Accelerating the decline in dental decay

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  Posted by: Dental Design      11th February 2024

Incidence of dental caries may be declining in the UK, but there is still work to do. It is estimated that almost one in three UK adults have tooth decay,[i] with an average of 2.1 decayed teeth per person.[ii] Nearly 11% of three-year-olds surveyed in 2018 had already experienced dental decay in an average of three teeth, while 23% of five-year-olds had received the diagnosis too.[iii] Extractions due to tooth decay remain a leading cause of hospital admissions for 0 to 19-year-olds in the UK, with nearly 27,000 episodes recorded in 2021/22.[iv]

A closer look

Though the overall figures don’t paint a fantastic picture, there is more information to be learned by digging deeper.

For example, it’s important for dental professionals to be aware of the inequalities that exist in this field. Statistics from 2018[v] suggested that 32% of the adult population in the South West of England had caries, compared to 21% in the South East. Similar differences were found between the regions among children, with 34% of five-year-olds in the North West and 16% in the South East experiencing some form of decay. Data has also shown a significant difference in the level of decay between regions, averaging 0.5 d3mft (the number of decayed teeth and those lost or filled due to decay) in the South East and 1.3 in the North West.[vi]

Though the impact of regional inequalities appears to be reducing with time,[vii] the gap remains unacceptably high.

Reducing inequalities with fluoride

Various approaches are being considered and implemented across the UK in an attempt to further reduce the regional inequalities with regards to dental decay. Water fluoridation is one option.

An area of interest since the 1930s, studies have clearly demonstrated the oral health benefits of fluoridated water, showing a notable reduction in dental caries in locations of higher fluoride concentrations.[viii] It has even been estimated that the number of hospital admissions for tooth extractions among children could be reduced by 17% with fluoridated water!

Despite the many positives, there is still some resistance among the general public to fluoridation of the main water supply. Studies are available that suggest adverse developmental effects in children due to maternal fluoride exposure,[ix] [x] as well as other negative effects like hypothyroidism, skeletal fluorosis, and enzyme and electrolyte derangement.[xi] However, much of this research has been criticised by experts, authorities and professional bodies, suggesting that water fluoridation should still be a priority – especially in more socioeconomically deprived areas of the nation. Some areas that have recently been advocating for or looking into water fluoridation for these reasons include Nottinghamshire[xii] and Isle of Man.[xiii]

Fighting on all fronts

Regardless of the wider discussion around water fluoridation, there are various other – smaller scale – strategies that dental professionals can support patients with in the fight against dental caries. An effective oral hygiene routine and chewing sugar-free gum between meals both go a long way to reducing the risk of decay. Preventive treatments like pit and fissure sealants, alternative remineralising agents to fluoride and potentially even chlorhexidine varnish may also be beneficial.[xiv]

Perhaps the most important aspect, however, is ensuring that patients are aware of the risks dental caries presents and how to protect their oral health, as well as that of their children. 

Boosting health literacy

Part of the problem contributing to oral health inequalities in the UK may be the health literacy of the nation. It has been estimated that 41% of working-age adults in the England don’t fully understand or make use of everyday health information. This number increases to 61% when the recommendations or advice also involve numeracy skills. Given that health literacy is directly linked to health outcomes and service use, it is crucial that public education be enhanced.[xv]
For dental professionals, this once again highlights the need to engage with patients and ensure that they really understand the importance of oral hygiene. It is necessary to communicate with patients in a way that allows them to effectively digest the information offered and apply it to their own lives. This is true when describing their current oral health status, including their risk of caries, as well as explaining potential treatments and therapies that could improve their situation.

Chairsyde is a state-of-the-art consultation platform that is designed for just this reason. It offers a library of animations that clearly and easily communicate a broad range of dental conditions and diseases, as well as the treatments associated with them. The videos cover the risks of disease progression, in addition to the benefits, limitations and potential risks of all recommended therapies, encouraging patient understanding for long-term health benefits and improving the quality of their consent. 

Reducing the caries burden

Dental caries can have a significant impact on patients’ lives and the wider healthcare system. Continuing to reduce the prevalence of dental decay in the UK is essential for better health in the future. Though general trends are looking positive, it’s time to tackle the inequalities to ensure that all areas of the nation are benefiting from improved oral health.

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[i] Oral Health Foundation. Oral health statistics in the UK. [Accessed December 2023]

[ii] Public Health England. National Dental Epidemiology Programme for England. Oral health survey of adults attending general dental practices 2028.

[iii] House of Commons. Oral health and dentistry in England. May 2021. [Accessed December 2023]

[iv] Office for Health Improvement & Disparities. Official Statistics. Hospital tooth extractions in 0 to 19 year olds 2022.,Main%20findings,0%20to%2019%20year%20olds. [Accessed December 2023]

[v] Statistica. Share of adults with active tooth decay in England in 2028, by region. [Accessed December]

[vi] Public Health England. National dental epidemiology programme for England: oral health survey of five-year-old children 2017. Revised May 2018.

[vii] Masood M, Mnatzaganian G, Baker SR. Inequalities in dental caries in children within the UK: Have there been changes over time? Community Dent Oral Epidemiol. 2019 Feb;47(1):71-77. doi: 10.1111/cdoe.12426. Epub 2018 Oct 9. PMID: 30298932.

[viii] Office for Health Improvement & Disparities. Water fluoridation. Health monitoring report for England 2022. Published 21 March 2022.

[ix] Bashash M, Thomas D, Hu H, Martinez-Mier EA, Sanchez BN, Basu N, Peterson KE, Ettinger AS, Wright R, Zhang Z, Liu Y, Schnaas L, Mercado-García A, Téllez-Rojo MM, Hernández-Avila M. Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6-12 Years of Age in Mexico. Environ Health Perspect. 2017 Sep 19;125(9):097017. doi: 10.1289/EHP655. PMID: 28937959; PMCID: PMC5915186.

[x] Green R, Lanphear B, Hornung R, Flora D, Martinez-Mier EA, Neufeld R, Ayotte P, Muckle G, Till C. Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada. JAMA Pediatr. 2019 Oct 1;173(10):940-948. doi: 10.1001/jamapediatrics.2019.1729. PMID: 31424532; PMCID: PMC6704756.

[xi] Peckham S, Awofeso N. Water fluoridation: a critical review of the physiological effects of ingested fluoride as a public health intervention. ScientificWorldJournal. 2014 Feb 26;2014:293019. doi: 10.1155/2014/293019. PMID: 24719570; PMCID: PMC3956646.

[xii] Nottinghamshire County Council. Newsroom Nottinghamshire County Council champions expansion of water fluoridation schemes. July 2023 [Accessed December 2023]

[xiii] BBC News. Public Health considers impact of putting fluoride in Manx water. June 2023. [Accessed December 2023]

[xiv] Department of Health & Social Care. Office for Health Improvement & Disparities. Guidance. Chapter 4: dental caries. Updated November 2021. [Accessed December 2023]

[xv] Public Health England. Local action on health inequalities. Improving health literacy to recue health inequalities. September 2015.

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