Reports and abstracts of articles originally published in Community Dental Health
Published in: Community Dental Health volume 19 March 2002BASCD Survey report
The dental caries experience of 12-year-old children in England and Wales. Surveys coordinated by the British Association for the Study of Community Dentistry in 2000 / 2001
N.B. Pitts(1), D.J. Evans(2), Z.J. Nugent(3) and C.M. Pine(4)
(1) BASCD Dental Epidemiology Programme Scientific Coordinator, Dental Health
Services Research Unit, University of Dundee, Dundee, UK;
(2) BASCD Dental Epidemiology Programme Service Coordinator, Newcastle and North
Tyneside Health Authority, Newcastle-upon-Tyne, UK;
(3) Statistician/IT Manager, Dental Health Services Research Unit, University
of Dundee, Dundee, UK
(4) BASCD Research and Development Coordinator, Liverpool University Dental
Hospital and School, Liverpool, UK.
Correspondence to:
Professor N B Pitts,
Dental Health Services Research Unit,
Dental School,
Park Place, Dundee,
Scotland, DD1 4HR.
Key Words: dental caries, dental epidemiology, caries prevalence, national surveys, oral health
Introduction
This paper sets out the results of the most recent series of surveys, of 12-year-olds, conducted within the National Health Services (NHS) under the auspices of the British Association for the Study of Community Dentistry (BASCD) Dental Epidemiology Programme during 2000/01. The programme seeks to monitor the dental health of children and contributes to the national monitoring of service provision and targets, while providing data locally to aid in service planning and evaluation of Oral Health Strategies.
Method
The agreed BASCD criteria and conventions (as set out in the BASCD trainer's pack) were employed. See the supplement on this programme for details of the methodology (Pitts et al., 1997). Dental caries was detected using clinical visual diagnostic criteria at the D3 (caries into dentine) threshold.
Results
A total of 105,979 twelve-year-old children from across England, Wales and the Isle of Man were examined (together with 715 subjects from Jersey), some 7% less than in the 1998/99 survey of the same regions (Pitts, Evans and Nugent, 2000). On average this represents 17% of the total population of this age group, although in the different areas there was a wide range in the size of samples chosen according to local needs and practices. Table 1 shows total populations and samples, results for DMFT and its components, sealed teeth, the percentage of and mean disease experience for children with DMFT > 0 and DT > 0, and values for care index percentage (FT/DMFT x 100) for every participating Health District, and for the current "regions" (of the National Health Service in England and Wales).
The results demonstrated a wide variation in prevalence across the regions, with mean values for DMFT for regions and countries ranging from 0.63 in the West Midlands to 1.31 in Wales (and 1.33 in the Isle of Man). The mean value for DMFT across England was 0.86 (DT=0.39, MT=0.06, FT=0.41). The variation in mean disease levels within regions and countries was also marked.
Overall, the extremes for District mean DMFT values ranged between 0.43 for Solihull and Warwickshire and 1.82 for Barnsley. The corresponding values for DT ranged from 0.12 in Enfield & Haringey to 1.00 for St. Helen & Knowsley, while for MT they ranged from 0 in North & East Hertfordshire and Barnet to 0.26 for North & East Devon. Although a mean of 38% of 12-year-old children in England and Wales had evidence of dentinal caries experience (DMFT> 0), the "regional" means ranged between 30% (West Midlands) and 51% (Wales). The England & Wales mean DMFT for those with disease at the dentinal threshold was more than double the overall mean at 2.35.
The overall number of filled teeth remains very low (England & Wales mean FT=0.43) and there were low proportions of restored dentinal caries in areas with higher or lower disease levels. The England & Wales mean care index was 48% with a "regional" range of 42% - 57%. In individual Districts and Boards the range of care index was from 78% in Enfield & Haringey to 30% in South & West Devon.
The geographical variation of caries experience is highlighted in map form in Figure 1. The lower levels of mean caries prevalence (DMFT < 1.0) were mainly in the south, the west, and the midlands, whilst the rest of England, Wales, and the Isle of Man had mean DMFT levels between 1.01 and 1.50.
Figure 2 presents the mean DMFT information as a bar chart; this shows an overall ranking of the regions and countries including the 95 per cent confidence intervals. The bar chart reveals that the UK can be seen as comprising two broad groupings, the 6 "southern" areas with mean DMFT values less than 1.0 and Wales and the two more northerly English areas (together with the Isle of Man) with mean DMFT between 1.0 and 1.5.
Figure 3 shows a comparison of the mean DMFT results (and components) from 2000 / 2001 with those from the 1996/7 surveys using the NHS boundaries currently in place.
In populations in which caries has become concentrated in a minority of children, i.e. in highly skewed distributions, the mean DMFT alone provides an incomplete picture of the impact on those most affected. To address this problem, Bratthall (2000) has proposed a new measure, the Significant Caries Index (SiC Index). The SiC Index is the mean DMFT of the one third of the population (or representative sample) that have the highest caries score. He further proposed that the new measure should be given alongside the mean DMFT. Figure 4 provides an illustration of the SiC Index using data from the North West region (regional SIC 3.24). In addition to the SiC Index, the mean of those in the lower two thirds of the distribution is also given.
Discussion
It should be appreciated that, due to a variety of sampling, consent and data protection issues, it is not possible this year to publish comparative data for Scotland and Northern Ireland. Attempts to overcome these difficulties are on-going.
Although there is an increasing focus on local and regional variations in dental health, the bar chart in Figure 2 should not be seen, or used, as a simple league table; as small differences between means which do not exceed the 95 per cent confidence intervals should not be given undue weight and intra-regional variation is considerable. These results can be compared with those of earlier BASCD coordinated surveys of 12-year-olds conducted in 1996/97 (Pitts, Evans and Nugent 1998), 1992/93 (Pitts and Palmer, 1994) and 1988/89 (Evans and Dowell, 1990). Trends over time demonstrate an improvement of 11% in overall DMFT for 12 year old children in England & Wales since 1996/97.
The care index (FT/DMFT x 100%) reflects the restorative care of those who have suffered disease, it therefore has to be viewed in conjunction with DMFT. These results are of interest in studying the provision of dental services to this age group. The data in Table 1 shows the wide variations in the care index. The overall level is disturbingly low with just 48% of the dentinal caries in permanent teeth being restored across England and Wales which compares with the (already low) figure of 58% found in 14 year-old children in 1998/99 (Pitts, Evans and Nugent, 2000). It should be appreciated that these data relate to permanent teeth and debates about management strategies in primary teeth are not relevant here.
There is marked variation in the percentage of children with at least one pit and fissure sealant, with a tendency for low use in lower caries areas. The mean percentage values of West Midlands (18%) were significantly below those seen for Wales (26%) and Northern and Yorkshire (33%) .
Although overall improvements in oral health are welcome, these findings and an apparent slow down in improvements (11% between 1996 and 2000, as compared to 15% between 1992 and 1996), demonstrate the continuing need for more effective preventive strategies and treatment services for this important age group. As the condition of the permanent teeth at age 12 years will, to a large extent, determine the future dental health of emerging population cohorts of young adults, there is thus a continuing need for the monitoring of trends at both the local and national levels. This is also required to establish whether Oral Health Strategy targets can be met.
The SiC Index and the illustration of the contrast between the worst third and the two thirds of children least affected provides important additional information to the mean DMFT used alone. In describing the new measure, Bratthall (2000) proposed a new oral health goal, that, by the year 2015, the SiC Index should be less than 3 DMFT among 12-year-olds globally. It is evident that considerable effort will be needed to reduce the stark inequalities in dental health amongst children such as those in the north west of England.
Acknowledgements
The authors are indebted to all those who assist in the BASCD co-ordinated epidemiology Programme, in particular to Nigel Thomas (R&D Associate), the "Regional/Country" Coordinators and Trainers and all the examining teams. The views expressed are those of the authors and not necessarily those of the UK Departments of Health. Professor Pitts and Dr Nugent acknowledge support from the Chief Scientist Office of the Scottish Executive Department of Health. Professor Pine is grateful to Miss Janet Terrell and Dr Gary Whittle of The Dental Observatory for providing the data for the calculation of the SiC Index and to the consultants in dental public health of the North West region for giving permission for the data to be used.
References
Bratthall, D. (2000): Introducing the Significant Caries Index together with a proposal for a new global oral health goal for 12-year-olds. International Dental Journal 50, 378-384.
Evans, D.J. and Dowell, T.B. (1990): The dental caries experience of 12-year-old children in Great Britain. A survey coordinated by the British Association for the Study of Community Dentistry in 1988-89. Community Dental Health 7, 307-314.
Pitts, N.B. (Ed) (1997): The BASCD coordinated NHS Dental Epidemiology Programme caries prevalence surveys 1985/6 - 1995/1996. Community Dental Health 14, (Suppl 1), 1-51.
Pitts, N.B., Evans, D.J. and Nugent Z.J. (1998) The dental caries experience of 12-year-old children in the United Kingdom. Surveys co-ordinated by the British Association for the Study of Community Dentistry in 1996/1997. Community Dental Health 15, 49-54.
Pitts, N.B., Evans, D.J., and Nugent, Z.J. (2000) The dental caries experience of 14-year-old children in the United Kingdom. Surveys coordinated by the British Association for the Study of Community Dentistry in 1998/1999. Community Dent Heath 17:48-53.
Pitts, N.B. and Palmer, J. (1994) The dental caries experience of 5-, 12- and 14-year-old children in Great Britain. Surveys coordinated by the British Association for the Study of Community Dentistry in 1991/92, 1992/93 and 1990-91. Community Dental Heath 11, 42-45.
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