Oral Health in Salford

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Oral Health in Salford

• Colette Bridgman
• Consultant in Dental Public Health
• Community, Health and Social Care Scrutiny - 23rd
  May 2007

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Presentation will cover

• Oral Health
• National/Regional
• Local Picture
• Children and Adults
• Decay Prevalence
• Utilisation of Services
• Impact of Poor Oral Health

• Policy Context
• New Working Arrangements
• Choosing Better Oral Health - Exposure to
  Fluorides
• Evidence base
• Prevention Toolkit

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Oral Health Key Marker

• 1994 OH Strategy for England. Defined it as .
  enables individuals to eat, speak and socialise
  without active disease, discomfort or
  embarrassment contributes to well-being.

• Two main dental
• diseases/conditions
• Tooth decay
• Periodontal (Gum) disease

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Oral Health Interdependence

• Key determinants
• Deprivation
• Lifestyle
• Educational attainment

• Indices
• DMFT/dmft (decayed, missing, filled teeth)
• National child and adult surveys
• Local BASCD co-ordinated surveys

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National/Regional/Salford Trends
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5-year-old children's average tooth decay levels
(dmft) and the percentage affected by tooth decay
in 2005/06 - Provisional
(47) NORTH WEST
2.00
The percentage of children with one or more
(48) Trafford North
2.02
d
ecayed,
m
issing or
f
illed
t
eeth
2.03
(51) Halton
is shown in brackets
(49) Birkenhead Wallasey
2.04
2.11
(49) Ashton, Leigh Wigan
(50) St Helens
2.14
(49) Heywood Middleton
2.19
2.24
(55) Tameside Glossop
(53) Blackpool
2.27
(52) North Liverpool
2.29
2.35
(54) Preston
2.39
(51) Burnley, Pendle Rossendale
2.42
(53) Salford
2.49
(52) Bolton
(57) South Manchester
2.54
(53) Oldham
2.60
2.93
(54) Rochdale
2.93
(62) Central Manchester
3.02
(62) Knowsley
3.21
(63) Blackburn with Darwen
3.47
(65) North Manchester
0.00
0.25
0.50
0.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
Average dmft
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Adults with no teeth 1968-1998
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  Figure 3 Baseline projections of adults in
different dental health categories (source
Report of the Primary Care Dental Workforce
Review)
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DPB Data April 03 March 04
Table 1 Salford Data for the period April 2003
March 2004
 Source Dental Practice Board Activity Data  
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Summary of Key Oral Health Needs in Salford

• Prevalence of decay, pre-school children
• Percentage of 5 year olds with obvious decay
• Inequalities in oral health experience and uptake
  of services

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Accessing Service 2006-07

• 40 practices in Salford PCT DS
• 104,000 seen in primary dental care - of those
  76,000 Salford residents
• 11,000 Salford residents attended primary dental
  care out of area
• Cost 12.5 million
• PPI 07 report noted that those who do access
  services happy with their care

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Impact of Poor Oral Health

• Salford Weekly General Anaesthetic list
• On average 8 children listed - some under 3
• On average 6 teeth extracted - can be up to 12
• Children have to travel to MDH and nil by mouth
  for 6 hours

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Quote from local dentist .

• Despite our best efforts to provide the patient
  with a comfortable journey, GA is always
  traumatic.
•  Little children tend to tolerate it better
  than older ones who may become so agitated that
  they cannot be seen in the out-patient setting
  and have to be referred into hospital so that
  they can be sedated prior to the procedure. (LS
  May 2007)

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Questions used in Childrens Dental Health in the
UK 2003

• In the last 12 months ..
• Some sort of impact was reported by parents
  across age groups (22 to 34)
• Impact on Emotions
• Has anything to do with your childrens teeth,
  gums or mouth affected your childs emotions such
  as making them less cheerful or more irritable?
  Found to be 4 to 10

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Policy Context

• New working arrangements
• Choosing Better Oral Health

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Reform of NHS Dentistry Local commissioning,
national framework
PCTs responsible for commissioning primary care
dental services within national framework of
3-year investment guarantee
New system of patient charges
NICE guidelines (recall intervals)
Contract regulations (GDS PDS)

Oral health plan, including fluoridation
Devolution of budgets to PCTs, based on historic
GDS spend 250m net investment
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DMFT/dmft per child in England 1973-2003
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Evidence-Based Interventions (1)

• Dental caries lower in fluoridated areas.
• Topical fluorides (mouth rinses, gels, or
  varnishes) used in addition to supervised
  fluoride toothpaste achieve caries reduction.
• Evidence that fluoride gels reduce caries.
• Benefits of fluoride toothpaste firmly
  established.

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Evidence-Based Interventions (2)

• Fluoride varnish reduces caries in permanent and
  deciduous dentition.
• Benefits of topical fluorides have been
  established from RCTs.
• Caries reduction with fluoride milk programmes
  not established.

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1 Guidance for third molars http//www.nice.org
.uk/page.aspx?o38040
2 Guidance for recall intervals
http//www.nice.org.uk/page.aspx?o225866  
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Commissioning Approach

• Need to work upstream for long term benefits
• Acknowledge and serve the disease burden already
  in Adults
• Focus prevention on Children using evidence
  informed interventions
• Commission actions, programmes and services
  necessary to improve and secure oral health

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Declaration for Child Oral Health
 
Poor oral health has a significant impact on the
quality of life, causing pain and embarrassment,
limiting function and being costly to treat.
Among children, decay the most important oral
disease. More than half of Salford children are
affected by dental decay by the time they reach
school, disease levels being highest in the
under-privileged groups and disease levels appear
to be rising.   Dental disease is well
understood, effective prevention is a realistic
goal and would contribute to wider public health
and social inclusion, work and aspirations. To
this end the following partners have joined
forces to call for concerted pan-Salford action
between now and 2010 to address the pressing
problem of poor child oral health. This could
make a difference to the percentage of children
reaching school in 2010 decay free and as a
direct consequence improve their health and well
being in future years.                      Figure
shows dmft trends (with confidence intervals) in
the number of decayed missing or filled teeth in
five year olds in Salford, North West and England
from 1991/2 to 2003/4 .   Good oral health is a
fundamental element of good general health.
Through established networks we will share
information on evidenced based prevention. We
will work to implement appropriate and effective
initiatives to improve oral health and to reduce
oral health inequalities both within and between
the localities of Salford.
 
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Patient Centred Approach

• Alternative models of service provision being
  explored workshop yesterday
• Greater emphasis on patient needs
• Increased use of skill mix evidence based
  preventive interventions
• Oral Health Improvement Team integral part of
  Public Health Department

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Thank you for listening