An Atlas of Oral Health in Wales

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AN ATLAS OF ORAL HEALTH IN WALES

Volume I Survey of rising 12 year olds 2008/09

WELSH ORAL HEALTH PUBLIC HEALTH WALES INFORMATION UNIT

Contents

Page Number i Summary 3

1. Average number of untreated decayed teeth (mean DT) 4-6

2 Percentage children with untreated decayed teeth 7-9

3 Average untreated decayed teeth of those with untreated decayed teeth 10-12

4 Average number of teeth decayed, missing or filled (mean DMFT) 13-15

5 Percentage of children with teeth decayed, missing or filled (%DMFT>0) 16-18

6 Average DMFT for those children with DMFT 19-21

7 Care Index 22-24

8 Treatment Index 25-27

9 Restorative Index 28-30

10 Percentage children who have been to the dentist within the previous year 31-33

11 A comparison of data from the 2008-09 and 2004-05 surveys of 12 year 34-40 olds

12 Comparison with England 42-43

13 Comparison with Europe 43

SUMMARY

This was the second survey of ‘rising’ twelve year olds undertaken in Wales, the first was undertaken in 2004-05. Subjects taking part were from school year 7 and became 12 during the school year, hence ‘rising 12 year olds’.

The survey took place between during the winter of 2008/2009. A total of 5,808 children in school year 7 (17% year 7 population) participated.

Key findings from the survey include:

 Four out of ten (42.5%) 12 year olds in Wales now have obvious dental decay (they have one or more adult teeth which are decayed, missing due to decay or filled).

 The percentage of 12 year old children affected by tooth decay (i.e. those with at least one tooth decayed, missing due to decay or filled teeth) has fallen from 51% in 2001 to 42.5% in this latest survey.

 Levels of decay vary across Welsh health boards, 51% of 12 year olds living in Cwm Taf have experience of decay compared with 36% of those living in Hywel Dda.

 There are wide differences between local areas in Wales ranging from 31% of 12 year olds being affected by decay in Ceredigion unitary authority (Hywel Dda HB) to 59% being affected in Blaenau Gwent unitary authority (Aneurin Bevan HB). This represents a two fold difference.

 Across the whole of the population examined, 12 year old children in Wales have an average of 0.98 decayed, missing or filled adult teeth (DMFT).

 However, among those children affected by tooth decay they had, on average, two teeth (2.31) that are either filled, extracted or with obvious lesions in them.

 The highest average DMFT was seen in Aneurin Bevan Health Board (1.23). The lowest average DMFT was seen in Hywel Dda Health Board (0.80).

 Within each health board area, there are variations in average DMFT between unitary authorities and the largest range is seen in Betsi Cadwaladr. The average value of 1.2 for Conwy is approximately twice the value of 0.66 for Anglesey.

The report was prepared by the Maria Morgan at the Welsh Oral Health Information Unit together with Nigel Monaghan from Public Health Wales, with help in data analysis and presentation from Mr Timothy Pickles and Dr Nigel Blewitt.

1. Average number of untreated decayed teeth (mean DT)

Map 1 Chart 1

Average Number of Decayed Teeth (ie, Mean DT) 1 0.9 0.8 0.7

0.6

0.5 Lower DT Similar 0.4 Higher 0.3 Wales 0.2 0.1 0 BLAENAU GWENT CAERPHILLY CONWY MONMOUTH TORFAEN RHONDDA CYNON TAF NEWPORT CARDIFF DENBIGHSHIRE TYDFIL MERTHYR PEMBROKESHIRE CARMARTHENSHIRE POWYS GWYNEDD OFGLAMORGANTHE VALE SWANSEA BRIDGEND WREXHAM ANGLESEY NEATH & PORTTALBOT FLINTSHIRE CEREDIGION

Significantly higher than Wales Within average range Significantly low er than Wales

Wales

Map 1 and charts 1-8 show the average number of decayed teeth (DT) for twelve year old children surveyed in the winter of 2008/09, by unitary authority, by Local Health Board (LHB) and by unitary authority within LHBs. The average DT for Wales was 0.41 (95% LCI 0.38; 95% UCI 0.43).

Unitary Authority Blaenau Gwent experienced the highest average decayed teeth (DT=0.91), followed by Caerphilly. Both these Unitary Authorities recorded significantly higher levels compared with the Welsh average. Conversely, Ceredigion experienced the lowest average decayed teeth (DT=0.15), a further two Unitary Authorities (namely Flintshire and Neath and Port Talbot) experienced significantly lower average decayed teeth when compared with Wales as a whole.

Local Health Board Aneurin Bevan experienced the highest average decayed teeth (DT=0.60), recording significantly higher levels when compared with the Welsh average. This was not a surprise as both Blaenau Gwent (DT=0.91) and Caerphilly (DT=0.64) unitary authorities had recorded high levels of DT amongst this age group. Whilst Abertawe Bro Morgannwg University LHB (DT=0.3) experienced DT levels which were significantly lower than the Welsh average. The five remaining LHBs had DT levels which were within the average range for Wales.

Average number of untreated decayed teeth (mean DT) – by LHB and UA within LHBs

Chart 2

Average Number of Decayed Teeth (ie, Mean DT) 0.7

0.6 0.60

0.5

0.48

0.4 DT 0.38 Lower 0.35 0.35 0.34 Similar 0.3 0.30 Higher Wales 0.2

0.1

0 Aneurin Bevan Cwm Taf Cardiff and Vale Powys Teaching Betsi Cadwaladr Hywel Dda Abertawe Bro University University Morgannwg University

Chart 3 Chart 4

Average Number of Decayed Teeth (ie, Mean DT), Abertawe Bro Morgannwg University Average Number of Decayed Teeth , (i.e. mean DT), Aneurin Bevan 0.45 1

0.4 0.9 0.91 0.8 0.35 0.7 0.3 0.31 0.30 0.30

0.6 0.64 DT DT 0.59 0.25 0.55 Lower 0.5 Lower Similar Similar 0.45 0.2 Higher 0.4 Higher Wales Wales 0.3 0.15 0.2 0.1 0.1 0.05 0 BLAENAU GWENT CAERPHILLY MONMOUTH TORFAEN NEWPORT 5 0 SWANSEA BRIDGEND NEATH & PORT TALBOT

Average number of untreated decayed teeth (mean DT) – by LHB and UA within LHBs

Chart 5 Chart 6

Average Number of Decayed Teeth (ie, Mean DT), Betsi Cadwaladr University Average Number of Decayed Teeth , (i.e. mean DT), Cardiff and Vale University 0.7 0.45 0.42 0.4 0.6 0.61

0.35 0.5 0.32

0.3 DT 0.4 DT 0.25 0.38 Lower Lower Similar 0.2 Similar 0.34 Higher Higher 0.3 Wales 0.30 0.30 Wales 0.15 0.2 0.1 0.19

0.05 0.1 0 CARDIFF THE VALE OF GLAMORGAN 0 CONWY DENBIGHSHIRE GWYNEDD WREXHAM ANGLESEY FLINTSHIRE

Chart 7 Chart 8

Average Number of Decayed Teeth , (i.e. mean DT), Cwm Taf Average Number of Decayed Teeth , (i.e. mean DT), Hywel Dda 0.6 0.45 0.4 0.5 0.49 0.37 0.35 0.36 0.4 0.3

0.37 DT DT 0.25

0.3 Lower Lower Similar 0.2 Similar Higher Higher Wales Wales 0.2 0.15 0.15

0.1 0.1 0.05

0 0 RHONDDA CYNON TAF MERTHYR TYDFIL PEMBROKESHIRE CARMARTHENSHIRE CEREDIGION 6

2. Percentage children with untreated decayed teeth

Map 1 Chart 9

Percentage of Children with Decayed Teeth (i.e. %DT>0) 45

30 Lower 25 Similar Higher Wales %DT>0 20

15 10 5 0

BLAENAU GWENT BLAENAU CAERPHILLY TORFAEN MONMOUTH CONWY TAF CYNON RHONDDA NEWPORT DENBIGHSHIRE CARDIFF MERTHYR TYDFIL CARMARTHENSHIRE THEOF VALE POWYS GWYNEDD & NEATH PORT WREXHAM BRIDGEND SWANSEA ANGLESEY PEMBROKESHIRE FLINTSHIRE CEREDIGION GLAMORGAN

TALBOT

Significantly higher than Wales Within average range Significantly low er than Wales

Wales

Map 2 and charts 9-16 show the percentage of twelve year old children surveyed in the winter of 2008/09 with one or more decayed teeth (%DT>0) by unitary authority, by Local Health Board (LHB) and by unitary authority within LHBs. The percentage for Wales was 23.1% (95% LCI 22.0%; 95% UCI 24.2%).

Unitary Authority Blaenau Gwent experienced the highest levels of decayed teeth (%DT>0 = 41.7%), followed by, Caerphilly which also recorded significantly higher levels compared with the Welsh average. Conversely, Ceredigion experienced the lowest levels of decayed teeth (%DT>0 = 10.1%) when compared with for all Welsh Unitary Authorities, followed by Flintshire, Pembrokeshire and Swansea who also experienced significantly lower levels of DT when compared with Wales as a whole.

Local Health Board Aneurin Bevan (%DT>0 = 33.6%) experienced significantly higher levels of decayed teeth when compared with the Welsh average. As noted above both Blaenau Gwent (%DT>0 = 41.7%) and Caerphilly (%DT>0 = 37.9%) unitary authorities had recorded significantly high levels of DT amongst 12 year olds contributing to the high LHB value. Conversely, Hywel Dda (%DT>0 = 17.7%) and Abertawe Bro Morgannwg University LHBs (%DT>0 = 18.0%) both experienced DT levels which were significantly lower than the Welsh average. The four remaining LHBs had DT levels which were within the average range for Wales.

Percentage children with untreated decayed teeth by LHB and UA within LHBs Chart 10

Percentage of Children with Decayed Teeth (ie, %DT>0) 40

25 Lower Similar DT>0 % 20 Higher 33.6 Wales 15 26.6 21.8 10 20.4 19.5 18.0 17.7 5 0 Aneurin Bevan Cwm Taf Cardiff and Vale Betsi Powys Abertawe Bro Hywel Dda University Cadwaladr Teaching Morgannwg University University

Chart 11 Chart 12

% of Children with Decayed Teeth (ie, %DT>0), Abertawe Bro Morgannwg University % of Children with Decayed Teeth (ie, %DT>0), Aneurin Bevan 25 45

20 35

30 15

25 %DT>0 Lower %DT>0 Lower Similar 41.7 Similar Higher 20 37.9 Higher 10 Wales Wales 18.6 18.0 17.8 32.2 31.8 15 26.7

10 5

5 8

0 0 NEATH & PORT TALBOT BRIDGEND SWANSEA BLAENAU GWENT CAERPHILLY TORFAEN MONMOUTH NEWPORT

Percentage children with untreated decayed teeth by LHB and UA within LHBs

Chart 13 Chart 14 % of Children with Decayed Teeth (ie, %DT>0), Betsi Cadwaladr University Percentage of Children with Decayed Teeth (ie, %DT>0), Cardiff and Vale University

35 25

15 20 Lower Lower Similar Similar Higher

23.4 Higher %DT>0 Wales %DT>0 15 29.3 Wales 10 19.6 23.8 10 18.9 18.4 16.8 13.5 5 5

0 0 CONWY DENBIGHSHIRE GWYNEDD WREXHAM ANGLESEY FLINTSHIRE CARDIFF THE VALE OF GLAMORGAN Chart 15 Chart 16 Percentage of Children with Decayed Teeth (ie, %DT>0), Cwm Taf Percentage of Children with Decayed Teeth (ie, %DT>0), Hywel Dda

30 25

25 20

15 Lower Lower Similar 15 Similar Higher

27.1 Higher %DT>0

Wales %DT>0 Wales 10 20.7 10 20.7 16.5

5 5 10.1

0 RHONDDA CYNON TAF MERTHYR TYDFIL 0 CARMARTHENSHIRE PEMBROKESHIRE CEREDIGION

3. Average untreated decayed teeth of those with untreated decayed teeth Map 3 Chart 17

Average Number of Decayed Teeth in those with Decayed Teeth (i.e. where DT>0, DT)

2.5

2.0

1.5 Lower Similar Higher Wales 1.0 DT DT>0, where 0.5

0.0

PEMBROKESHIRE GWENT BLAENAU CONWY MONMOUTH TAF CYNON RHONDDA CARDIFF POWYS MERTHYR TYDFIL GWYNEDD ANGLESEY SWANSEA CARMARTHENSHIRE TORFAEN NEWPORT BRIDGEND CAERPHILLY THEOF VALE WREXHAM DENBIGHSHIRE & NEATH PORT CEREDIGION FLINTSHIRE GLAMORGAN

TALBOT

Significantly higher than Wales Within average range Significantly low er than Wales Wales

Map 3 and charts 17-24 show the average number of decayed teeth for those with experience of decay (average DT for those with DT>0), for twelve year old children surveyed in the winter of 2008/09 by unitary authority, by Local Health Board (LHB) and by unitary authority within LHBs. The average DT of those with decay experience for Wales was 1.77 (95% LCI 1.71; 95% UCI 1.83).

Unitary Authority Pembrokeshire experienced the highest levels of decayed teeth amongst those with decay (DT for those with DT>0=2.26), followed by Blaenau Gwent, and Conwy, however none of these UAs had decay levels which were significantly worse than the Welsh average (Appendix 1). Flintshire experienced the lowest levels of decayed teeth amongst those with decay (DT for those with DT>0=1.39). Further it was the only unitary authority to experience significantly lower levels of DT amongst those with decay when compared with Wales as a whole.

Local Health Board The average DT for those with DT>0 for all seven LHBs were within average range when compared with the Welsh average. Values ranged from 1.9 in Hywel Dda to 1.7 in Abertawe Bro Morgannwg.

Average untreated decayed teeth of those with untreated decayed teeth by LHB and UA within LHBs

Chart 18

Average Number of Decayed Teeth in those with Decayed Teeth (ie, where DT>0, DT)

1.8

1.6

1.4

1.2 Lower 1 Similar 1.9 1.8 1.8 1.8 Higher 1.8 1.7 1.7 0.8 Wales

0.6 where % DT>0, DT DT>0,% where 0.4

0.2

0 Hywel Dda Powys Cwm Taf Aneurin Bevan Cardiff and Vale Betsi Abertawe Bro Teaching University Cadwaladr Morgannwg University University

Chart 19 Chart 20

Average Number of Decayed Teeth in those with Decayed Teeth (ie, where DT>0, DT), Average Number of Decayed Teeth in those with Decayed Teeth (ie, where DT>0, DT), Abertawe Bro Morgannwg University Aneurin Bevan 2 2.5 1.8 2 1.6 1.4

1.2 1.5 Lower Lower Similar 1 Similar Higher Higher 2.17 1.74 1.69 0.8 Wales 1 Wales 1.60 1.84

1.69 1.69 1.69 where DT>0, DT DT>0, where

where DT>0, DT DT>0, where 0.6

0.4 0.5 0.2 0 0 SWANSEA BRIDGEND NEATH & PORT TALBOT BLAENAU GWENT MONMOUTH TORFAEN NEWPORT CAERPHILLY 11

Average untreated decayed teeth of those with untreated decayed teeth by LHB and UA within LHBs

Chart 21 Chart 22

Average Number of Decayed Teeth in those with Decayed Teeth (ie, where DT>0, DT), Average Number of Decayed Teeth in those with Decayed Teeth (ie, where DT>0, DT), Betsi Cadwaladr University Cardiff and Vale University 2.5 2

1.8

2 1.6

1.4

1.5 1.2 Lower Lower Similar 1 Similar Higher 1.82 Higher 2.10 1 Wales 0.8 1.62 Wales 1.78 1.76

1.62 1.61 where DT>0, DT DT>0, where where DT>0, DT DT>0, where 0.6 1.39 0.5 0.4 0.2 0 0 CONWY GWYNEDD ANGLESEY WREXHAM DENBIGHSHIRE FLINTSHIRE CARDIFF THE VALE OF GLAMORGAN

Chart 23 Chart 24

Average Number of Decayed Teeth in those with Decayed Teeth (ie, where DT>0, DT), Average Number of Decayed Teeth in those with Decayed Teeth (ie, where DT>0, DT), Cwm Taf Hywel Dda 2 2.5

1.8

1.6 2

1.4

1.2 1.5 Lower Lower 1 Similar Similar 1.82 1.80 Higher 2.26 Higher 0.8 Wales 1 Wales

1.72 where DT>0, DT DT>0, where where DT>0, DT DT>0, where 0.6 1.50

0.4 0.5

0.2

0 0 RHONDDA CYNON TAF MERTHYR TYDFIL PEMBROKESHIRE CARMARTHENSHIRE CEREDIGION 12

4. Average number of teeth decayed, missing or filled (mean DMFT)

Map 4 Chart 25

Average Number of Carious Teeth (ie, Mean DMFT)

1.8

1.6

1.4

1.2

1 Lower Similar

DMFT 0.8 Higher Wales 0.6

0.4

0.2

0 BLAENAU GWENT TORFAEN RHONDDA CYNON TAF CONWY CAERPHILLY MONMOUTH NEWPORT WREXHAM DENBIGHSHIRE OFGLAMORGANTHE VALE SWANSEA GWYNEDD CARDIFF NEATH & PORTTALBOT TYDFIL MERTHYR PEMBROKESHIRE POWYS CARMARTHENSHIRE FLINTSHIRE BRIDGEND ANGLESEY CEREDIGION

Significantly higher than Wales Within average range Significantly low er than Wales

Wales Map 4 and charts 25-32 show the average number of carious teeth (DMFT) for twelve year old children surveyed in the winter of 2008/09 by unitary authority, by Local Health Board (LHB) and by unitary authority within LHBs. The average DMFT for Wales was 0.98 (95% LCI 0.94; 95% UCI 1.02).

Unitary Authority Blaenau Gwent experienced the highest average DMFT (1.61), followed by Torfaen, Rhondda Cynon Taff, Conwy and Caerphilly, all these Unitary Authorities except for Conwy recorded significantly higher levels compared with the Welsh average. Conversely, Ceredigion experienced the lowest average DMFT (0.61); Anglesey, Bridgend, Flintshire and Carmarthenshire also experienced significantly lower average DMFT when compared with Wales as a whole.

Local Health Board Both Aneurin Bevan and Cwm Taf health boards experienced average DMFT levels which were significantly higher than the Welsh average, reflecting the high levels of DMFT experienced by constituent unitary authorities. Aneurin Bevan had the worst DMFT level (DMFT= 1.23) and Cwm Taf the second worst (DT=1.18) when all seven were ranked from worst to best. Hywel Dda had the lowest average DMFT (DMFT=0.8) and this was significantly lower than the Welsh average.

Average number of teeth decayed, missing or filled (mean DMFT) by LHB and UA within LHBs

Chart 26

Average Number of Carious Teeth (ie, Mean DMFT) 1.4

1.2

0.8 Lower Similar 1.23

0.6 1.18 Higher DMFT Wales 0.93 0.90 0.87 0.4 0.83 0.80

0.2

0 Aneurin Bevan Cwm Taf Betsi Cadwaladr Cardiff and Vale Abertawe Bro Powys Teaching Hywel Dda University University Morgannwg University

Chart 27 Chart 28

Average Number of Carious Teeth (ie, Mean DMFT), Abertawe Bro Morgannwg University 1.2 Average Number of Carious Teeth (ie, Mean DMFT), Aneurin Bevan 1.8

1.6 1 1.4

1.2 0.8 Lower

DMFT 1 Similar 0.8 1.61 Higher DMFT Lower Wales 0.6 1.39 Similar 0.6 1.19 1.07 1.07 Higher Wales 0.4 0.92 0.89 0.4 0.76 0.2

0 BLAENAU GWENT TORFAEN CAERPHILLY MONMOUTH NEWPORT 0.2 14

0 SWANSEA NEATH & PORT TALBOT BRIDGEND

Average number of teeth decayed, missing or filled (mean DMFT) by LHB and UA within LHBs

Chart 29 Chart 30

Average Number of Carious Teeth (ie, Mean DMFT), Betsi Cadwaladr University Average Number of Carious Teeth (ie, Mean DMFT), Cardiff and Vale University 1.4 1.2

1.2 1

1 0.8

0.8 DMFT DMFT Lower Lower 0.6 Similar Similar 0.6 1.20 Higher Higher Wales 0.93 Wales 1.03 0.89 0.95 0.4 0.90 0.4 0.77 0.66 0.2 0.2

0 0 CONWY WREXHAM DENBIGHSHIRE GWYNEDD FLINTSHIRE ANGLESEY THE VALE OF GLAMORGAN CARDIFF

Chart 31 Chart 32 Average Number of Carious Teeth (ie, Mean DMFT), Cwm Taf Average Number of Carious Teeth (ie, Mean DMFT), Hwyel Dda 1.4 1.2

1.2 1

1 0.8

0.8 DMFT DMFT Lower Lower 0.6 Similar Similar 0.6 1.2 Higher Higher Wales Wales 0.87 0.4 0.87 0.78 0.4 0.61

0.2 0.2 15

0 0 RHONDDA CYNON TAF MERTHYR TYDFIL PEMBROKESHIRE CARMARTHENSHIRE CEREDIGION

5. Percentage of children with teeth decayed, missing or filled (%DMFT>0)

Map 5 Chart 33

Percentage of Children with Carious Teeth (i.e. %DMFT>0)

60 50

Lower 40 Similar Higher 30 Wales %DMFT>0

BLAENAU GWENT BLAENAU CAERPHILLY TORFAEN TAF CYNON RHONDDA NEWPORT MONMOUTH WREXHAM DENBIGHSHIRE MERTHYR TYDFIL SWANSEA & NEATH PORT CONWY THEOF VALE GWYNEDD POWYS CARDIFF FLINTSHIRE CARMARTHENSHIRE PEMBROKESHIRE BRIDGEND ANGLESEY CEREDIGION GLAMORGAN TALBOT

Significantly higher than Wales Within average range Significantly low er than Wales

Wales Map 5 and charts 33-40 show the percentage of twelve year old children surveyed in the winter of 2008/09 with one or more carious teeth (%DMFT>0) by unitary authority, by Local Health Board (LHB) and by unitary authority within LHBs. The percentage for Wales was 42.5% (95% LCI 41.2%; 95% UCI 43.8%).

Unitary Authority Blaenau Gwent experienced the highest levels of caries prevalence (%DMFT>0 = 58.8%), followed by Caerphilly, Torfaen and Rhondda Cynon Taff; all these unitary authorities except for Torfaen recorded significantly higher levels compared with the Welsh average. Conversely, Ceredigion experienced the lowest levels of caries experience (%DMFT>0 =31.0%) and a further three unitary authorities experienced significantly lower levels of DMFT when compared with Wales as a whole.

Local Health Board Prevalence of caries (%DMFT>0) in both Cwm Taf and Aneurin Bevan health boards were significantly higher than the Welsh average, reflecting the high levels of %DMFT>0 experienced by constituent unitary authorities. Cwm Taf had the highest prevalence of caries, with 50.8% of 12 year olds having at least one or more carious teeth, with Aneurin Bevan having the second highest prevalence (%DMFT=50.4%) when all seven health boards were ranked from worst to best. Hywel Dda had the lowest prevalence of DMFT (%DMFT>0= 35.6%) experiencing levels which were significantly lower than the Welsh average.

Percentage of children with teeth decayed, missing or filled (%DMFT>0) by LHB and UA within LHBs

Chart 34

Percentage of Children with Carious Teeth (ie, %DMFT>0)

40 Lower 30 Similar Higher %DMFT>0 50.8 50.4 Wales 20 40.3 40.0 39.7 38.3 35.6

0 Cwm Taf Aneurin Bevan Betsi Powys Abertawe Bro Cardiff and Vale Hywel Dda Cadwaladr Teaching Morgannwg University University University

Chart 35 Chart 36 % of Children with Carious Teeth (ie, %DMFT>0), Abertawe Bro Morgannwg University Percentage of Children with Carious Teeth (ie, %DMFT>0), Aneurin Bevan 45 70 40 60 35 50 30

25 40 Lower Lower Similar Similar Higher %DMFT>0 20 41.3 41.3 Higher Wales 30 58.8 34.8 Wales %DMFT>0 52.3 51.9 15 46.5 43.7 20 10 10 5 17

0 0 BLAENAU GWENT CAERPHILLY TORFAEN NEWPORT MONMOUTH SWANSEA NEATH & PORT TALBOT BRIDGEND

Percentage of children with teeth decayed, missing or filled (%DMFT>0) by LHB and UA within LHBs

Chart 37 Chart 38 % of Children with Carious Teeth (ie, %DMFT>0), Betsi Cadwaladr University % of Children with Carious Teeth (ie, %DMFT>0), Cardiff and Vale University 50 45 45 40

40 35 35 30 30 25 Lower 25 Lower

Similar Similar %DMFT>0

%DMFT>0 40.8 43.1 43.0 Higher 20 Higher 20 40.9 40.2 37.5 Wales Wales 35.9 33.0 15 15

10 10

5 5

0 0 WREXHAM DENBIGHSHIRE CONWY GWYNEDD FLINTSHIRE ANGLESEY THE VALE OF GLAMORGAN CARDIFF

Chart 39 Chart 40

% of Children with Carious Teeth (ie, %DMFT>0), Cwm Taf % of Children with Carious Teeth (ie, %DMFT>0), Hywel Dda 60 45

40 50 35

40 30

25 Lower Lower 30

Similar Similar %DMFT>0 %DMFT>0 20 51.4 Higher Higher Wales 35.8 35.6 Wales 42.7 20 15 31.0

10 10 5 18 0 0 RHONDDA CYNON TAF MERTHYR TYDFIL CARMARTHENSHIRE PEMBROKESHIRE CEREDIGION

6. Average DMFT for those children with DMFT

Map 6 Chart 41

Average Number of Carious Teeth in those with Carious teeth (i.e. where DMFT>0, DMFT)

3.5 3.0

2.5

Lower 2.0 Similar Higher 1.5 Wales

DMFT DMFT>0, where 1.0 0.5

0.0

CONWY GWENT BLAENAU TORFAEN MONMOUTH PEMBROKESHIRE CARDIFF WREXHAM TAF CYNON RHONDDA NEWPORT THEOF VALE CAERPHILLY GWYNEDD SWANSEA DENBIGHSHIRE BRIDGEND CARMARTHENSHIRE & NEATH PORT FLINTSHIRE POWYS MERTHYR TYDFIL ANGLESEY CEREDIGION

GLAMORGAN

TALBOT

Significantly higher than Wales Within average range Significantly low er than Wales

Wales Map 6 and charts 41-48 show the average number of carious teeth for those with caries (average DMFT for those with DMFT>0), for twelve year old children surveyed in the winter of 2008/09 by unitary authority, by Local Health Board (LHB) and by unitary authority within LHBs. The average DMFT of those with caries for Wales was 2.31 (95% LCI 2.25; 95% UCI 2.37).

Unitary Authority Conwy experienced the highest levels of carious teeth amongst those with caries (DMFT for those with DMFT>0=2.94), followed by Blaenau Gwent, Torfaen and Monmouth, but only Conwy recorded significantly higher levels when compared with the Welsh average. Whilst, Ceredigion experienced the lowest levels of carious teeth amongst those with caries (DMFT for those with DMFT>0=1.95), followed by Anglesey and Merthyr Tydfil, however the values for these unitary authorities fell within the average range for Wales, as they were not statistically significantly different from the Welsh average.

Local Health Board The average DMFT for those with DMFT>0 for all seven LHBs were within average range when compared with the Welsh average. Values ranged from 2.4 in Aneurin Bevan to 2.1 in Powys Teaching LHB.

Average DMFT for those children with DMFT by LHB and UA within LHBs

Chart 42

Average Number of Carious Teeth in those with Carious teeth (ie, where DMFT>0, DMFT) 3

2.5

2 Lower 1.5 Similar Higher 2.4 2.3 2.3 Wales 2.3 2.2 2.2 1 2.1

0.5 where %DMFT>0, DMFT%DMFT>0,where 0 Aneurin Bevan Cardiff and Vale Cwm Taf Betsi Hywel Dda Abertawe Bro Powys University Cadwaladr Morgannwg Teaching University University

Chart 43 Chart 44

Average Number of Carious Teeth in those with Carious teeth (ie, where DMFT>0, DMFT) Average Number of Carious Teeth in those with Carious teeth (ie, where DMFT>0, DMFT) Abertawe Bro Morgannwg University Aneurin Bevan 2.5 3

2.5 2 2 1.5 Lower Lower Similar 1.5 Similar 2.74 Higher 2.23 Higher 2.67 2.17 2.15 2.45 1 Wales 2.31 2.28 Wales 1

0.5

0.5 where DMFT>0, DMFT DMFT>0,where where DMFT>0, DMFT DMFT>0,where

0 0 SWANSEA BRIDGEND NEATH & PORT TALBOT BLAENAU GWENT TORFAEN MONMOUTH NEWPORT CAERPHILLY 20

Average DMFT for those children with DMFT by LHB and UA within LHBs

Chart 45 Chart 46

Average Number of Carious Teeth in those with Carious teeth (ie, where DMFT>0, DMFT) Average Number of Carious Teeth in those with Carious teeth (ie, where DMFT>0, DMFT) Betsi Cadwaladr University Cardiff and Vale University 3.5 3

3 2.5

2.5 2 2 Lower Lower Similar 1.5 Similar Higher Higher 1.5 2.94 Wales 2.38 2.28 Wales 2.38 1 2.23 2.20 1 2.13 2.00

0.5 where DMFT>0, DMFT DMFT>0,where where DMFT>0, DMFT DMFT>0,where 0.5 0 0 CONWY WREXHAM GWYNEDD DENBIGHSHIRE FLINTSHIRE ANGLESEY CARDIFF THE VALE OF GLAMORGAN

Chart 47 Chart 48

Average Number of Carious Teeth in those with Carious teeth (ie, where DMFT>0, DMFT) Average Number of Carious Teeth in those with Carious teeth (ie, where DMFT>0, DMFT) Cym Taf Hywel Dda 3 3

2.5 2.5

2 2

Lower Lower Similar 1.5 Similar 1.5 Higher Higher 2.44 Wales 2.38 Wales 2.17 1 2.05 1 1.95

0.5

0.5 DMFT DMFT>0,where where DMFT>0, DMFT DMFT>0,where

0 0 RHONDDA CYNON TAF MERTHYR TYDFIL PEMBROKESHIRE CARMARTHENSHIRE CEREDIGION 21

7. Care Index - (F/DMF)*100

Map 7 Chart 49

Care Index - (FT/DMFT)*100

70 60

40 Lower Similar Higher 30 Wales Index Care 20 10

CEREDIGION & NEATH PORT FLINTSHIRE THEOF VALE WREXHAM ANGLESEY BRIDGEND SWANSEA TORFAEN GWYNEDD CARMARTHENSHIRE NEWPORT PEMBROKESHIRE POWYS TAF CYNON RHONDDA DENBIGHSHIRE MERTHYR TYDFIL CARDIFF MONMOUTH CAERPHILLY CONWY GWENT BLAENAU

GLAMORGAN

TALBOT

Care Index by Welsh Unitary Authorities Within average range (13) Significantly higher than w elsh average (5) Wales Significantly low er than Welsh average (4)

Map 7 and charts 49-56 show the Care Index for twelve year old children surveyed in the winter of 2008/09 ((F/DMF)*100) by unitary authority, by Local Health Board (LHB) and by unitary authority within LHBs. The Care Index expresses the proportion of the caries experience that has been treated restoratively. The care index for Wales indicates that 46% of the teeth with dentinal caries have been restored (95% LCI 45%; 95% UCI 48%).

Unitary Authority The unitary authority values for the Care Index ranged from 30% in Blaenau Gwent to 64% in Ceredigion. Blaenau Gwent, Conwy, Caerphilly and Cardiff recorded significantly lower levels of restoration compared with the Welsh average. Conversely, Ceredigion, Neath Port Talbot, Flintshire, The Vale of Glamorgan and Wrexham experienced significantly higher levels of restoration when compared with Wales as a whole.

Local Health Board The Care Index for Aneurin Bevan was 41%; exhibiting significantly lower levels of restoration when compared with the Welsh average which was 46%. Whilst Abertawe Bro Morgannwg University LHB had the highest Care Index, 52%, and this was significantly higher than the Welsh average. The remaining 5 LHBs had care indices which fell within the average range for Wales.

Care Index - (F/DMF)*100 by LHB and UA within LHBs

Chart 50

60 Care Index - (FT/DMFT)*100

30 52.1 Lower

Care Index Care 49.7 47.7 Similar 46.3 45.7 45.1 Higher 20 40.5 Wales

0 Abertawe Bro Hywel Dda Betsi Cadwaladr Powys Teaching Cardiff and Vale Cwm Taf Aneurin Bevan Morgannwg University University University

Chart 51 Chart 52

Care Index - (FT/DMFT)*100, Abertawe Bro Morgannwg University Care Index - (FT/DMFT)*100, Aneurin Bevan 70 60

60 50

50 40

30 Lower Lower Similar Similar Higher

30 Higher Index Care

Care Index Care 58.9 48.4 47.9 Wales Wales 50.3 49.7 20 38.0 36.8 20 29.5 10 10 23

0 0 NEATH & PORT TALBOT BRIDGEND SWANSEA TORFAEN NEWPORT MONMOUTH CAERPHILLY BLAENAU GWENT

Care Index - (F/DMF)*100 by LHB and UA within LHBs

Chart 53 Chart 54

Care Index - (FT/DMFT)*100, Betsi Cadwaladr University Care Index - (FT/DMFT)*100, Cardiff and Vale University 60 60

50 50

40 40

30 Lower 30 Lower 56.0 54.5 Similar 54.6 Similar

51.0 Higher Higher

Care Index Care Care Index Care 48.3 Wales Wales 44.0 20 20 40.9 35.8

10 10

0 0 FLINTSHIRE WREXHAM ANGLESEY GWYNEDD DENBIGHSHIRE CONWY THE VALE OF GLAMORGAN CARDIFF

Chart 55 Chart 56

Care Index - (FT/DMFT)*100, Cym Taf Care Index - (FT/DMFT)*100, Hywel Dda 50 70

45 60 40 35 50

30 40 25 Lower Lower 45.2 Similar 64.3 Similar

Higher 30 Higher Care Index Care Care Index Care 41.5 20 Wales Wales 48.1 47.0 15 20 10 10 5 24

0 0 RHONDDA CYNON TAF MERTHYR TYDFIL CEREDIGION CARMARTHENSHIRE PEMBROKESHIRE

8. Treatment index (M+F)/DMF*100

Chart 57 Map 8

Treatment Index ((MT+FT)/DMFT)*100

80 70 60

50 Lower Similar 40 Higher Wales 30 Index Treatment 20

FLINTSHIRE CEREDIGION WREXHAM & NEATH PORT SWANSEA THEOF VALE GWYNEDD TORFAEN BRIDGEND TAF CYNON RHONDDA DENBIGHSHIRE POWYS NEWPORT MERTHYR TYDFIL PEMBROKESHIRE ANGLESEY CARMARTHENSHIRE CARDIFF CONWY CAERPHILLY MONMOUTH GWENT BLAENAU

GLAMORGAN

TALBOT

Treatment Index by Welsh Unitary Authority Within average range (12) Significantly higher than Welsh average (6) Wales Significantly low er than Welsh average (4)

Map 8 and charts 57-64 show the Treatment Index for twelve year old children surveyed in the winter of 2008/09 ((M+F/DMF)*100) by unitary authority, by Local Health Board (LHB) and by unitary authority within LHBs. The Treatment Index expresses the proportion of the caries experience that is missing or has been filled. The Treatment Index for Wales indicates that 58% of the teeth with dentinal caries have been filled or are missing (95% LCI 57%; 95% UCI 60%).

Unitary Authority The Unitary Authority values for the Treatment Index ranged from 44% in Blaenau Gwent to 75% in Flintshire. Blaenau Gwent, Monmouthshire, Caerphilly, and Cardiff recorded significantly lower treatment indices when compared with the Welsh average. Conversely, Flintshire, Ceredigion, Wrexham, Neath Port Talbot, Swansea and The Vale of Glamorgan experienced significantly higher treatment indices when compared with Wales as a whole.

Local Health Board The Treatment Indices for Abertawe Bro Morgannwg and Betsi Cadwaladr University LHBs were significantly higher than the Welsh average, with 65% and 62% respectively of the caries experience having been filled or missing. In contrast, Aneurin Bevan exhibited the lowest Treatment Index, with only 51% of the caries being missing or filled; this value was significantly lower than the Welsh average.

Treatment index (M+F)/DMF*100 by LHB and UA within LHBs

Chart 58

70 Treatment Index - (M+F/DMF)*100

65.1 62.3 Lower 30 59.4 57.8 57.6 57.4 Similar Higher Treatment Index Treatment 51.0 Wales 20

0 Abertawe Bro Betsi Cadwaladr Cwm Taf Hywel Dda Powys Teaching Cardiff and Vale Aneurin Bevan Morgannwg University University University

Chart 59 Chart 60

Treatment Index - (M+F/DMF)*100, Abertawe Bro Morgannwg University Treatment Index ((MT+FT)/DMFT)*100, Aneurin Bevan 70 70

60 60

50 50

40 40 Lower Lower 66.6 66.4 Similar Similar 30 60.0 Higher 30 60.6 Higher 57.8

Wales Wales

Treatment Index Treatment Treatment Index Treatment 46.4 45.4 43.8 20 20

10 10 26

0 0 NEATH & PORT TALBOT SWANSEA BRIDGEND TORFAEN NEWPORT CAERPHILLY MONMOUTH BLAENAU GWENT

Treatment index (M+F)/DMF*100 by LHB and UA within LHBs Chart 62 Chart 61 Treatment Index - (M+F/DMF)*100, Betsi Cadwaladr University Treatment Index - (M+F/DMF)*100, Cardiff and Vale University 80 70

70 60

60 50

50 40

40 Lower Lower 75.5 Similar 65.9 Similar 71.1 Higher 30 Higher Wales Wales 30 62.5

Treatment Index Treatment 59.6 52.6 Treatment Index Treatment 55.1 48.9 20 20

10 10

0 0 FLINTSHIRE WREXHAM GWYNEDD DENBIGHSHIRE ANGLESEY CONWY THE VALE OF GLAMORGAN CARDIFF

Chart 63 Chart 64

Treatment Index - (M+F/DMF)*100, Cym Taf Treatment Index - (M+F/DMF)*100, Hywel Dda 70 80

70 60

60 50

50 40

Lower 40 Lower Similar 75.0 Similar 30 59.7 Higher Higher 57.3 Wales Wales

30 Treatment Index Treatment Treatment Index Treatment 57.0 54.2 20 20

10 10

0 0 27 RHONDDA CYNON TAF MERTHYR TYDFIL CEREDIGION PEMBROKESHIRE CARMARTHENSHIRE

9. Restorative index (F/(D+F)*100)

Map 9 Chart 65

Restorative Index - (FT/(DT+FT))*100

60 50 Lower Similar 40 Higher Wales 30 Index Restorative 20

CEREDIGION FLINTSHIRE WREXHAM & NEATH PORT THEOF VALE SWANSEA GWYNEDD BRIDGEND TORFAEN ANGLESEY NEWPORT TAF CYNON RHONDDA POWYS PEMBROKESHIRE DENBIGHSHIRE CARMARTHENSHIRE MERTHYR TYDFIL CARDIFF CONWY MONMOUTH CAERPHILLY GWENT BLAENAU GLAMORGAN TALBOT

Restorative Index by Welsh Unitary Authority Within average range (11) Signifcantly higher than Welsh average (6) Wales Significantly low er than Welsh average (5)

Map 9 and charts 65-72 show the Restorative Index for twelve year old children surveyed in the winter of 2008/09 ((F/D+F)*100) by unitary authority, by Local Health Board (LHB) and by unitary authority within LHBs. The Restorative Index expresses the proportion of the decayed and filled teeth that have been treated restoratively. The restorative index for Wales indicates that 53% of the teeth which are decayed or filled have been restored (95% LCI 51%; 95% UCI 54%).

Unitary Authority The Unitary Authority values for the Restorative Index ranged from 34% in Blaenau Gwent to 72% in Ceredigion. Blaenau Gwent, Caerphilly, Monmouthshire, Conwy and Cardiff recorded significantly lower levels of restoration compared with the Welsh average. Conversely, Ceredigion, Flintshire, Wrexham, Neath and Port Talbot, The Vale of Glamorgan and Swansea experienced significantly higher levels of restoration when compared with Wales as a whole.

Local Health Board The LHB values for the Restorative Index ranged from 45% in Aneurin Bevan to 60% in Abertawe Bro Morgannwg University LHB. The former LHB had a Restorative Index which was significantly lower than the Welsh average and the latter LHB had a Restorative Index which was significantly higher. The remaining five LHBs had restorative Indices which fell within the average range for Wales as a whole.

Restorative index (F/(D+F)*100) by LHB and UA within LHBs Chart 66

70 RestorativeIndex - (F/D+F)*100

Lower 30 59.9 55.9 Similar 54.1 52.7 52.2 51.7 Higher Restorative Index Restorative Wales 45.2 20

0 Abertawe Bro Betsi Cadwaladr Hywel Dda Cwm Taf Powys Teaching Cardiff and Vale Aneurin Bevan Morgannwg University University University

Chart 67 Chart 68 Restorative Index - (F/D+F)*100, Abertawe Bro Morgannwg University Restorative Index - (F/D+F)*100, Aneurin Bevan 70 60

60 50

50 40

Lower 30 Lower Similar 55.1 Similar 63.8 53.1 30 59.6 Higher Higher

55.7 Wales Wales Restorative Index Restorative Restorative Index Restorative 20 41.1 40.7 20 34.4

10 10 29 0 0 NEATH & PORT TALBOT SWANSEA BRIDGEND TORFAEN NEWPORT MONMOUTH CAERPHILLY BLAENAU GWENT

Restorative index (F/(D+F)*100) by LHB and UA within LHBs

Chart 69 Chart 70

Restorative Index - (F/D+F)*100, Betsi Cadwaladr University Restorative Index - (F/D+F)*100, Cardiff and Vale University 80 70

70 60

60 50 50 40 40 Lower Lower Similar Similar 69.6 Higher 30 61.5 Higher 65.3 Wales Wales

30 Restorative Index Restorative Restorative Index Restorative 56.3 53.2 52.1 46.3 20 20 41.2

10 10

0 0 FLINTSHIRE WREXHAM GWYNEDD ANGLESEY DENBIGHSHIRE CONWY THE VALE OF GLAMORGAN CARDIFF Chart 71 Chart 72

Restorative Index - (F/D+F)*100, Cwm Taf Restorative Index - (F/D+F)*100, Hywel Dda 60 80

70 50

40 50

30 Lower 40 Lower Similar Similar 72.0 52.8 Higher Higher 49.3 Wales Wales

Restorative Index Restorative Restorative Index Restorative 20 52.2 51.2

10 10 30 0 0 RHONDDA CYNON TAF MERTHYR TYDFIL CEREDIGION PEMBROKESHIRE CARMARTHENSHIRE

10. Percentage children who have been to the dentist within the previous year

Map 10 Chart 73

Percentage children who have been to the dentist within the previous year

100.0

90.0 80.0 70.0 60.0 50.0

40.0 30.0 20.0 10.0

0.0

CARDIFF

DENBIGHSHIRE

CEREDIGION

BRIDGEND

CONWY

MONMOUTH

CAERPHILLY

CARMARTHENSHIRE

FLINTSHIRE

TORFAEN

SWANSEA

GWYNEDD WREXHAM POWYS

MERTHYR TYDFIL MERTHYR

PEMBROKESHIRE

RHONDDA CYNON TAF CYNON RHONDDA NEWPORT

THE VALE OF GLAMORGAN OF THE VALE

ANGLESEY BLAENAU GWENT BLAENAU TALBOT PORT NEATH &

Map 10 and charts 73-80 show the percentage of twelve year old children who stated that they had been to the dentist within the previous year. Reported attendance rates were very good for the whole of Wales, the percentage children who had been to the dentist within the previous year was 95.1% (95% LCI 94.6%; 95% UCI 95.7%).

Unitary Authority The Unitary Authority values for the Restorative Index ranged from 89.3% in Pembrokeshire to 98.2% in Flintshire. Pembrokeshire and Carmarthenshire recorded significantly lower levels of attendance within the previous year when compared with the Welsh average. Conversely, Flintshire, Bridgend and Swansea experienced significantly higher levels of attendance when compared with Wales as a whole.

Local Health Board The LHB values for reported dental attendance during the previous year ranged from 90.6% in Hywel Dda University LHB to 97% in Abertawe Bro Morgannwg University LHB. The former LHB had reported attendance levels which were significantly lower than the Welsh average. The remaining six LHBs had attendance levels which fell within the average range for Wales as a whole.

Percentage children who have been to the dentist within the previous year by LHB and UA within LHBs

Chart 74

Percentage children who have been to the dentist within the previous year 100.0 90.0

80.0

70.0

60.0 50.0 97.0 96.8 95.5 95.3 94.9 92.8 90.6 40.0

30.0

20.0

10.0

0.0 Abertawe Bro Cardiff and Vale Betsi Cadwaladr Aneurin Bevan Cwm Taf Powys Teaching Hywel Dda Morgannwg University University University

Chart 75 Chart 76

Percentage children who have been to the dentist within the previous year, Percentage children who have been to the dentist within the previous year, Abertawe Bro Morgannwg University Aneurin Bevan 100.0 100.0 90.0 90.0 80.0 80.0

70.0 70.0

60.0 60.0

50.0 97.6 97.5 50.0 97.3 97.4 95.8 95.3 94.4 94.4 40.0 40.0

30.0 30.0 20.0 20.0 10.0 10.0 0.0 0.0 BRIDGEND SWANSEA NEATH & PORT TALBOT TORFAEN BLAENAU GWENT CAERPHILLY NEWPORT MONMOUTH 32

Percentage children who have been to the dentist within the previous year by LHB and UA within LHBs

Chart 77 Chart 78

Percentage children who have been to the dentist within the previous year, Percentage children who have been to the dentist within the previous year, Betsi Cadwaldr University Cardiff and Vale University 100.0 100.0 90.0 90.0 80.0 80.0 70.0 70.0

60.0 60.0

50.0 50.0 98.2 97.2 96.3 95.3 95.0 94.9 92.8 96.6 40.0 40.0

30.0 30.0

20.0 20.0

10.0 10.0 0.0 0.0 FLINTSHIRE CONWY WREXHAM DENBIGHSHIRE GWYNEDD ANGLESEY THE VALE OF GLAMORGAN CARDIFF

Chart 79 Chart 80

Percentage children who have been to the dentist within the previous year, Percentage children who have been to the dentist within the previous year, Hywel Dda Cwm Taf 100.0 100.0

90.0 90.0

80.0 80.0

70.0 70.0

60.0 60.0

50.0 50.0 94.1 95.0 94.9 90.0 89.3 40.0 40.0

30.0 30.0

20.0 20.0

10.0 10.0

0.0 0.0 CEREDIGION CARMARTHENSHIRE PEMBROKESHIRE MERTHYR TYDFIL RHONDDA CYNON TAF 33

11. A comparison of data from the 2008-09 and 2004-05 surveys of 12 year olds

(i) Average number of teeth decayed, missing or filled (mean DMFT) 12 year olds - 2004-05 & 2008-09

In this section the average number of teeth decayed, missing or filled (mean DMFT) for Wales, LHBs and UAs, for two surveys of 12 year olds (school year 7) conducted in 2004-05 and 2008- 09 are compared. Across Wales, 6,749 were examined during the former survey and 5,808 children were examined in the latter survey. Both surveys took place between September and April.

The mean DMFT for 12 year olds for the whole of Wales as recorded by the 2008-09 survey was 0.98 (95%LCI: 0.94 – 95%UCI: 1.02) which was statistically lower than the mean DMFT recorded by the 2004-05 survey which was 1.09 (95%LCI: 1.05 – 95%UCI: 1.13). This is indicative of an improvement in the mean DMFT for Welsh 12 year olds (Figure 1)1.

Abertawe Bro Morgannwg University Health Board was the only LHB to display a statistically significant improvement in caries experience over the period; mean DMFT was 1.17 (95%LCI: 1.08 – 95%UCI: 1.26) in 2004-05 compared with 0.87 (95%LCI: 0.79 – 95%UCI: 0.95) in 2008- 09. This was a reflection of the average DMFT levels in ABM’s constituent UAs, all three displayed statistically significant improvements in DMFT between the two surveys (Figure 2.2).

Hywel Dda Health Board displayed a reduction in caries levels between the survey years, mean DMFT was 0.99 (95%LCI: 0.893 – 95%UCI: 1.0) in 2004-05 compared with 0.80 (95%LCI: 0.70 – 95%UCI: 0.894) in 2008-09. But because the 95% confidence intervals just overlap this difference was not statistically significant (Figure 1).

All the unitary authorities in Hywel Dda displayed reductions in mean DMFT between the surveys, but none of these were statistically significant. It is important to note, that Ceredigion displayed a reduction of approximately half a tooth; the mean DMFT was 1.08 (95%LCI: 0.78 – 95%UCI: 1.39) in 2004-05 compared with 0.61 (95%LCI: 0.42 – 95%UCI: 0.80) in 2008-09; but the 95% confidence intervals just overlapped – so it is not possible to judge whether this is a true reduction (Figure 2.6).

The caries levels for both Aneurin Bevan and Cwm Taf Health Boards remained consistent across the two surveys. The mean DMFT for the former LHB was 1.28 in 2004-05 compared with 1.23 in 2008-09 and for the latter LHB it was 1.20 in 2004-05 compared with 1.18 in 2008- 09 (Figure 1).

Within Aneurin Bevan, the UAs displayed some changes in DMFT levels, for example both Blaenau Gwent and Torfaen recorded reductions in DMFT and Monmouth recorded an increase. However these changes were not statistically significant.

In Cwm Taf, Merthyr Tydfil recorded a reduction in mean DMFT between 2004-05 (1.22, 95%LCI: 0.96 95%UCI: 1.48) and 2008-09 (0.87, 95%LCI: 0.64 95%UCI: 1.11), but again this was not statistically significant (Figure 2.5).

Both Betsi Cadwaladr University and Powys teaching Health Boards displayed reductions in caries levels but these were not statistically significant improvements as evidenced by the 95% confidence intervals.

1 Comparisons are made for LHBs and UAs across the two surveys. Differences are viewed as statistically significant if the 95% confidence intervals associated with the means do not overlap. 34

Figure 1 Local Health Boards and Wales, mean DMFT 12 year olds, 2004-05 and 2008-09

Local Health Boards

2.40 2.20

2.00

1.80

1.60 1.40

1.20 DMFT 1.00 0.80 1.28 0.60 1.23 1.20 1.18 1.17 1.09 1.04 0.99 1.07 0.93 0.90 0.98 0.40 0.87 0.83 0.77 0.80 0.20

0.00

Aneurin Bevan Aneurin 08 Aneurin Bevan Aneurin 04

Powys Teaching Powys 04

Betsi Cadwaladr Betsi U Cadwaladr 04 Betsi U Cadwaladr 08

Powys teaching Powys 08

Cardiff and Cardiff Vale U 04 Cardiff and Vale Cardiff U 08

Hywel Hywel Dda 04 Hywel Dda 08

Abertawe Bro Morgannwg U 04 Abertawe Bro Morgannwg U 08

Cwm Taf 04 Cwm Taf 08 WALES 08 WALES 04

- -

09 05

- - 09

- -

05 09

05 09 -

09 05

- -

05 09 09 05

- -

Figure 2 Unitary Authority mean values for DMFT within LHBs, 12 year olds (2004-05 & 2008-09) compared with Wales

Fig 2.1 Aneurin Bevan

2.40

2.20 2.00 1.80 1.60 1.40

DMFT 1.20

2.09 1.00

1.70 0.80 1.61 1.39 0.60 1.17 1.19 1.07 1.07 1.09 0.99 0.98 0.40 0.83

0.20

0.00

MONMOUTH MONMOUTH 04 MONMOUTH 08

BLAENAU BLAENAU GWENT 04 BLAENAU GWENT 08 TORFAEN TORFAEN 08

TORFAEN 04

CAERPHILLY 04 CAERPHILLY 08

NEWPORT 04 NEWPORT 08 WALES 04 WALES 08

- -

05 09

- - -

09 05

05 09

- -

05 09

- - 09

- - 09 05 Fig 2.2 Abertawe Bro Morgannwg University

2.40 2.20

2.00 1.80 1.60 1.40

1.20 DMFT 1.00 0.80 0.60 1.23 1.22 1.09 1.07 0.98 0.89 0.92 0.40 0.76

0.20

0.00

NEATH NEATH & PORT 08 TALBOT NEATH NEATH & PORT 04 TALBOT

BRIDGEND BRIDGEND 04 BRIDGEND 08

SWANSEA 08 SWANSEA 04 WALES 08 WALES 04

- -

05 09

- - -

09 05

05 09

- - 09 05 36

Figure 2 Unitary Authority mean values for DMFT within LHBs, 12 year olds (2004-05 & 2008-09) compared with Wales

Fig. 2.3 Betsi Cadwaladr University

2.40

2.20

2.00 1.80 1.60 1.40 DMFT 1.20 1.00 0.80 1.24 0.60 1.15 1.20 1.04 1.05 1.03 1.09 0.95 0.98 0.87 0.94 0.90 0.40 0.77 0.66 0.20

0.00

FLINTSHIRE FLINTSHIRE 04 FLINTSHIRE 08

GWYNEDD 04 GWYNEDD 08

DENBIGHSHIRE 08 DENBIGHSHIRE 04

WREXHAM 04 WREXHAM 08

WALES 04 WALES 08

ANGLESEY 04 ANGLESEY 08 CONWY 08 CONWY 04

- -

05 09

- -

05 09

05 09 -

05 09

- - 09 05

Fig 2.4 Cardiff and Vale University 2.40 2.20 2.00

1.80 1.60 1.40 1.20

1.00 DMFT 0.80 0.60 1.09 0.93 0.98 0.40 0.82 0.89 0.69 0.20

0.00

VALE 08 OFGLAMORGAN WALES04 WALES08 VALE 04 OFGLAMORGAN CARDIFF 08 CARDIFF 04

- - 09

- - 09 05 37

Figure 2 Unitary Authority mean values for DMFT within LHBs, 12 year olds (2004-05 & 2008-09) compared with Wales

Fig. 2.5 Cwm Taf 2.40 2.20 2.00

1.80 1.60 1.40 1.20

1.00 DMFT

0.80

0.60 1.22 1.23 1.18 1.09 0.98 0.40 0.87 0.20

0.00

RHONDDA RHONDDA CYNON TAF 04 RHONDDA CYNON TAF 08

MERTHYR TYDFIL 04 MERTHYR TYDFIL 08 WALES 08 WALES 04

- - 09

05 -

05 09

- - 09 05

Fig. 2.6 Hywel Dda 2.40 2.20 2.00 1.80 1.60 1.40

1.20 DMFT

1.00

0.80

0.60 1.08 1.13 1.09 0.98 0.87 0.40 0.84 0.78 0.61 0.20

0.00

CARMARTHENSHIRE 04 CARMARTHENSHIRE 08

CEREDIGION CEREDIGION 08 CEREDIGION CEREDIGION 04

PEMBROKESHIRE 08 PEMBROKESHIRE 04 WALES 08 WALES 04

- - 09

- -

09 05

- - 09

05 38

- - 09 05

Figure 2 Unitary Authority mean values for DMFT within LHBs, 12 year olds (2004-05 & 2008-09) compared with Wales

Fig. 2.7 Powys Teaching

2.40

2.20 2.00 1.80 1.60 1.40 1.20 DMFT 1.00

0.80

0.60 1.09 1.07 0.98 0.40 0.84 0.20

0.00

POWYS UA 04 POWYS UA 08 WALES 08 WALES 04

- - 09

- - 05 09

Within Betsi Cadwaladr University LHB, Anglesey unitary authority displayed a notable reduction in caries experience over the period; mean DMFT was 1.15 (95%LCI: 0.84 – 95%UCI: 1.47) in 2004-05 compared with 0.66 (95%LCI: 0.47 – 95%UCI: 0.85) in 2008-09. But, this difference was not statistically significant. This reduction is uncharacteristic for the Unitary Authority and needs to be monitored in future surveys. Flintshire, Gwynedd and Wrexham all displayed small reductions and Conwy experienced a small increase in DMFT between the surveys but these were not statistically significant (Figure 2.3).

It is important to note, that there are 2 values for DMFT data variables for Powys UA and then for Powys Teaching LHB. Data is weighted using the BASCD protocols and this weights according to the numbers of children examined relative to the childhood population size for the geographical boundaries being studied. This is why the values for Powys UA which is weighted according to the demography of 22 UAs is very slightly different to the values for Powys teaching LHB which is weighted according to the demography of 7 LHBs (Table 1).

Table 1 Mean DMFT for Powys UA compared with Powys Teaching LHB, 12 year olds 2008-09 Mean DMFT 95% LCI 95% UCI Powys UA 0.84 0.69 1.00 Powys Teaching LHB 0.83 0.68 0.98

Powys Teaching LHB displayed a small, but not statistically significant, reduction in mean DMFT between (1.07 – 95%LCI: 0.88 95%UCI: 1.25) 2004-05 and (0.83 – 95%LCI: 0.68 95%UCI:0.98) 2008-09.

Cardiff and Vale University LHB displayed a small increase in DMFT between the two surveys; in 2004-05 it was 0.77 (95%LCI: 0.69 – 95%UCI: 0.86) compared with 0.90 (95%LCI: 0.80 – 95%UCI: 1.00) in 2008-09 (Figure 1). Reflecting small but not statistically significant increases in the respective unitary authority values (Figure 2.4).

(ii) CARIES PREVALENCE - Percentage of children with teeth decayed, missing or filled

Across Wales, the percentage of children with teeth decayed, missing due to caries or filled (%DMFT>0) has continued to fall, from 51.1% in 2001, to 45.1% in 2005 and it now stands at 42.5%. This represents a significant 8.6% reduction in the prevalence of caries experience in Welsh 12 year olds in the past eight years.

Figure 3 The percentage of children with teeth decayed, missing due to caries or filled (%DMFT>0) in Wales for surveys 2001-2008

60.0

50.0

40.0

30.0

51.1 45.1 20.0 42.5

10.0

0.0 2000-01 2004-05 2008-09

WALES %DMFT>0 LCI UCI 2000-01 51.10 49.96 52.24 2004-05 45.13 43.94 46.32 2008-09 42.50 41.20 43.80

Caries prevalence has also fallen for Welsh unitary authorities; in 2004-05 for example, the %DMFT>0 ranged from 34.6% in the Vale of Glamorgan to 69.6% in Blaenau Gwent2 whereas in 2008-09 it ranged from 31.0% in Ceredigion to 59.8% in Blaenau Gwent (Chart 33).

2 Dental Epidemiological Survey of rising 12 year old children in Wales 2004/05 - summary report, WOHIU http://www.cardiff.ac.uk/dentl/research/themes/appliedclinicalresearch/epidemiology/oralhealth/index.html 41

12. COMPARISON WITH ENGLAND

As in previous years the average number of decayed, missing due to caries and filled teeth (mean DMFT) and the percentage of children with caries experience (%DMFT>0) was lower in England when compared with Wales. Furthermore, these differences were statistically different (Figures 4.1 and 4.2).

Figure 4 Comparison of England and Wales for 2007-08

Figure 4.1 Average number of teeth decayed, Figure 4.2 Percentage of children with teeth missing or filled (mean DMFT) decayed, missing or filled (%DMFT>0)

2.0 60.0

50.0

1.5

40.0

1.0 30.0

20.0 42.5 33.4 0.5 1.0

0.7 10.0

0.0 0.0 England Wales England Wales

The average DMFT was 0.74 (95% Lower Confidence Interval, 0.73; 95% Upper Confidence Interval, 0.75) in England compared with 0.98 in Wales (95%LCI 0.94; 95% UCI, 1.02). The prevalence of caries was 33.4% (95% LCI 33.1; 95%UCI 33.7%) in England compared with 42.5% in Wales (95% LCI 41.2; 95%UCI 43.8%).

Table 2 A comparison of the average number of teeth decayed, missing or filled (mean DMFT) in Welsh Health Boards compared with the best and worst PCTs and SHAs in England

Number of times worse than:

Mean Best PCT- Worst PCT - Best SHA - Worst SHA - DMFT Southwark Aston Leigh & South East Yorkshire & 0.23 Wigan 1.48 Coast 0.48 the Humber 1.07 Hywel Dda 0.80 3.48 0.54 1.13 0.51 Powys Teaching 0.83 3.61 0.56 1.17 0.52 Abertawe Bro Morgannwg 0.87 3.78 0.59 1.22 0.55 University Cardiff and Vale University 0.90 3.91 0.61 1.27 0.57 Betsi Cadwaladr 0.93 4.04 0.63 1.31 0.59 University CwmTaf 1.18 5.13 0.80 1.66 0.75 Aneurin Bevan 1.23 5.35 0.83 1.73 0.78

WALES 0.98 4.26 0.66 1.38 0.62

When comparing Welsh Health Boards with the best PCT in England; Hywel Dda HB has an average DMFT which is approximately 3 ½ times worse that Southwark PCT and Cwm Taf HB has an average DMFT which is over 5 times worse. However, Aston Leigh and Wigan, the PCT with the worst average caries experience (1.48) had a DMFT which was worse than all the Welsh LHBs (Table 2). Comparisons of Welsh HBs and English Strategic Health Authorities are also presented.

13. COMPARISON WITH EUROPE

It is acknowledged that the oral health of Welsh 12 year olds is worse than that of English 12 year olds and that in some areas of Wales caries experience is higher than the average experience. However, it is important to note that both England and Wales have good oral health in 12 year olds when compared with the rest of Europe.

Wales with an average of one decayed, missing due to caries or filled tooth (mean DMFT) for 12 year olds, ranks 7th out of 33 European countries. England ranks 1st with an average DMFT of 0.74 and Romania ranks 33rd with an average DMFT of 7.3.

Figure 5 Average levels of tooth decay in 12 year old children in Europe

8.0 7.0 6.0 5.0 4.0

DMFT 3.0 2.0 1.0

0.0

Italy

Spain

Latvia

Wales

Ireland

Austria Poland France

Iceland

Finland

Greece

Albania

Belarus

Estonia

Norway

Ukraine

Belgium Sweden

England

Portugal

Slovakia

Slovenia

Romania

Denmark

Lithuania

Germany

Macedonia

Switzerland

Netherlands

Luxembourg

Czech RepublicCzech

UnitedKingdom RussianFederation Country

Source: WHO Oral Health Country/Area Profile programme