Oral Health

• Tooth decay can cause problems with eating, sleeping, communication and socialising, and results in at least 60,000 days being missed from school during the year for hospital extractions alone.
• Children with poor oral health are likely to have time off school and their parents and carers are likely to have time off work to take them for treatment. Research found 1 in 4 had missed school because of dental pain and infection
• Amongst adults – time off work due to pain or for treatment.
• Tooth decay is still the most common reason for hospital admissions in the 6 to 10 year old age group

• Good oral health is essential for general health and wellbeing – poor oral health has been associated with poor diabetic control, lung disease (mainly pneumonia) among the frail and elderly, and cardiovascular diseases.
• The ‘Oral health survey of adults attending general dental practices 2018’ showed:
• More than a quarter of participants (27%) had tooth decay, having on average 2.1 decayed teeth, and more than half (53%) had gingival (gum) bleeding.
• 18% reported currently being in pain and the same number had experienced one or more impacts of poor oral health ‘fairly’ or ‘very often’ in the previous year.
• Periodontitis or deep gum disease, the second most widespread oral disease after cavities, affects more than 47% of adults over the age of 30. By the age of 65 and older, 64% have either moderate or severe periodontitis
• Poorer oral health disproportionately affected those at the older end of the age spectrum and those from more deprived areas.
• Tooth loss, in particular, has been found to be associated with low intakes of fruits and vegetables, vitamin C, vitamin E, as well as higher consumption of processed foods and fatty acids in adults (> 18 years) – Studies have found that poor diet quality and increased intake of saturated fat were associated with the progression of periodontal disease (chronic gum disease) and tooth loss in older adults
• It is possible that the association between oral health and fat intake may be due to higher consumption of processed meat which is a source of saturated fat which is easy to chew and requires little preparation
• Tooth loss also associated with poor diet quality and low protein intake in older people
• Evidence suggests tooth loss independently associated with cognitive impairment and dementia;
• risk of diminished cognitive function increased incrementally with numbers of teeth lost.

• Tooth decay can cause problems with eating, sleeping, communication and socialising, and results in at least 60,000 days being missed from school during the year for hospital extractions alone.
• Children with poor oral health are likely to have time off school and their parents and carers are likely to have time off work to take them for treatment. Research found 1 in 4 had missed school because of dental pain and infection
• Amongst adults – time off work due to pain or for treatment.
• Tooth decay is still the most common reason for hospital admissions in the 6 to 10 year old age group

Deprivation

• Participants living in the most deprived areas of the country were more likely (13.5%) to report not being able to afford to pay the charge than participants living in the least deprived areas (3.4%)
• Research by the Oral Health Foundation showed more than one-in-three (36%) UK adults admit that they are sacrificing dental visits in order to keep their bank balance in check.
• Just under two-in-three (59%) 18-24-year-olds freely admit to their financial inability to look after their mouth, teeth and gums.

• Band 2 treatments – Participants living in the most deprived areas of the country were more likely (13.5%) to report not being able to afford to pay the charge than participants living in the least deprived areas (3.4%) – This rises significantly for Band 3 treatment

A survey of secondary teachers by grassroots hygiene poverty charity Beauty Banks in partnership with the British Dental Association (BDA) showed the following results:

• 83% say they or their school have given students toothbrushes and toothpaste.
• 81% said there are children in their school who don’t have regular access to toothpaste.
• 40% said this leads to students being socially excluded by their peers because of oral hygiene issues. Half report children isolating themselves. One third have witnessed bullying directly.
• 25% say children miss school because of poor oral hygiene.
• 74% said children who don’t have regular access to oral health products have discoloured teeth. Half said children had noticeable tooth decay.
• 30% noted children in dental pain or suffering from halitosis.
• 31% of teachers who witness poverty in the classroom report said it effected their mental health. 1 in 4 are kept awake at night worrying about their students’ wellbeing.
• 38% report feeling helpless.

Learning Disability

• compared to the general population, people with learning disabilities have:
• higher levels of gum (periodontal) disease
• greater gingival inflammation
• higher numbers of missing teeth
• increased rates of edentulism (toothlessness)
• higher plaque levels
• greater unmet oral health needs
• higher levels of untreated tooth decay
• poorer access to dental services and less preventative dentistry

Ethnicity

• a high level of caries experienced among preschool and school children from Pakistani, Bangladeshi, Chinese and East European backgrounds, even after controlling for levels of socioeconomic deprivation
• Afro-Caribbean children generally had better or similar oral health than White children

 

Homeless

• 90% had an issue with their mouth health since becoming homeless
• 30% of homeless people currently experiencing dental pain.
• 7 in 10 reported lost teeth since becoming homeless. 15% of homeless people have pulled out their own teeth.
• Alcohol and drugs commonly used in an attempt to manage oral health issues. 27% of participants have used alcohol to help them deal with dental pain and 28% have used drugs.

The All Party Parliamentary Group on A Fit and Healthy Childhood reported in 2018 on The Impact of Social and Economic Inequalities on Children’s Health and made a number of recommendations on children’s oral health including:

• Embedding dental health in all children’s services at strategic and operational levels in order to reduce the social and economic inequalities that are a determining factor in the oral health of children
• Commissioners, healthcare practitioners, specialist societies, the voluntary sector, consultants in dental public health and the Royal Colleges should be engaged in creative partnership.

In the same year, Groundswell’s Healthy Mouths report on oral healthcare for people who are homeless recommended that Health and Homelessness Commissioners consider a range of actions including:

1. Enhanced contracts and additional funding. 5. Access to hygienists.
2. Funded dental appointment slots for homeless people. 6. Independent Peer Advocacy support.
3. Homelessness exemption on FP17 form. 7. Promoting services.
4. Mobile dental services. 8. Peer research, consultation and co-design.

DIY dentistry is nothing new. In 2006 the British Dental Journal published a letter describing how a 40 year old middle class man had visited an access centre with dental pain. He had last visited a dentist 4-5 years earlier, when his dentist had discontinued their NHS service and he had been unable to register with another or afford private care. The patient had tooth pain, knowing exactly which one was affected, as he had repaired two of his own teeth in the last three years.

‘On questioning he revealed that to debride the cavity he used a holiday-dental-kit comprising of plastic mirror, forceps and probe combined with an electric toothbrush with a small round head. For convenience, the patient had trimmed the bristles to fit into the cavity. He had used tactile senses for plugging the filling material into the prepared cavity, using material called Quick Steel bought from a DIY motorcar parts retailer.’ 

During the Covid-19 pandemic, many more people turned to DIY dentistry. In September 2020 a poll reported by the Association of Dental Groups found that 25% of households across the UK had attempted at least one form of DIY dentistry. Within the 25% figure, the polling suggested that:

1.Someone has taken painkillers for tooth or gum pain in 12.7% of households / 3.5m homes

2.Someone has attempted to treat a cavity in a tooth 7.9% of households / 2.2m homes

3.Someone has attempted to extract a tooth in 7.6% of households / 2.1m homes

Child oral health: applying All Our Health – GOV.UK (www.gov.uk)

Oral health survey of adults attending general dental practices 2018 (publishing.service.gov.uk)

Oral health and dentistry in England (parliament.uk)

National Dental Epidemiology Programme for England: oral health survey of five-year-old children 2015 A report on the prevalence and severity of dental decay (publishing.service.gov.uk)

Oral Health Foundation (dentalhealth.org)

Comorbidity of periodontal disease: two sides of the same coin? An introduction for the clinician – PMC (nih.gov)

Poor oral health and the association with diet quality and intake in older people in two studies in the UK and USA – PMC (nih.gov)

Comorbidity of periodontal disease: two sides of the same coin? An introduction for the clinician – PMC (nih.gov)

The silent danger of deep gum disease – BBC Future

Dose-Response Meta-Analysis on Tooth Loss With the Risk of Cognitive Impairment and Dementia – ScienceDirect

Learning Disability Profiles – OHID (phe.org.uk)   Public health profiles – OHID (phe.org.uk)

Socioeconomic and ethnic inequalities in oral health among children and adolescents living in England, Wales and Northern Ireland – Rouxel – 2018 – Community Dentistry and Oral Epidemiology – Wiley Online Library

Healthy Mouths | Groundswell

THE TOOTH HURTS – FEB 2023 (dentistry.co.uk)

Suffolk User Forum – Keeping your teeth in mind – A guide for people experiencing psychosis and those who care for them