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Betsi Cadwaladr University Health Board Betsi Cadwaladr University Health Board Key messages Introduction March 2012 Oral health was defined by the Department of Health in 1994 as the ‘standard of . Dental decay is preventable health of the oral and related tissues which enables an individual to eat, speak and Two fifths of five and of twelve socialise without active disease, discomfort or embarrassment and which year olds living in Betsi contributes to general well-being’. Cadwaladr UHB have experience of dental decay. Oral health is integral to general health and should not be considered in isolation. Oral disease has detrimental effects on an individual’s physical and psychological There a wide inequalities in well-being and reduces quality of life. A range of conditions are classified as oral oral health experience associated with pockets of diseases. The main oral disease of childhood is dental caries (or tooth decay). deprivation. Among adults other important conditions are periodontal (gum) disease and oral cancers. Designed to Smile is working to address poor oral health in Figure 1 Changes in mean decayed, missing and filled permanent or children from deprived areas primary teeth (DMFT or dmft) for children in Wales, 1983-2003 within the LHB. 8 Plans need to be made to meet the oral health needs of 7 the people living in Betsi 6 Cadwaladr more effectively. 5 4 Contents 3 mean DMFT/dmft mean 2 1 Trends in Oral Disease 1 0 1-3 Caries in 5 &12 year olds 1983 1993 2003+ 4 Inequalities in children’s Year oral health 5 year olds - dmft 12 year olds - DMFT 15 yr olds - DMFT 5 Designed to Smile 6 Oral health in adults Trends in oral disease 7 Current service use in The main surveys that provide information on trends in oral disease are the relation to need national decennial Adult Dental Health Survey and Children’s Dental Health Survey, and the local surveys that are coordinated by the British Association for Authors the Study of Community Dentistry (BASCD). Maria Morgan Caries trends in children Welsh Oral Health Information The UK Child Dental Health surveys have reported improvements in Welsh Unit, in association with the Public children’s caries experience during the years previous to 1993 (Figure1); this is Health Wales Dental Public Health thought to be mainly due to the widespread use of fluoride toothpaste. However, Team since 1993 the rate of improvement in the dental health of 12 and 15 year olds has markedly decreased and the oral health of Welsh 5 year olds has worsened. 1 5.0 Figure 2 4.0 Average dmft for 5 year olds, 1999-2006, Wales compared with England and Scotland 3.0 mean dmft mean 2.0 1.0 0.0 1999-00 2001-02 2003-04 2005-06 England Scotland Wales 5.0 4.22 3.82 4.0 3.72 3.70 Mean dmft Figure 3 3.52 3.56 Mean decayed, missing and filled primary teeth (dmft) of five year olds in unitary authorities 3.0 Mean dmft for within Betsi Cadwaladr University Health 2.13 those with dmft 2.0 1.76 experience 1.56 1.59 Board, 2007-8 1.43 1.45 1.0 0.0 Anglesey Conwy Flintshire Gwynedd Wrexham Denbighshire 70 60 Figure 4 50 50.5 Percentage of 5 year olds with caries 46.0 42.9 40 41.8 experience (%dmft>0) in unitary authorities 40.6 40.6 Lower within Betsi Cadwaladr University Health Percentage Similar 30 Higher Board, 2007-8 Wales 20 10 0 Anglesey Conwy Flinsthire Gwynedd Wrexham Denbighshire 5.0 Figure 5 4.0 Mean decayed, missing and filled permanent teeth (DMFT) of 12 year olds in unitary 3.0 Lower authorities within Betsi Cadwaladr, 2008-9 Similar Higher Wales DMFT 2.0 1.0 1.20 1.03 0.95 0.90 0.77 0.66 0.0 Conwy Wrexham Denbighshire Gwynedd Flintshire Anglesey 2 70 60 Figure 6 50 Percentage of 12 year olds who have 40 43.1 43.0 caries experience in their permanent 40.9 40.2 Lower 35.9 Similar teeth (%DMFT>0) in unitary authorities 33.0 30 Higher Wales within Betsi Cadwaladr University Health Percentage 20 Board, 2008-9 10 0 Wrexham Denbighshire Conwy Gwynedd Flintshire Anglesey 5.0 4.0 2020 Target Figure 7 3.0 2.65 Average dmft for 5 year olds 2007-8, 2.04 Mean dmft Mean 2.0 1.77 1.56 presented by quintiles of the Welsh 1.16 1.0 Index of Multiple Deprivation (2020 target dmft most deprived = 1.77) 0.0 Least deprived Second least Middle deprived Second most Most deprived deprived deprived Welsh Index of Multiple Deprivation 2008 - Quintiles FIVE YEAR OLDS (due to caries) or filled tooth; this was TWELVE YEAR OLDS The decennial Child Dental Health not significantly different from the Decennial Child Dental Health surveys surveys showed that there was a small Wales figure, 47.6%. have shown that the oral health of 12 improvement in the decay experience of Unitary Authority data year olds has improved considerably. Welsh 5 year olds between 1983 and Dental caries is a preventable disease, The percentage of children in Wales 1993, but caries experience seems to Denbighshire 5 year olds, for example, with tooth decay has fallen from 83% in 1 have plateaued since then (Figure 1). have on average 2.13 teeth affected by 1983 to 43% in 2003 . The average GB country comparison dental caries and for those with the DMFT has also fallen for this age-group, Local data are more regularly collected disease an average of 4.22 teeth are from 3.3 in 1983 to 1.0 in 2003 (Fig. 1). via the NHS Dental Epidemiology affected (Figure 3). The oral health of Welsh 12 year olds is 2 programme. Wales is now ranked third The percentages having at least one now among some of the best in Europe . when average dmft, collected via these decayed, missing or filled tooth ranged Most recent local survey, 2008-9 surveys, is compared across the countries from 40.6% in Anglesey to 50.5% in Health Board data of Great Britain (Figure 2). In 2005-6, Denbighshire (Figure 4). The average DMFT for Betsi Cadwaladr for the first time since these local surveys The 2007-08 survey of 5 year olds was (collected via the NHS Epidemiology began in the mid 1980s, the average dmft the first to use positive consent. As a programme) was 0.93 which was within for 5 year olds in Wales was significantly result participation rates have fallen; in average range, as it did not differ higher than in Scotland. Anglesey for example they fell by 30%. significantly from the Welsh experience. Most recent local survey, 2007-8 The data significantly under-estimates Unitary Authority data Health Board data the true picture of oral health and need Figure 5 shows average DMFT for 12 In Betsi Cadwaladr UHB the average dmft to be interpreted with caution until we year olds, in Betsi Cadwaladr unitary for all children aged 5, surveyed in 2007-8 have future surveys to monitor trends. authorities. This ranged from 0.66 in was 1.64 and the average dmft for those Upper Super Output Area data Anglesey which experienced lower than with experience of caries was 3.76. The range in average dmft is more average DMFT when compared with Although, these were lower than the marked when considering USOA level Wales to 1.20 for Conwy, which was Welsh averages (1.98 & 4.16) Welsh data; with Wrexham U004 having an within average range when compared experience of this preventable disease is average dmft of 0.98 compared with with Wales. Similarly the percentage the worst in the UK. Also health board 2.42 in Conwy U003 (Table 3). For the with caries experience were within level data masks important inequalities in percentage with caries experience, this average range for all Betsi Cadwaladr oral health. ranged from 30.0% of 5 year olds in unitary authorities except for Anglesey Two fifths (43.4%) of five year olds living Wrexham U004 to 53.2% in Wrexham which had a lower than average in the LHB have at least one, missing U002 (Table 3). experience (Figure 6). 3 Inequalities in children’s oral health Table 1: Mean dmft & %dmft>0 for 5 year olds (2007-8) by quintiles of deprivation index, for Wales and Betsi Although children’s oral health has improved on average, Cadwaladr University Health Board inequalities remain. Caries, like many other diseases increases with social deprivation. WALES Betsi Cadwaladr Child poverty targets mean dmft %dmft>0 mean dmft %dmft>0 Recent Welsh Government policy aims to eradicate the Least deprived 1.16 34.5 1.18 35.8 wider effects of childhood poverty; to that end the Deputy Second least deprived 1.56 41.3 1.59 43.8 Minister for Social Justice and Regeneration proposed Middle deprived 1.77 44.1 1.66 42.4 targets on infant mortality, low birth weight, childhood second most deprived 2.04 49.2 1.87 48.8 injuries, teenage conceptions and dental caries. Most deprived 2.65 57.6 2.10 48.3 These Welsh targets use data from the NHS surveys to help address the widening gap between the oral health of All within area 1.98 47.6 1.64 43.4 Ratio - most children from the least well off and the most well off families deprived:middle 1.50 1.31 1.26 1.14 in Wales. There are Wales level targets for 5 and 12 year deprived olds which focus on the average dmft and the percentage 5 year old children with caries.
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