Scottish Health Survey 2015 - volume 1: main report

3 Dental Health

Gemma Kirkpatrick

Summary

• In 2015, 92% of adults had at least some natural teeth, an increase from 88% in 2008.
• The proportion of men and women with some natural teeth increased between 2008 and 2015 (from 91% to 94% for men and from 86% to 91% for women).
• Around six in ten (61%) adults aged 75 and over had some natural teeth compared with almost all (97-100%) of those aged 16 to 54.
• Women were significantly less likely than men to have some natural teeth in the 65-74 age group (77% compared with 85%) and the 75 and over age group (56% compared with 68%).

• Women were more likely than men to use dental floss every day (35% compared with 19%) and restrict their sugar intake to help improve their dental health (27% compared with 21%).
• Almost all (97%) adults with some natural teeth say they brush them daily with fluoride toothpaste, while 40% reported using a mouth rinse.

3.1 Introduction

In the Annual Report of the Chief Dental Officer ( CDO) 2012, the CDO flagged oral health as an important component of wider general health which can influence a person's quality of life ^[1] . Oral disease can detrimentally impact on a person's health and wellbeing and has potentially wider socio-economic consequences. The most common types of oral disease, dental caries and gum disease, are largely preventable. Of greatest concern is oral cancer. Major risk factors for oral cancer include tobacco use and excessive alcohol consumption ^[1] .

Child and adult registration rates have increased in recent years, with 94% of children and 90% of adults registered with an NHS dentist at the end of September 2015. ^[2] All NHS boards in Scotland have also now met the 2010 national target for 60% of P1 and P7 pupils to have no obvious decay experience. In recent years there has also been a reduction in general anaesthetics for dental extractions among children ^[1] .

Despite these improvements, inequalities in oral health persist ^[1] and the latest figures indicate that there has been a long term increase in the incidence of oral cancer ^[4] .

3.1.1 Policy background

In September 2015, when the First Minister launched A Stronger Scotland: The Government's Programme for Scotland 2015-16 ^[5] , the need to address 'significant and persistent inequalities' was highlighted. The evidence from the National Dental Inspection Programme ^[3] ( NDIP) shows that although oral health has improved significantly across all communities, children living in the most deprived communities still have more decay experience compared with those in the least deprived. The Scottish Government has made an undertaking to improve the oral health of people in Scotland with a clear focus on reducing inequalities ^[6] .

The Programme for Government also recognised deficiencies in the current system, which was set up when levels of dental health were poorer and people of all ages required multiple fillings and extractions. There is now a need to transform the system to meet the needs of younger people who require a preventive focus whilst ensuring that the system continues to allow for the treatment needs of the older population.

Ministers agreed that a consultation should take place on a new oral health plan. The consultation will run from 15 September until 8 December 2016.

The ageing of the Scottish population means that by 2039 the number of people over 75 is projected to increase by 85% ^[7] . The improvements that have been made in oral health in Scotland have also presented new challenges. The increasingly ageing population, combined with more adults retaining some or all of their natural teeth, is likely to mean there will be a significant increase in people requiring domiciliary dental care, either in their own home or in residential care.

There has been a long term increase in the incidence of oral cancer, while incidence of a number of other cancers is decreasing ^[4] . Increasing numbers of patients are presenting at an earlier age, and while oral cancer primarily affects those over 50 years of age it can also affect younger people ^[8] .

3.1.2 Reporting on dental health in the Scottish Health Survey ( SHeS)

The focus of this chapter is on dental health and actions taken by individuals to improve dental health. The section on dental health presents the findings on the prevalence of natural teeth in the Scottish population and allows for further analysis by age and sex. The remainder of the chapter looks at a number of daily actions that adults could take to improve oral health, by age and sex.

3.2 Methods And Definitions

Adults aged 16 and over are asked questions on dental health annually and on dental health services and actions taken to improve dental health biennially. Two changes made to the questions on dental health have implications for the time series data presented here. Since 2008 participants have been asked how many natural teeth they have. Prior to 2008, participants were asked if they had their own teeth but were not asked how many of their own 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 differed from 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. In addition, since 2003 measurements have been collected for all adults aged 16 years and older, whereas in the 1995 survey data were obtained for adults aged 16-64 only, and in 1998 for adults aged 16-74.

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, comparisons over time (1995-2003 and from 2008 onwards) in the text or tables should be made with caution. As a result, trends in natural teeth prevalence within this chapter focus primarily on the figures from 2008 onwards.

3.3 Dental Health

3.3.1 Trends in prevalence of natural teeth since 2008

In 2008, 88% of all adults aged 16 and over had some natural teeth, rising gradually to 92% in 2015. The proportion of men aged 16 and over with some natural teeth was 91% in 2008 and was at a similar level in 2013 (92%) before rising significantly to 94% in 2015. The percentage of women with some natural teeth rose significantly from 86% in 2008 to 91% in 2015.

Since 2008 there has been a significant increase in the proportion of all adults aged 16 and over with 20 or more teeth (71% in 2008, 76% in 2015). In 2015, around three-quarters (76%) of both men and women had at least 20 teeth, a significant increase from the 2008 figure for both groups (72% for men, 70% for women).

Figure 3A, Table 3.1

3.3.2 Number of natural teeth and prevalence of no natural teeth in 2015, by age and sex

As noted in previous years, natural teeth prevalence was strongly associated with age, with the presence of at least some natural teeth tending to decrease in line with increased age. Almost all (99-100%) adults aged 16 to 44 had at least some natural teeth, decreasing significantly to 97% of those aged 45-54, 92% of those aged 55-64, 81% of those aged 65-74 and 61% of those aged 75 and over.

Natural teeth prevalence did not vary significantly for men and women under the age of 65 (91-100% for men compared with 93-100% for women) but did for those in the older age groups. Men aged 65 to 74 were more likely than women to report having at least some natural teeth (85% compared with 77% of women) with a similar pattern for those aged 75 and over (68% and 56% respectively).

Table 3.2

3.3.3 Daily actions taken to improve dental health, 2013/2015 (combined)

Almost all (97%) adults aged 16 and over in 2013/2015 with some natural teeth brushed their teeth daily with fluoride toothpaste to improve their dental health, and 40% used a mouth rinse each day. Around a quarter reported using dental floss (27%) daily with a similar proportion (24%) saying they restricted their daily intake of sugary foods and drinks.

The average number of daily actions taken to improve dental health was significantly higher for women with some natural teeth (mean of 2.2 actions) than for men (1.9). Women were significantly more likely than men to report using dental floss daily (35% compared with 19%) and to restrict their daily intake of sugary and soft drinks (27% compared with 21%).

The mean number of daily actions undertaken increased with age from 1.7 for those aged 16-24 with some natural teeth to 2.2-2.3 for those aged 55 and over. Those aged 75 and over were the least likely to brush their teeth with fluoride toothpaste (93%), use a mouth rinse (29%) and, along with the youngest age group, least likely to restrict their intake of sugary food and drink (17% for those aged 75 and over, 18% for those aged 16-24). Actions to care for dentures were higher among older adults, as would be expected given the higher prevalence of denture usage for this age group. Around a third (32-35%) of all those aged 65 and over cleaned their dentures daily and 18-25% left their dentures out at night. Daily dental floss use increased significantly with age from 19% of those aged 16-24 to 34% of adults aged 55 to 64, before decreasing to 25% of adults aged 75 and over.

Table 3.3