IMPROVING DENTAL CARE AND ORAL HEALTH A CALL TO ACTION EVIDENCE RESOURCE PACK

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1 IMPROVING DENTAL CARE AND ORAL HEALTH A CALL TO ACTION EVIDENCE RESOURCE PACK NHS England Dental Analytical Team February 2013/14 Gateway reference: 01173

2 Introduction to this pack This data pack has been produced to support the call to action to stimulate debate in local communities amongst dentists, dental care professionals, patients and public, dental commissioners, health and wellbeing boards and other stakeholders as to how best to develop NHS dental services. We have included a number of graphs and information on oral health in England, demand and access to NHS Dental services and patient experience. We would welcome suggestions on how to build and improve the pack. 2

3 Summary headlines Oral health has been improving for both adults and children There are regional and socio-demographic differences in oral health across England The majority of dental treatment occurs in the primary care setting, of which; The number of patients seeing NHS dentists has increased steadily since 2008 Patient experience of NHS dentistry has improved in recent years For secondary care dentistry, the main outpatient attendance are for oral surgery and for inpatient its treatment of dental caries (tooth decay) 3

4 4 NHS NHS England Improving Dentistry [February 2013/14] Oral Health

5 Adult oral health has been improving over time Between 1998 and 2009 the percentage of adults with teeth in England who have reported experiencing one or more problems on the Oral Health Impact Profile scale (OHIP-14), fell by 12 percentage points; 51% in 1998 to 39% in * 2009 figures exclude Scotland Data source/s: Adult Dental Health Survey

6 The prevalence of periodontal (gum) disease 1 increases with age and is more likely for those who did not visit the dentist regularly In % of adults with teeth had no evidence of periodontal (gum) disease 1 (see slide 20 for full definition). Good periodontal health was much more prevalent amongst adults under 45 years than in older age groups. It can also be seen that regular attendance is associated with good periodontal health 6 Data source/s: Adult Dental Health Survey 2009 * Excluding Scotland

7 Time series and future projection of adult dental health: Less healthy teeth Healthier teeth Healthier is defined as those having 18 or more sound, untreated teeth. Less healthy is defined as those with less than 18 sound, untreated teeth. 7 Data source/s: Adult Dental Health Survey, 1998 & 2009

8 Children s dental health has also been improving over time Results of caries surveys of five-year-olds in England from the Children s Dental Health Surveys and NHS Dental Epidemiology surveys*, 1973 to 2012 *For the 2007/08 and 2011/12 surveys positive consent was needed for children to be included and therefore these years are not directly comparable to the previous surveys. d 3 mft, seen on this graph, is a standardised way of measuring dental health, which involves visual-only examination for missing teeth (mt), filled teeth (ft) and teeth with obvious dentinal decay (d 3 t). 8 NHS NHS England Improving Dentistry [February 2013/14 Data source/s: Children's Dental Health Survey and National Epidemiology Dental 5-year old dmft Survey

9 International comparisons of dental health for 12 year-old children Average number of decayed, missing or filled teeth, 12 year-old children, 2006 (or latest year available) Decline in average number of decayed, missing or filled teeth, 12 year-old children, Germany ( ) United Kingdom ( ) Denmark (2006) Luxembourg ( ) Netherlands ( ) Sw itzerland ( ) Sw eden ( ) Australia ( ) Belgium ( ) Ireland ( ) Finland ( ) France (2006) Italy ( ) Spain (2005) United States ( ) Austria ( ) Portugal ( ) OECD New Zealand ( ) Norw ay ( ) Japan ( ) Turkey (2007) Greece (2005) Iceland ( ) Korea (2006) Slovak Republic (2006) Czech Republic (2006) Hungary ( ) Poland ( ) 9 Data source/s: Health at a Glance 2009: OECD Indicators

10 Regional and deprivation variations in children's dental health a survey of 5 year-old children Percentage of 5 year-old children with decay experience including 95% confidence limits, by Government Office Regions, 2012 Correlation between the rate of decay among 5 year-old children and deprivation score. Lower tier local authorities in England 2012 There is regional variation in the prevalence of tooth decay in the 5 year olds surveyed. For those 5 year olds with decay, the extent of the decay correlates with deprivation. The more deprived the area the higher the rate of decay found in the 5 year olds surveyed. 10 Data source/s: Public Health England National Dental Epidemiology 5-year old dmft Survey

11 11 NHS NHS England Improving Dentistry [February 2013/14] Dental Services

12 Primary Care Dentistry: About 85% of NHS dental spend occurs in Primary Care and can be broken down into two main types: General Dental Practices known as High Street Dentists, where the majority of the patients are seen. In 2012/13 there were 39.3 million NHS dental Courses of Treatment carried out in this setting. Community Dental Services- Patients whose social, medical and dental needs mean that they cannot be efficiently and effectively managed in General Dental Practices are seen by these services. For example, they look after elderly and housebound people and people with severe physical disabilities or mental illness. 12

13 13 NHS NHS England Improving Dentistry [February 2013/14] Primary Care Dentistry Access

14 The number of patients accessing primary care NHS dentistry has increased steadily since 2008, to 29.9 million patients in December 2013 Access is measured by the number of patients who have had visited an NHS dentist in the preceding two years. This time period was chosen as NICE (National Institute of Clinical Excellence) guidelines recommended the public should visit the dentists at least once every two years. 14 Data source/s: Health and Social Care Information Centre NHS Dental Activity Statistics: March December 2013

15 Regional variation in access to NHS dentistry By Region, a higher proportion of the population see an NHS dentist in the North (for both children and adults), with the lowest levels found in London. In England, 94.8% of adults who tried to get an NHS dental appointment in the last two years were successful. There was little variation across regions, with all regions having a success rate above 92%. 15 Data source/s: Health and Social Care Information Centre NHS Dental Activity Statistics: December 2013 and GP Patient Survey Dental Results 2013/14

16 Overall picture of primary care dental attendance in England 16 Data source/s: GP Patient Survey Dental Results 2013/14

17 17 NHS NHS England Improving Dentistry [February 2013/14] Primary Care Dentistry Patient Experience

18 Trend of patient satisfaction with NHS dental services had been on the decline until 2009 and has since been increasing The British Attitudes Survey has asked about NHS dental satisfaction on/off since The most recent figure gives NHS dental satisfaction at 56% (based on their own experience or what they have heard). More recently, the GP Patient Survey has asked adults who have tried to get an NHS dental appointment in the last two years about their experience of NHS dental services and 83.8% rated it as positive. 18 Data source/s: British Social Attitudes Surveys: and GP Patient Survey Dental Results 2013/14

19 19 NHS NHS England Improving Dentistry [February 2013/14] Dentistry in Secondary Care

20 Dentistry in Secondary Care: The following slides highlight some aspects of dentistry in secondary care. To be aware: A range of dental specialist procedures may be carried out in both primary and secondary care settings. When in the hospital setting the bulk of work other than oral and maxillofacial surgery is delivered as either out-patient or in-patient day-cases. There are data issues particularly with outpatient and A&E data, which make it difficult to fully explore dentistry in secondary care. For example, not all fields are mandatory and therefore not fully completed. Such as the field outpatient primary diagnosis, in it was only coded for 4.1% of attendances. This limits the dental comparisons we can make across the areas of secondary care. 20

21 Dentistry across the areas of secondary care: Outpatient 3 : 2.7 million outpatient appointments in 2012/13 came under a dental specialty 6, 3.5% of all outpatient appointments. Of these, 1.4 million appointments were under Oral Surgery and Oral & Maxillo Facial Surgery (1.9% of all outpatient appointments) Inpatient 4 : There were 320,000 inpatient Finished Consultant Episodes (FCEs) 7 under a dental specialty in , 1.8% of all FCEs. In , 230,000 inpatient Finished Consultant Episodes (FCEs) had a primary diagnosis code 8 relating to dental/oral health conditions. This accounts for 1.3% of all inpatient FCEs. Accident & Emergency (A&E) 5 : There were 14.5 thousand A&E attendances in whose first treatment was classed as dental, less than 0.1% of all A&E attendances. 21 See slide 25 & 26 for a definition of secondary care terms

22 For outpatients, oral surgery is the main dental specialty Outpatient Attendances by Dental Speciality in England, This graph shows oral surgery is the most common dental specialty in outpatient secondary care, accounting for 39% of dental specialty attendances. This is followed by orthodontics, which accounts for 28% of dental specialty attendances. Oral & Maxillo Facial Surgery consultants differ from the other dental specialities, in that they are required to have both a dental and medical training. 22 NHS NHS England Improving Dentistry [February 2013/14]

23 For inpatients, caries (tooth decay) is the main diagnosis for dental procedures taking place There were 209,874 finished admission episodes (FAEs) 10 for which the primary operative procedure was dental in Just under half of these FAEs were for caries (tooth decay). A number of these inpatient caries treatments in secondary care, are when there is a necessity for general anaesthetic 23 Data source/s: Health and Social Care Information Centre Hospital Episode Statistics, Dentistry Topic of Interest Report 2 See slide 20 for full definition of dental secondary care

24 Hospital inpatient admissions for dental caries (tooth decay) are higher for those from more deprived areas The number of 'dental caries FAEs as a primary diagnosis increases along with increasing socio- economic deprivation. Amongst the least deprived 10% of the population 31.9% of FAEs for dental procedures were due to 'caries', whereas amongst the most deprived 10% of the population 61.2% of FAEs for dental procedures were due to 'caries'. 24 Data source/s: Health and Social Care Information Centre Hospital Episode Statistics, Dentistry Topic of Interest Report See slide 25 & 26 for a definition of secondary terms

25 Footnote page 1: Slide 6 - Periodontal disease: Footnote 1: The definition of the periodontal categories: Periodontally healthy is defined as no bleeding, no calculus, no periodontal pocketing of 4mm or more, and in the case of adults aged 55 or over, no loss of periodontal attachment of 4mm or more anywhere in their mouth. Some periodontal disease present is defined as pocketing and loss of attachment of 4mm or more, around at least one tooth Footnote 2: For the 85 and over some periodontal disease present category, as the sample size was so small these estimates are unreliable and analysis using these figures may be invalid. Slide 21 to 24 - Secondary Care, definition of terms: Footnote 3 - Outpatient: An attendance at which a patient is seen and the patient does not use a hospital bed for recovery purposes. (If a bed or trolley is used for a specific short procedure rather than because of the patient's condition this does not count as a bed. Footnote 4 - Inpatient: Inpatients are patients who are admitted to hospital & occupy a bed, including both admissions where an overnight stay is planned and day cases. Footnote 5 - Accident and Emergency (A&E): Records in the A&E HES database are called attendances, and each A&E attendance relates to a single visit by an individual to A&E. Footnote 6: Dental Specialty: Main specialty reflects the specialty of the consultant or health professional with prime responsibility for the patient. The following main specialty codes were used to distinguish dental specialties: Oral Surgery; Restorative Dentistry; Paediatric Dentistry; 143 Orthodontics; 145 Oral & Maxillo Facial Surgery; 147 Periodontics; Prosthodontics; Surgical Dentistry Footnote 7 - Finished Consultant Episodes (FCE): An inpatient or day case episode where the patient has completed a period of care under a consultant and is either transferred to another consultant or discharged. Continued on next slide. 25

26 Footnotes 2: Slide 21 to 24 - Secondary Care, definition of terms, continued: Footnote 8 - Primary Diagnosis Codes included: The primary diagnosis is the main reason the patient is receiving care in hospital. The following primary diagnosis codes have been used to identify the dental type diagnoses: K00 - Disorders of tooth development and eruption; K01 - Embedded and impacted teeth; K02 -Dental caries; K03 - Other diseases of hard tissues of teeth; K04 - Diseases of pulp and periapical tissues; K05 - Gingivitis and periodontal diseases; K06 - Other disorders of gingiva and edentulous alveolar ridge; K07 Dento-facial anomalies [including malocclusion]; K08 - Other disorders of teeth and supporting structures; K09 - Cysts of oral region, not elsewhere classified. Footnote 9 - Main Procedure: The following procedure codes have been used to identify the dental procedures: F08 - Implantation of tooth; F09-Surgical removal of tooth; F10-Simple extraction of tooth; F11-Preprosthetic oral surgery; F12-Surgery on apex of tooth; F13-Restoration of tooth; F14-Orthodontic operations; F15-Other orthodontic operations; F16-Other operations on tooth; F17-Operations on teeth using dental crown or bridge; F63-Insertion of dental prosthesis. Footnote 10 - Finished Admission Episodes (FAE): The first period of inpatient care under one consultant within one healthcare provider. FAEs are counted against the year in which the admission episode finishes. Admissions do not represent the number of inpatients, as a person may have more than one admission within the year. 26 NHS NHS England Improving Dentistry [February 2013/14]

27 Sources used for this data pack: Adult Dental Health Survey 2009 (slides 5, 6 & 7): Public Health England. National Dental Epidemiology Programme for England : oral health survey of five-year-old children 2012 (slides 8 & 10): OECD International Comparison (slide 9): en GP Patient Survey Dental Results (slides 15, 16 & 18 ): Health and Social Care Information Centre (slides 12, 14,15 & 21-24): Number of patient seen by NHS dentist figures: Inpatient Special Report: Outpatient figures: A&E figures: British Attitudes Survey (slide 18): 27

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