natural teeth	1	0	1	3	13	26	40	9
Gum Bleeding
Yes, often	5	8	6	7	2	1	2	5
Yes, ocassionally	24	27	31	27	23	15	6	24
No	71	64	62	63	62	58	52	63
No natural teeth	1	0	1	3	13	26	40	9
Difficulty chewing
Yes, often	2	2	3	5	2	3	4	3
Yes, ocassionally	6	12	14	12	7	10	7	10
No	91	86	83	80	78	62	49	78
No natural teeth	1	0	1	3	13	26	40	9
Women
Toothache
Yes	24	15	13	13	9	7	6	13
No	76	85	86	84	76	64	45	76
No natural teeth	1	0	1	3	15	29	49	12
Gum Bleeding
Yes, often	5	8	7	7	4	1	1	5
Yes, ocassionally	21	32	29	27	21	16	7	23
No	74	60	62	62	60	54	43	60
No natural teeth	1	0	1	3	15	29	49	12
Difficulty chewing
Yes, often	2	4	3	5	4	3	2	3
Yes, ocassionally	8	9	8	8	8	9	8	8
No	90	87	88	84	73	59	41	77
No natural teeth	1	0	1	3	15	29	49	12
Bases (weighted):
Men	339	383	380	420	362	251	173	2309
Women	324	376	414	454	382	287	263	2500
All adults	663	760	795	874	744	539	435	4809
Bases (unweighted):
Men	170	228	346	409	364	385	224	2126
Women	227	329	474	498	442	388	326	2684
All adults	397	557	820	907	806	773	550	4810