2 November 2017

There is a divide in good dental health between northern and southern England as well as rich and poor, according to a new report published by the Nuffield Trust and the Health Foundation. While significant improvements have been made in improving people’s dental health over time, this progress risks stalling if appropriate action isn’t taken to tackle persistent inequalities, the report warns.

The report, Root causes: quality and inequality in dental health, published as part of the Nuffield Trust and the Health Foundation’s QualityWatch programme, analyses routine and publicly available data on dental health outcomes and activity.[1] It reveals that, across several different data sources, dental health is generally better in the south and east of England and poorer in the north of England.[2]

As well as there being a regional divide, the report highlights a consistent gap between the dental health of rich and poor, with deprived groups more likely require hospital treatment and parents of children recieving free school meals finding it harder to access a dentist.

Key findings from the report include:

- Overall, dental health has been improving over time: the proportion of adults with no natural teeth has reached an all-time low; the proportion of young children with tooth decay has been steadily falling; and satisfaction with dentistry remains high. But there is significant variation within this.

- Children in the Blackburn with Darwen local authority area were four times more likely to have missing, decayed or filled teeth than children in South Gloucestershire in 2015: just 44% of children in Blackburn were free from decay compared with 86% in South Gloucestershire.

- In Yorkshire, hospitalisation for tooth extractions in the under 10s was five times higher than the East of England in 2015/16 (845 per 100,000 population compared with 160 per 100,000).

- 83% of five-year-olds in the least deprived areas of the country had healthy teeth, compared to 70% in the most deprived areas in 2014/15.

- People from the most deprived backgrounds were twice as likely (14%) to be hospitalised for dental work than those that were better off (7%) in 2015.

- 18% of parents with children on free school meals found it difficult to find an NHS dentist in 2013, compared with 11% of parents whose children were not.

The report details the rise in dental charges over time, with charges rising in real terms over the seven years to 2017 at around 1% per year and increases over the last two years likely to amount to over 6% in real terms. Meanwhile, the amount of money spent on NHS dentistry is 15% lower than in 2010/11. A fifth of adults were put off from seeing a dentist by the cost of NHS dental charges in 2009.

The report’s authors argue that dentists and their teams are perfectly placed to deliver prevention and promotion advice and interventions to patients, including advice on smoking cessation, healthy eating or responsible alcohol use. But dentistry seems to be absent from many of the initiatives under way across the NHS to prevent poor overall health, something the authors suggest is a missed opportunity to tackle the persistent inequalities identified.

Report author and Nuffield Trust Director of Research, Professor John Appleby said:

“As a nation our dental health is improving, but it is shocking that your income or where you live can still determine your dental health, how likely you are to be hospitalised with dental problems and how easily you can access the dental treatment you need.

“We know that poor oral health is linked to other health problems, like obesity, alcohol consumption and smoking. So it makes sense to involve dentists more in plans across the NHS to address these problems. But unless more efforts are made to tackle the inequalities we identify and embed prevention of ill health across dentistry, the progress made over the past few decades in improving the nation’s oral health could stall.”

The report outlines four areas that policymakers should focus in order to reduce the inequalities identified. These are: focusing on the wider determinants of poor dental health; using the new dental contract currently under review to embed a more preventative approach; improving access to dentists among the most deprived; and supporting research to better understand the impact of dental health interventions.

Notes to editors

1. This report draws on a wide range of published data relating to dental health outcomes, activity, education and patient experience and satisfaction. The published data the report authors looked at includes the decennial Adult Dental Health Survey (ADHS) and Children’s Dental Health Survey (CDHS), the dental results from the GP Patient Survey, the oral health surveys by Public Health England and NHS Digital’s dental statistics.

2. Across the datasets offering a regional breakdown (Adult Dental Health Survey, Public Health England’s oral health survey of five-year olds, NHS Outcomes framework), outcomes tend to be better in southern and eastern regions. An exception to this is London, which appears to experience worse than average outcomes where children’s dental health is concerned.

3. The full QualityWatch briefing, Root causes: quality and inequality in dental health by John Appleby, Robert Reed and Leonora Merry is available to download from this website.

4. QualityWatch is a joint programme by the Nuffield Trust and Health Foundation providing independent scrutiny of health and social care quality data. The programme monitors over 300 care quality indicators, which are published on the QualityWatch website. It also publishes research reports, news and blogs about care quality and data. 

5. The Nuffield Trust is an independent health policy think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate. 

6. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. Our aim is a healthier population, supported by high quality health care. 

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