Data released by Public Health England on 30 September 2014 has shown what many interested in health in the early years know already. Over 80,000 3-year-old children in England – about 12% – suffer from a completely preventable disease. Dental decay is painful, the treatments are unpleasant, and decayed, missing and filled teeth affect appearance. Oral disease can have very serious consequences: in Bristol alone 721 children aged 0-19 years (of whom 155 were under 5) were admitted hospital for extraction of decayed teeth in a one year period (2012/13).
Tooth decay is of importance for us in the School for Policy Studies because while rates have reduced dramatically since the 1970s, there remain important and significant inequalities. Closer examination of
data suggests geographical and social disparities in oral health. Children from more disadvantaged backgrounds are significantly more likely to have early tooth decay and to need teeth extracted under general anaesthetic. In Bristol, while the rate of child dental decay was on a par with the UK average in 2008, the DMFT (decayed, missing, filled, in teeth) index for children in South Bristol, an area of high deprivation, is currently twice the city average. Ashley and Lawrence Hill wards experience nearly three times as many dental fillings in under 5 years old, compared to neighbouring Bishopston and Redland wards.
The Public Health England (PHE) report points out that the most important cause of dental decay is sugar in diet, and the most important preventive action is fluoride (in toothpaste or water). The response from PHE focuses on the former, but it is important not to ignore the latter, and to understand the policy context for this. Despite clear evidence that very small amounts of fluoride in water supplies reduces dental decay, few water supplies are fluoridated in the UK. Water supplies are a shared resource, and public and legislative barriers mean addition of fluoride seldom happens. In the absence of this, use of fluoridated toothpaste and fluoride varnishes by dentists are the next line of defence.
One difficulty for local policy makers is that we don’t have good enough data on oral health in childhood. The new PHE Survey is important, but sampled just 211 3 year olds in Bristol. We need better local data to really understand what is happening to have a reliable estimate of the local rate, including how this varies between areas.
Our study, which is part of the BoNEE project, will improve our understanding of oral health inequalities among children in Bristol. We will do this by looking at dental hospital records of who is attending for dental extractions, by understanding better what happens when children do visit the dentist, and by gathering parents views and experiences of oral health services in Bristol.
Patricia is Head of the Centre for Research in Health and Social Care in the School for Policy Studies at the University of Bristol.