| 2.1
Dental Caries |
| 2.1.1 The
prevalence of dental decay in Scotland is much higher
than in England and Wales. A recent study(1) showed that
the proportion of 5 year olds in Scotland with experience
of deciduous dentinal decay was 58% compared with 44% in
England. The same study showed that the proportion of
children with dentinal decay experience in the permanent
teeth at the age of 12 years was 61% compared with an
English figure of 50%. Although these figures show a
considerable improvement when compared with a similar
study(2) in 1983, there is evidence to show that most of
the improvement occurred between 1983 and 1987 and that
there has been no sign of any improvement in the last 6
years. Indeed there is some evidence that the situation
has worsened. Scottish surveys(3), which started in 1987,
showed that of 5 year olds in 1987/88, 57.6% had already
experienced dental decay; in 1989/90, 59.2% and in
1991/92, 58.2%. The latest survey(4) indicates that in
1993/94, 61.8% had experienced dental decay. |
| 2.1.2 Dental
caries experience varies across Scotland. In the latest
survey (4), west central Scotland shows the highest
levels of decay, and the adjoining areas to the
south-west and north-east have relatively high levels.
South-east Scotland and the north and north-west had
intermediate levels while Orkney and Shetland had the
lowest levels of decay. |
| |
| Periodontal
Disease |
| 2.2.1 In a
survey in 1988(5), it was found that 79% of dentate
adults had some bleeding from their gums; and 75% had
some periodontal pockets. The figures for pockets
compared to 69% in England. The survey in 1988
established the baseline for the periodontal health of
Scottish adults. It will not be measured again in a
comparative survey until 1998. Data are difficult to
collect, but periodontal disease may be more common than
we suspect. Many teeth are lost through periodontal
disease. |
| |
| Derangement
of Oro-facial Tissues |
| 2.3.1 Dental
and jaw disproportion is common in the UK. In a recent
survey(6), at the age of 9 years, 54% of the children
examined were assessed as having treatment need ranging
from moderate to very great, with 17% classified as
having very great need. By the age of 15, 35% of the
children examined still had at least a moderate treatment
need, but just 4% had very great treatment need. In the
survey, the assessment of future requirements for
orthodontic treatment was evaluated by constructing an
index of the level of need for orthodontic treatment
based on the Index of Orthodontic Treatment Need. A 5
point scale was created ranging from no treatment to very
great need for treatment. |
| Among
children aged 12 and under, 10% were classified as having
no treatment need. This rose to 18% among 15 year olds.
At the other end of the scale, 17% of 9 year olds were
classified as having very great treatment need. This
proportion decreased gradually among children aged 11 and
over so that by the age of 15, only 4% of children
remained in this category. The figures given here
represent the United Kingdom as a whole because analysis
by country showed no significant differences between the
countries on measures of orthodontic health or the need
for treatment. |
| 2.3.2 Clefts
of the lip and palate are severe deformities which are
mainly congenital in origin, though there may be other
causes such as trauma. The prevalence of cleft lip and
palate in Scotland is 1.56 per thousand births affecting
about 90 children each year(7). Although children with
these congenital deformities are treated in infancy, they
may suffer from problems thoughout life, inlcuding speech
difficulties, hearing difficulties and residual facial
disfigurement. |
| |
| Oral
Cancer |
| 2.4.1
Throughout this century until the mid-1970s, there was a
substantial decline in mortality rates from oral cancer
in Scotland. Unfortunately, this trend has since reversed
and there have been considerable increases in incidence,
particularly in younger age groups. Death rates in the
younger age groups have increased to levels previously
recorded during the 1940s and, since these increases seem
to be cohort based, it is likely that they will continue
into the future. |
| 2.4.2 Death
rates due to mouth cancer(8) in men were highest in the
period 1931-35, with a crude rate of 2.6 per 100,000.
These rates fell steadily and by 1971-75 were less than a
third of their previous level. Unfortunately, since then,
there has been an increase in the crude rate to 1.1 per
100,000. In men aged 35-64 the mortality increased from
0.5 per 100,000 in 1971-75 to 1.9 per 100,000 in 1985-89
(which is equivalent to the prevailing rate in the
1940s). In 1993, 173 men died of mouth cancer. In
comparison, the figure for lung cancer deaths in men in
1993 was 2,755. |
| 2.4.3 Women
have always had a lower level of mouth cancer than men.
The mortality rate due to oral cancer in women has been
around 0.3 per100,000 throughout this century but the
rate has more than doubled since 1971 to a rate of 0.7
per 100,000. In 1993, 91 women died of mouth cancer. In
the same year, 170 died of cervical cancer and 1,544 of
lung cancer. |
| 2.4.4
Tobacco smoking and alcohol misuse have consistently been
found to be important independent risk factors for oral
cancer. However the reasons for the increases noted above
cannot be explained purely by reference to these factors. |
