The programme studied the prevalence and severity of dental decay among 110,000 five year olds last year. Of those surveyed, less than 25 per cent of the cohort suffers from tooth decay.
This continues the downward trend seen since 2008, when the PHE first asked parents to opt in to the oral health survey of five year olds. In 2008, 31 per cent of five year olds suffered tooth decay and, in 2012, it was 27 per cent.
Sandra White, director of dental public health at Public Health England, said:
“This is great news. However, one child with tooth decay is one too many and there is still much inequality in dental health around the country. Tooth decay is painful and too often results in teeth extraction, some under general anaesthetic.
According to the survey an estimated 166,467 five year olds suffer from tooth decay, compared with 177,423 in 2008.
While there has been a significant decline in tooth decay at a national level, there is still a great deal of regional variation. In the North West, a third (33.4 per cent) of five year olds suffer from tooth decay, whereas only a fifth (20.1 per cent) do in the in the South East. As with the two previous surveys, areas with higher levels of deprivation tend to have higher levels of tooth decay.
The proportion of five year olds who have had teeth removed due to decay was 2.5 per cent, compared to 3.5 per cent in 2008 – about 2,000 fewer children. There is regional variation here too with results showing that only 1.9 per cent of five year olds in the East Midlands have had tooth extractions due to decay, compared with 3.9 per cent of children in Yorkshire and the Humber.
The survey also shows the average number of teeth affected by decay per child was 0.8, down from 1.1 in 2008. For the first time, data has also been collected across the survey on ethnicity and dental health.
The last three surveys have indicated that the dental health of five year olds is improving. There has been a nine per cent increase in the proportion of children with no obvious decay since 2008. Further analysis is needed to understand the factors that have contributed to this welcome trend. This will help local authorities identify the steps they can take to extend the improvement in decay levels to all sectors of their populations.
Commentators on the news have echoed Sandra White’s words, generally welcoming the decline in reported cases of decay but feeling that whilst this is encouraging there is a great deal still to be done.
The Faculty of General Dental Practice (UK) in particular warned against complacence by government.
Mick Horton, dean of FGDP(UK), said: “The further increase in the proportion of young children free of tooth decay is great news, but the fact remains that a quarter of five year olds have an almost entirely preventable disease – and a quarter of these are not even receiving treatment.
“We all know the end result – tens of thousands of children in hospital having their teeth extracted, often under general anaesthetic. It’s distressing for them and their families, and it costs the NHS a fortune.
“We need to better educate parents and children in how to improve their diet and look after their teeth. There are so many places we could be doing this – through GP surgeries, nurseries and schools to name but a few – but these opportunities are routinely missed.
“To avoid decades more of filling and extracting young children’s teeth, the Government must forge a joined up approach focussed on prevention of tooth decay as well as treating disease.”
The British Dental Association (BDA) also commented on the survey results, calling them only a “modest” improvement. Its interpretation of the data is that one in four children in England are still living with tooth decay and though the results are promising this is still not acceptable.
In comparison with Wales and Scotland, the BDA pointed out that England’s policymakers do not seem to have had the same appetite for innovation. Wales recently reported the largest improvement on record in dental decay among five year olds, with a Cardiff University study showing rates fell by 12 percentage points since 2007, from 47.6 per cent to 35.4 per cent. Scotland has seen decay rates among young children fall from 42 per cent to 32 per cent in the same period.
Wales operates ‘Designed to Smile’, a preventative programme targeting young children in areas of high deprivation. ‘Childsmile’, a similar pioneering effort from the Scottish government has reportedly cut £5m off treatment costs. There is no equivalent national scheme in England.
Henrik Overgaard-Nielsen, chair of the BDA's General Dental Practice Committee said:
“We are seeing modest improvements in oral health, not the breakthrough our children deserve. We are paying the price for decades of government indifference, which has left persistent oral health inequalities and an ever growing number of kids facing extractions in hospital.
“It is a scandal that one in four young children are now living with decay. Sadly, Westminster has been unwilling to embrace innovation or break with the failed government targets that have held back a genuinely preventive approach to oral health.
“It is now imperative that ministers provide a strategy and a contract that can put prevention first.”
In addition to feelings that the data is positive but not game changing, a number of commentators have expressed unease specifically at the amount of regional variation indicated by the data.
Izzi Seccombe, community wellbeing spokesperson for the Local Government Association, said that she felt “it is deeply concerning that a quarter of children starting school have rotting teeth, whereas in some parts of the country, this is nearly a third”.
Dental treatment provider, mydentist, stated that the data released by PHE correlates with the results of its own recent survey of three and five year olds, however, Steve Williams, clinical services director at mydentist, voiced concerns that “the wider figures seem to mask what is happening on a regional basis.”
Claire Stevens, media spokesperson for the British Society of Paediatric Dentistry, summed up the implications of the data and the BSPD’s hopes for the future. She said:
“BSPD believes there is a need for a national programme of prevention and the involvement of health visitors, midwives and nurseries in getting across important oral health messages – such as all children having a dental check by the age of one.
“The regional differences need to be tackled too. How unfair that if you are born and brought up in the North West you have a much higher chance of experiencing dental decay than in the South East. In Manchester, where I work, 66.6 per cent of children in the survey had no visually obvious decay experience compared with 79.9 per cent in the South East.”
Claire said that since the last survey, there had been an improved focus on prevention resulting in a seven fold increase in fluoride prescriptions by dentists between 2007 and 2014. She also believed that the Department of Health’s guidance on fluoride toothpaste might have made a difference – today’s children are more likely to use toothpaste with the recommended proportion of fluoride instead of the low fluoride products which are thankfully being phased out.
The National Epidemiology Programme provides valuable information, said Claire, and it’s important that surveys of this kind continue to be undertaken. Local authorities are now responsible for dental health and it’s vital that they can assess local need and commission appropriate programmes of prevention.