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Towards Better Oral Health in Children

Introduction

A healthy mouth is an asset to be prized. Yet, despite some improvements in oral health over the last 30 years, too many people in Scotland still suffer from tooth decay and other oral diseases, with the attendant miseries of pain, infection, disfigurement, absence from school and work, and occasionally, even more serious consequences.

In Scotland at present:

• By the age of 3, over 60% of children from areas of severe deprivation have dental disease.
• By the age of 5, 55% of children have dental disease.
• Over a quarter of a million (250,000) teeth are extracted from children each year.
• By the age of 14, 68% of children already have decay in their adult teeth.
• Tooth extraction remains the largest single reason for children receiving general anaesthesia in hospital.
• By middle age (35-44), the average adult has lost seven adult teeth and has 11 teeth filled.
• Over 65 years of age, 56% of adults have lost all their teeth.

At the same time, there are some encouraging signs that the many measures taken in recent years in the health service, schools and other settings are leading to better oral health in Scotland.

In Scotland:

• Compared with 1996, 38,000 more children under 5 have registered with a family dentist.
• Compared with 1983, there has been a reduction by over a third in the average number of teeth affected by disease in 5-year-old children.
• Since 1983 there has been a reduction of over 60% in the average number of teeth affected by decay in 14 year olds in Scotland.

Severe dental decay affecting the permanent teeth

By the teenage years extensive restoration may be needed to restore teeth so badly affected by tooth decay.

• Since 1972, the number of general anaesthetics for extraction of teeth has reduced from an estimated 200,000 per year to less than the 25,000 now, all offered within a safer environment.
• Since 1972, the number of people over 16 years with no teeth has fallen dramatically from 44% to 18% in 1998.

Much remains to be done if we are to bring our children's oral health up to a level of which we can be proud. Dental decay is a preventable disease and tackling children's dental health will contribute to future improvement in adult oral health.

The main reasons for our continuing high dental disease rates in Scotland are the high consumption of sugar in our diet and poor oral care - mainly lack of toothbrushing - on the part of many children and adults. As is the case for health generally, we find the worst oral health where deprivation is most evident.

A great deal of work is going on to bring further improvement, and we hope that the initiatives being taken by the Scottish Executive, right across its range of functions, and by the Health Education Board for Scotland and the Food Standards Agency, will help create a climate where oral as well as general health can get better. In the past we set ambitious targets, with limited results. Yet, for any individual child, we only have one short opportunity to get things right. Other countries do much better. Why can't we?

We need much more urgency and commitment to this task, and in particular we need everyone to share that urgency and commitment if we are to make a significant difference.

This consultation document sets out the problem, describes what is being done to address it, and seeks your views on how we can make quicker progress to improve the oral health of children in Scotland.

Please take the time to consider the issues and send us your views to the address at the end of this document.

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