Oral health: local authorities and partners

Introduction

Oral health is important to general health and wellbeing. Poor oral and dental health can affect a person's ability to eat, speak and socialise normally (for example, due to social embarrassment, pain) (Dental quality and outcomes framework, Department of Health 2011). Oral diseases are also associated with coronary heart disease (Humphrey et al. 2008; Mathews 2008); diabetes complications (Grossi and Genco 1998; Stewart et al. 2001; Taylor 2001); rheumatoid arthritis (Ortiz et al. 2009); and adverse pregnancy outcomes (Xiong et al. 2006).

Tooth decay (dental caries) and gum disease (periodontal disease) are the most common dental problems in the UK. They can be painful, expensive to treat and can seriously damage health if left unchecked ('Dental quality and outcomes framework'). However, both problems are largely preventable (Levine and Stillman-Lowe 2009).

Oral health in England

While oral health in England has improved significantly across the population as a whole over recent decades, marked inequalities persist. The adult dental health survey 2009 (The Health and Social Care Information Centre 2011) reported that the proportion of adults in England without any natural teeth fell over the last 30 years from 28% to 6%. However, the survey also showed a clear socioeconomic gradient. For example, people from managerial and professional occupation households had better oral health (91%) compared with people from routine and manual occupation households (79%).

The NHS dental epidemiology programme for England oral health survey of children aged 12 showed that levels of dental disease among this group are decreasing, in line with previous survey years.However, from May 2006, data are collected about children only if written information and consent has been provided. Previously, consent was assumed if a letter was sent to the parents or guardians and no objection was received. These consent arrangements suggest a bias towards the participation of those who are less likely to have tooth decay (Davies et al. 2011).

Data collected between 2008 and 2009 show 66.6% of 12 year old children were free from visually obvious dental decay. However, 33.4% are reported as having dental caries (with 1 or more teeth severely decayed, extracted or filled). The same survey reported a higher prevalence and severity of oral disease among those living in Yorkshire and the Humber, the north west and north east compared to those in the midlands and south west; with the lowest levels of disease reported in the south and east (The NHS dental epidemiology programme for England: oral health survey of 12 year old children 2008/2009, North West Public Health Observatory 2010).

The National dental epidemiology programme for England oral health survey of 5 year old children 2012 (Public Health England 2013) indicates wide variations in dental health across the general population. A significant proportion of children (72.1%) are free from obvious dental decay, with 27.9% having at least 1 decayed, missing or filled tooth. However, at the local authority level, the prevalence of dental caries ranges greatly: from the lowest reported of 12.5% in Brighton and Hove to the highest of 53.2% in Leicester.

Improving the oral health of local populations

The risk factors for poor oral health – diet, smoking, alcohol use, hygiene, stress and trauma – are the same as those for many chronic conditions (Watt and Sheiham 2012).

Risk factors for severe dental caries in the UK include: living in a deprived area; being from a lower socioeconomic group or living with a family in receipt of income support; belonging to a family of Asian origin; or living with a Muslim family where the mother speaks little English (Rayner et al. 2003). Other risk factors include substance misuse or having a chronic medical condition (Valuing people's oral health: a good practice guide for improving the oral health of disabled children and adults, Department of Health 2007).

The oral health of local communities is important for their general health and wellbeing and their quality of life. It may be improved by adopting a 'common risk factor' approach and by providing evidence-based oral health promotion programmes and interventions. The aim of the latter is to improve people's:

The role of local authorities in improving oral health

Since April 2013, NHS England (previously the NHS Commissioning Board) has been working with local authorities and Public Health England to develop and deliver oral health improvement strategies and commissioning plans specific to the needs of local populations (Securing excellence in commissioning primary care, NHS Commissioning Board 2012; Commissioning better oral health for children and young people, Public Health England 2014).

Oral health needs assessments are required to inform joint strategic needs assessments. Local authorities have the responsibility for commissioning surveys of dental health, dental screening and improving the oral health of their populations.

Delivering better oral health toolkit

Below (box 1) is an edited extract from: Delivering better oral health: an evidence-based toolkit for prevention (Public Health England 2014). This toolkit provides practical, evidence‑based guidance to help dentists and their teams promote oral health and prevent oral disease among their patients.