Oral health (health and wellbeing needs in South Tyneside)

Dental caries

• Dental caries (tooth decay) is the most common disease of the dental tissues and affects the majority of the population. It is caused by bacteria in the mouth utilising sugars in the diet as a source of food and producing acids as a by-product. The acids dissolve away the tooth substance leading to dental decay, abscess formation and eventually tooth loss.
• Every time sugar is consumed (in food and drink); bacteria in plaque in the mouth react with the sugar to produce acid. This creates holes in the teeth or 'tooth decay' (also known as 'dental caries').

Children

• Nationally, dental caries are the top cause of childhood hospital admission for five to nine-year-olds, with just under 26,000 admitted 2013 / 14 making 8.7 per cent of all admissions at an estimated cost of £14.5 million. In 2014 / 15 English hospital trusts spent £35 million on extraction of multiple teeth for under 18s).
• Whilst children's oral health has improved over the last 20 years, almost a third of five-year-olds and 12 per cent of three year olds in England have experienced tooth decay.

Periodontal disease

• Periodontal disease affects the structures which support the teeth; these are the tissues and ligaments which secure the teeth to the jaw bones. This disease is caused by a build-up of plaque around the teeth leading to the development of inflammation. In susceptible individuals the disease progresses by destroying the supporting structures of the teeth, the teeth become loose and if unchecked the disease results in tooth loss.

Trauma

• Teeth may be traumatised as a result of accidents and participation in contact sports. The upper incisor teeth are at greatest risk and experience most damage. The most recent data for England was published in March 2015 using a survey of 15 year olds which found the proportion of 15 year olds affected is very similar across the three countries (England, Wales, Northern Ireland), at around 4% of the population and there are no significant differences related to sex, free school meals, brushing or school attendance.

Mouth cancer

• Mouth cancer is the major fatal condition which affects the oral tissues. There is a high risk of developing mouth cancer in people who smoke and those who consume excessive amounts of alcohol.

Vulnerable groups

• Vulnerable groups in society are also more likely to suffer from poor oral health. NICE guidance 55 identifies a list of vulnerable groups who require specific support to improve their oral health. These include those who are:
  • From lower socio economic groups
  • Live in disadvantaged areas
  • Older and frail
  • Physical or mental disabilities
  • Who are, or who have been in care
  • Socially isolated
  • Have a poor diet
  • Smoke or misuse substances (including alcohol)
  • Some Black, Asian and minority ethnic groups

Lower socio economic groups

• Significant inequalities in oral health continue to exist with children in deprived communities having poorer oral health than those living in more affluent communities. For example across England there is huge variation ranging from 13 per cent to 53 per cent of five-year-olds having experience of tooth decay, these children have an average of three teeth affected. 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. School-age children from the poorest backgrounds are up to three times more likely to be admitted to hospital for tooth extraction.

Older people

• The WHO noted that 'the interrelationship between oral health and general health is particularly pronounced among older people. Poor oral health can increase the risks to general health and, with compromised chewing and eating abilities, affect nutritional intake.'
• Maintaining good oral health can be difficult for elderly people. Moreover, the increasing numbers of older people with more teeth needing restoration has meant increasingly complex work for dentists. People living in residential care face additional challenges: oral health tends to be worse among elderly people residing in care homes. They also face particular difficulties accessing dental treatment and education regarding oral hygiene.

Physical or mental disabilities

• There are no national and local data on the oral health needs of people with mental health problems. There is a need for dental commissioners to tie oral health into any local commissioning arrangements that are set to improve the physical health of these vulnerable people.

Looked after children

• Although there are some national data to describe the health needs of looked after children, their oral health needs are routinely monitored. There is a requirement that all looked after children should have a health and dental check and this requirement from Ofsted requires Local Authority Fostering Services and its health partners to work together to achieve this. There is evidence to suggest that the oral health of looked after children and those entering care is poor.

Socially isolated

• Socially excluded people are accommodated in prisons, young offenders' institutes, secure children's homes, police custody suites or courts. They often have chaotic lifestyles and low aspirations for health, making it difficult for them to navigate systems and access healthcare. South Tyneside's blue light community are an appropriate example of this group.

Severely obese

• Severely obese people are in a high risk category for tooth decay due to diets high in refined sugars. They often have co-morbidities such as diabetes that can affect their oral health. However, severely obese people are unlikely to be able to access routine dental care within conventional dental practices due to the lack of suitable facilities.

Risk Factors

Teeth brushing

• Not brushing teeth at least twice a day is a key risk factor for poor oral health. 68 % of adults in routine and manual occupations have the lowest levels of reported brushing twice a day or more, compared with 79% of adults in managerial and professional occupations.

Lifestyle risk factors

• The risk factors for many general health conditions are common to those that affect oral health, namely a poor diet, smoking and alcohol misuse.

Diet

• The Scientific Advisory Committee on Nutrition found that high levels of sugar consumption are associated with a greater risk of tooth decay.
• PHE estimate that school-aged children consume around three times more sugar than the recommended maximum amount. Adults consume around twice the recommended maximum amount.
• Furthermore, high sugar consumption is associated with deprivation. Findings from the National Diet and Nutrition Survey reveal higher sugar intakes in adults in the lowest income group compared with other income groups.

Tobacco

• Smoking has a negative impact upon oral health. Seven per cent of current smokers have excellent oral health, compared with 11% of those who have never smoked.

Alcohol

• Guidelines on alcohol consumption produced by the Chief Medical Officer warns that drinking any level of alcohol increases the risk of a range of cancers including mouth cancer.  This is supported by a new review from the Committee on Carcinogenicity (CoC) on alcohol and cancer risk.