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Scottish Prisons' Dental Health Survey 2002

11. RESULTS

The fieldwork was carried out between 3 ^rd April and 22 ^nd May 2002 by three experienced dental examiners. Table 3 shows the intra-examiner reliability.

The Kappa Scores of their reliability of the DMFS Index varied between 0.93 - 0.97 indicating excellent reliability.

TABLE 3 - Intra examiner variation

A total of 559 subjects were included in the survey which is an estimated 8.6% of the total prison population (6484 on 26/4/02, Personal communication, Prison Statistical Unit, Scottish Executive). Table 4 shows the establishments visited and the numbers seen.

The 110 female subjects represented 41.5% (110/265) of the total Scottish female population.

A total of 149 young offenders were seen which is 16.8% (149/887) of this population. 300 adult males were seen which is 5.4% (300/5368) of the adult male prison population.

Weighted Results

The samples drawn in the survey allow results for each group to be presented separately. However, unequal proportions of prisoner populations are included for each prisoner group and a simple mean figure would be unrepresentative of the total population. To produce a figure for all male prisoners the results from either group (adult male and young offenders) have to be weighted in proportion to the sample size of the group and to the proportion of each group in the total male prison population. As adult males were a much larger group of the total, the weighting process produces a "weighted mean" closer to the adult male results. Similarly the weighted mean results for the entire prison population (male and female) is closer to the male figure as they are a larger proportion of the total prison population than the female prisoners.

TABLE 4 - Scottish Prisons Dental Survey 2002, responses

TABLE 5 - Age of Prisoners seen

The average age of the total sample was 31.4 years (see table 5). The average age of adult males was 33.6 years, Young Offenders were 18.8 years and female prisoners had a mean age of 27.5 years. For male prisoners overall they had a mean age of 31.6.

Edentulousness (Prisoners with no natural teeth)

Table 6 shows that 6.2% of the total sample had no natural teeth. This varied from 7.3% of the adult males, 3.6% of the females to none of the young offenders having no natural teeth.

TABLE 6 - Prisoners with no teeth

* weighted to reflect the total prison population.

Denture use in the Prison Population

Table 7 shows that 88% (23/26) of prisoners without natural teeth reported they had both upper and lower dentures. Two prisoners had only a full upper denture and one had only a lower full denture.

TABLE 7 - No weighting, subjects with no teeth but with full dentures

Of the 25 patients with an upper denture 22 (88%) reported that they wore it. Of the 24 with a lower denture only 14 (58%) reported that they wore it. Of those prisoners with full dentures of some type, 81% reported cleaning the denture every night but only 46% reported leaving their denture out at night, the recommended action to maintain oral health (Table 8). Prisoners who reported no natural teeth did not receive a clinical examination in this survey.

TABLE 8 - Cleaning and nocturnal wearing of complete dentures.

Table 9 shows the number of respondents with a denture of any description. A total of 18% of the total sample had a denture of any type. Of these subjects with dentures 93%, had a partial or full upper denture.

TABLE 9 - Type & combination of dentures found in survey

*F = Full Denture; P = Partial Denture

Of those with a denture of any type (both full and partial) 88% reported cleaning their denture at least once a day and 54% reported that they removed their denture(s) at night.

TABLE 10 - Unweighted. Comparison of upper and lower denture wearing

Statistically significantly more prisoners wore their upper complete or partial denture than their lower denture. This reflects the pattern of denture wearing found in the general population (Table 10).

11.2 Dental Health

TABLE 11 - Dental Health of Prisoners

All of the young offenders had some natural teeth. Four of the females and 22 of the adult male prisoners had no natural teeth. A total of 530 of the remaining 533 subjects had a dental examination. (Table 11)

Table 11 shows the mean numbers of teeth which were decayed or filled in each prisoner group. In adult males the mean number of decayed teeth was 2.5, in the young offenders it was nearly three teeth (2.9) and the female prisoners had almost 4 decayed teeth (3.8). In contrast adult males had an average of 4.9 filled teeth, in the young offenders group it was nearly three teeth (2.7) and the female prisoners had almost 4 filled teeth (3.9). Two thirds of all prisoners had untreated tooth decay.

TABLE 12 - Normative Treatment Needs of Prisoners (Percentages)

Table 12 shows the percentage of prisoners who had decayed teeth and also severe decay. Severe decay is defined as destruction of tooth substance that is so severe that extraction of the remains is often the only satisfactory treatment.

In adult males 60% had decayed teeth, in the young offenders it was three quarters (75%) of the total sample and for the female prisoners it was 73%. Those with severe decay were 28% of adult males, 32% of the young offenders and 42% among the female prisoners.

TABLE 13 - Attendance at a Prison Dentist

Of the total, 69.8% reported they had attended a prison dentist at some stage. Over 70% of all prisoners reported that dentists did not spend enough time treating patients in the jails and over three-quarters reported difficulty in getting an appointment to see the dentist. (Table 13). It is interesting to note that only 48% of young offenders reported a visit to a prison dentist, yet 84% reported it was difficult to get a dental appointment. Clearly for many young offenders this cannot be based on direct experience. In contrast adult male and female prisoners had similar levels of both attendance and difficulty in getting an appointment. Responses to question 29(d) and (e) cannot be quantified because a baseline denominator cannot be calculated. (See Appendix 5) Some prisons use a written request form while others rely on a verbal referral. Further comments were requested from prisoners on the prison dental service and are listed below.

Qualitative responses

Many comments centred on the availability of dental care and illustrate the finding that 77% of prisoners reported difficulty in getting an appointment:

"The waiting lists for routine dental care are too long. "

"New dentist needed and more regular visits."

"The wait between appointments is too long."
"Slow to complete treatment."
"Dentists should come to the prison more often."
"More dentists are needed."
"Have to go into Perth for a dentist.""
"We (prisoners) should be able to go to the dentist at any time."
"Waiting list is too long - the service is provided during visiting hours.""
"Waiting too long - rush job when in the dental chair."
"Case records lost, too short appointments."
"The dentist should be here more often."
"More time at the dentist per patient."
"Dentist doesn't spend enough time with each patient."
"Dentists should be here more often and private care should be available."
We need a full-time dentist."

There were many comments about the quality and availability of toothbrushes and other oral hygiene aids. Some prisoners also requested more information on maintaining oral health:

"Should be able to sell toothbrushes, toothpaste."
"Toothbrushes not good quality."
"Better quality of toothbrushes needed."
"Get decent toothbrushes and floss."
"Poor quality toothbrushes, wants mouthwash."
"More information on eating things, and toothpaste."
"Don't get steredent (a denture cleaner) - have to buy it"
"More preventive advice should be available."

Other responses have been grouped around comments on, treatment, organisation of services or other specific issues:

"Treatment should be more relaxed."
"Not happy with treatment received."
"Prison dentist had poor cross-infection control."
"More sensitive to patients' needs proper cross infection."
"We want fillings, dentist just wants to extract teeth."
"Dentist takes out teeth rather than filling teeth."
"Better pain control (choice of treatment e.g. sedation)."
"The dentist is a butcher, not enough time for the local anaesthetic to work."
"Dental health education and polishing."
"You should be able to get a scale and polish whenever you want."
"General anaesthesia should be available on premises."
"Sedation should be available."
"Take more care."

TABLE 14 - Percentage with unmet dental needs.

Table 14 shows the normative treatment needs of the prison population. The data is presented hierarchically, so the most serious problem takes precedence. The weighted result shows that 22.3% had no recognised dental need, so 77.7% had a recognised need to visit a dentist.

TABLE 15 - Reported Attitudes and Behaviour, statistical comparisons.

Table 15 shows that 42% of adult male prisoners; 41% of male young offenders and 58% of females reported bleeding gums. The difference between the two male groups was not significant but significantly more females (58%) reported bleeding gums on both brushing and eating compared to the male prison population (42%).

The adult male prisoners had more dentures and were more likely to have visited a prison dentist than the young offenders. These differences were statistically significant. More male than female prisoners had a denture.

Similar numbers 52%, 58% and 60% reported they did not like visiting a dentist either in prison or elsewhere. 92% of adult males with teeth and 95% of young offender males reported brushing their teeth at least once a day. 95% of female prisoners with teeth reported regular tooth brushing at least once a day.

Table 16 shows that there were significant differences between the percentages of adult male and young offenders percentages reporting having ever had a tooth extracted or crowned. This is most likely to be due to the age difference between the two male groups. A significantly greater percentage of female prisoners reported receiving sedation for dental care.

TABLE 16, Reported dental treatment ever received (not just prison dentist)

Attitudes to Dental Treatment

Table 17 shows that 42% of adult male prisoners were nervous about visiting the dentist or could not be bothered attending a dentist. (This includes all dentists not just prison dentists). Young offenders reported lower levels of anxiety about visiting a dentist than adult males. Female prisoners reported higher levels of anxiety than males. Both differences were statistically significant.

TABLE 17 - Attitudes to Dental Attendance

Treatment preferences

Table 18 compares the reported preferences of the male, young offender and female prisoners when asked,

"If you went to a dentist with an aching back tooth would you prefer to have it taken out or filled (supposing it could be filled)?"

and

"If a dentist said that a front tooth would have to be extracted (taken out) or crowned, what would you prefer?"

The differences between the percentages of adult males, young offenders and females were not statistically significant. Female prisoners reported the highest preference for saving rather than extracting teeth which reflects the gender differential found in the general population.

TABLE 18 - Reported treatment preferences by prisoner group

Table 19 records the percentages reporting their last trip to a dentist. Once again there is no statistically significant difference between the two male sub-groups, or between the male and female prisoners. Although not statistically significant a higher percentage of females reported visiting a dentist in the previous 12 months which again reflects findings in the general population.

TABLE 19 - Time since last dental visit. (Any dentist including prison dentist).

Table 20 shows that there was a statistically significant difference in the reason for their last attendance at a dentist between adult males and male young offenders. Female prisoners reported they were least likely to attend for a check-up and young offenders most likely, although this difference was not significant. Young offenders were also the most likely to attend because of trouble with their teeth.

TABLE 20 - Reason for last dental visit by prisoner group.

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