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Towards Better Oral Health in Children

The Problem

Pre-school children

• By the age of 3, over 60% of children from areas of severe deprivation have dental disease.

Surveys in the West of Scotland have consistently shown high levels of dental decay in very young children. When consumption of sugar is high, decay begins, almost as soon as teeth erupt into the mouth. Children as young as 3 regularly need extractions for infected and abscessed teeth and often require general anaesthesia. "Nursing" caries (decay seen in the front teeth of infants due to high dietary sugars used around weaning), is a particular problem in very young children. Principally, this is related to the use of sugared drinks in baby bottles and the use of sugar products with comforters (dummies). To help tackle this, targeting prevention and treatment services at pre-school children has begun and, with over 38,000 extra registrations with family dentists, including 25,000 aged 2 and under since 1996, a significant start has been made. But further impetus is needed.

• By the age of 5, over 55% of all Scottish children have dental disease.

In Scotland on first attending school, children have an average of 2.5 teeth affected by decay. Of those children with decay attending school, the average number of affected teeth is more than four. Around 27% of children who have dental disease at age 5 have already had to have a tooth taken out.

Severe decay affecting the deciduous dentition. Age 6 years

Very extensive tooth decay may have developed by the time a child is attending school.

Our poor performance as a nation is underlined when we compare ourselves with other countries. For example, 70% of 5 year olds in the Netherlands are decay-free, and 71% in Denmark.

Children from the most deprived areas are three times more likely to have already had dental decay at the age of 5 years than children from the least deprived area.

The sad fact is that four times as many 5-year-old children in the most deprived categories require extractions or endodontics (advanced treatment of the dental pulp), compared with children in the most advantageous circumstances. The 33% reduction in decayed and filled teeth among 5 year olds achieved since 1983, while encouraging, is most evident among more affluent children.

The proportion free of dental decay (d₃mft=0) by Deprivation Category (DEPCAT)
Line represents National target of 60% 5 year olds decay-free by 2010.

The chart demonstrates the enormous gap in dental health which exists between those living in the most affluent sectors of our society (5 year olds) when compared with those 5 year olds who live in our most deprived communities. With the most deprived children least likely to be free from decay.

However, if we use changes in the proportion of children free of dental decay as a monitor of improvement, there has actually been no meaningful improvement since the late 1980s in children aged 5 years.

School children

Around the age of 6, the adult teeth start to erupt and almost immediately, for the reasons already mentioned, decay may start. The result is that, by the time they are 14, 68% of children have suffered from dental caries in their adult teeth. In Scotland for this age group there is an average of 2.75 decayed teeth per child. Of those children with decay the average number of affected teeth is over four. Although there have been consistent improvements in the oral health of this age group, with reductions in decay of over 60% since 1983, recent information again points to a considerable slowing in improvement rates.

Adults

Over the past 30 years, oral health improvement has been most dramatic in adults. Dental decay is less prevalent. Loss of teeth through gum disease has also decreased. One million more of the adult population of Scotland now have some natural teeth compared to 1972. This improvement has been achieved through a combination of more positive attitudes to prevention and improved dental services.

In 1972, 44% of adults over the age of 16 had lost all their teeth. Even with large improvements in oral care by 1998, the average adult had, by middle age (35-44), still lost seven adult teeth and had 11 teeth filled. Oral health continues to deteriorate with age and, by 65, 56% of adults have lost all their teeth.

The main oral disease in adults continues to be dental decay, although periodontal disease (gum disease) starts to become a more significant problem after middle age.

The lesson here is that good habits, when we are young, will help ensure healthy teeth when we are older.

Other Oral Problems in Children

Dental erosion

Dental erosion is the progressive loss of the hard component of the teeth, enamel and dentine, resulting from chemical action on the teeth, other than that which is caused by bacteria. Causes include carbonated (fizzy) acidic drinks and consumption of acidic fruit drinks.

Scotland has the highest level of erosion of teeth in the UK. Compared with a UK average of 24% Scottish surveys have recorded 34% of 5 year olds suffering from the problem. This is directly linked to the consumption of acidic drinks.

Accidental damage to teeth

Accidental damage to teeth is one of the commonest reasons for young children attending health services for treatment of trauma. Surveys show that 8% of boys and 5% of girls aged 14 years have damaged front teeth. Environmental changes to play areas and prompt action by carers and professionals can limit damage due to such injuries.

Enamel defects and mottling

41% of 12 year olds in Scotland have some type of enamel defect. The appearance of these can range from milky-white to yellow and can affect one or more than one tooth. These defects arise in the developing tooth from a variety of causes, including trauma, fluoride, infections and nutritional disturbances. Usually, there is minimal effect on the long-term health of the mouth. (This is illustrated later in the document.)

Conclusion

These statistics tell a contrasting story. Despite some significant improvements, we still have unacceptably poor levels of oral health. Scotland's children still have too many diseased teeth. Dental disease still results in extreme pain and discomfort, infection, social embarrassment and interrupted work and education for a significant part of the Scottish population.

We extract over half-a-million teeth from all Scots, and fill over 2 million teeth every year. We spend over £200 million a year on dental services and there are over 7,000 staff in Scotland treating patients with oral problems. Most of this resource is spent treating dental decay, a disease which can be prevented.

Scotland lags behind other areas of Great Britain, with substantially higher decay levels recorded for Scotland than for England and Wales (Map1). It should also be noted that there is large variation in average recorded decay levels between Scottish health boards, with some boards much closer to meeting the National Target of 60% of 5 year olds free from decay (d₃mft=0) by 2010 (Map2).

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