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Scotland's National Dental Inspections Programme 2003

The National Dental Inspection Programme (NDIP)

It is important that each child's dental wellbeing is observed so that children and their parents can maintain oral health and take necessary steps to remedy any problems that may arise. There is also a need to monitor children's dental health at a national and regional level so that reliable information is available for planning and evaluating initiatives directed towards improvements. The National Dental Inspection Programme (NDIP) aims to fulfill these functions by providing an essential source of information for keeping track of any changes in the dental health of Scottish children. Combined with the rich, historical nature of the existing data bank gathered from 1987 by the Scottish Health Boards' Dental Epidemiological Programme[1], NDIP will be able to forecast trends and assist in planning future dental services.

Scottish five year old's dental health in 2003

All young people should hope to enter adult life with a healthy mouth. However, despite improvements in the last thirty years, many Scottish children still suffer from tooth decay and have already embarked upon a journey of deteriorating oral health. Even aged five at the start of their school career, well over half of Scottish children have some established dental decay.

Scotland does not compare well with other Western European nations. In the Netherlands for example, 70% of five year old children have no obvious dental decay experience compared with just 45% in Scotland[2]. Tooth extraction remains the single most common reason for Scottish children receiving a general anaesthetic. Additionally, most of the improvement in dental health in recent years has occurred in children from the more advantaged sections in society. The brunt of dental disease continues to be borne by children from more deprived backgrounds where five year olds are more than three times as likely to suffer from severe dental decay and missing teeth than their classmates from wealthier homes. The Scottish Executive consultation document `Towards Better Oral Health in Children'[3] sums up the situation..."Despite some significant improvements, we still have unacceptably poor levels of oral health. Scotland's children still have too many diseased teeth. Dental disease still results in extreme pain and discomfort, infection, social embarrassment and interrupted work and education for a significant part of the Scottish population."

Scottish Health Boards' Dental Epidemiological Programme (SHBDEP)

The Scottish Health Boards' Dental Epidemiological Programme, a series of annual surveys of key age groups of Scottish children was established in 1987 as a joint venture between the Scottish Health Boards and the Dental Health Services Research Unit at the University of Dundee. These surveys provided a useful and reliable picture of Scottish children's oral health for thirteen years. However, variations at regional level in interpretation of the Data Protection Act and methods of obtaining consent resulted in the comparability of the data being compromised and the last national survey took place in 1999/2000. Over the years SHBDEP built up a reliable data set which was crucial to the planning of dental services at both national and local levels.

Establishment of the National Dental Inspection Programme (NDIP)

Following a review by the Chief Dental Officer of the existing schemes and processes related to dental inspection of children at school in Scotland and in accordance with the framework outlined in the NHS Scotland Act 1978 and the Education (Scotland) Act 1980, the National Dental Inspection Programme was set up in 2002. Its principal aims are to gather appropriate information in order to inform children (and parents) of their dental/oral health status and, through appropriately anonymised, combined data, advise the Scottish Executive, Health Boards, Trusts and other organisations concerned with children's health of the oral disease prevalence in their area.

Key age groups are targeted: at entry into school in Primary I and in Primary VII before the move to secondary education.

The 2003 inspection was the first and pilot year of the new NDIP Programme and concerned only Primary I children. A joint effort took place across Scotland involving the Scottish Association of Community Dental Directors, Community Dental Officers, Health Boards, Local Education Authorities and schools and the Chief Scientist Office's Dental Health Services Research Unit (DHSRU) at the University of Dundee.

The inspection programme has two levels; a Basic Inspection (which all children in Primary I received) and a Detailed Inspection (for a representative sample of this group).

What did the Basic NDIP Inspection consist of?

The Basic Inspection involved a simple assessment of the child's mouth using a light, mirror and ball probe. The child was then placed into one of three categories, depending on the level of dental health, and a letter sent to the parents informing them that their child had

• severe decay and should seek immediate dental care
• some established decay and should seek dental care in the near future
• no obvious decay but should continue to see the family dentist on a regular basis

The results of the Basic Inspection will also be used to feed back health information locally.

What did the Detailed NDIP Inspection consist of?

The Detailed Inspection was a more rigorous and comprehensive assessment which involved recording of the status of each tooth surface in accordance with international epidemiological conventions.

The specific goals of the Detailed Inspection were to determine current levels of established tooth decay, to obtain a simple measure of the level of oral cleanliness and to illustrate the impact of deprivation on the dental health of five year old children in Scotland in 2003.

The remainder of this report gives the results for the Detailed Inspection only. Further information about the Basic Inspection can be found on pages 17 and 18 of this document.

How many children had a Detailed Inspection?

Each health board was required to identify the number of schools needed to obtain a representative sample of a given size from the Primary I population[4]. The sample sizes used provided adequate numbers to allow meaningful comparisons between health boards to be drawn. The procedure for NDIP differs from the previous SHBDEP surveys in so far as whole classes are now selected to simplify the process for schools while ensuring results reflect the Primary I population in Scotland.

Health Board Primary I Population Inspected (% of PI Population Inspected) Argyll & Clyde 4790 579 (12%) Ayrshire & Arran 4010 375 (9%) Borders 1218 318 (26%) Dumfries & Galloway 1582 338 (21%) Fife 3631 543 (15%) Forth Valley 3241 517 (16%) Grampian 5751 413 (7%) Greater Glasgow 9686 2401 (25%) Highland 2284 388 (17%) Lanarkshire 6728 2277 (34%) Lothian 7861 934 (12%) Orkney 227 184 (81%) Shetland 272 250 (92%) Tayside 4291 313 (7%) Western Isles 268 250 (93%) Scottish Total 55840 10080 (18%)

Table 1. Primary I population and number of children inspected

 

Table 1 shows that more than 10,000 children across Scotland were inspected, almost one fifth of the Primary I population. Across the health boards, the percentage varied from 7% to 93% (Health boards can choose to increase the sample size in order to assist with local planning needs and some less populated Boards need to include large proportions to achieve meaningful numbers).

During the course of the survey 10% of the children were re-inspected to assess the consistency of the inspecting dentists' results.

When did the dental inspections take place and what age were the children?

The previous SHBDEP surveys of five year olds were largely carried out in November and December. The average age of the children examined was 5.25. As NDIP inspections took place from November 2002 until June 2003, the average age rose to 5.5. This modest increase in the average age of children examined is expected to have a limited impact on the results.

Average Age Male Female Range for Health Boards 5.55 5.57 5.53 5.37 - 5.67

Who conducted the inspections?

The inspections were conducted by community dentists from each health board.

How was consistency achieved in the conduct of the inspections across Scotland?

An important part of the NDIP process was that the conduct of the Detailed Inspections all over Scotland remained consistent with key elements of the previous SHBDEP system and that the participating community dentists recorded their findings in the same manner. In order to ensure this, the dentists were required to undergo a training and calibration exercise before the programme began.

Mandatory two-day training courses took place in Perth in November 2002 consisting of illustrated lectures and discussion sessions on how to record the inspections (in accordance with criteria set down by the British Association for the Study of Community Dentistry[5], appropriately modified for NDIP). These were followed by clinical training sessions using Primary I children from two local primary schools. When these were completed, the dentists conducted a series of assessments on another group of schoolchildren and the results were compared so that any dentists falling outwith the range of `substantial agreement,[6] would not participate in the actual Detailed Inspections. In 2003, two dentists were excluded from the programme having not "calibrated" sufficiently closely with their colleagues.

What is meant by `obvious decay' in this report?

It is important to note that when obvious tooth decay is discussed in this report it means decay that can be seen to go into the dentine of deciduous (baby) teeth, ie. the layer below the outer white enamel.

What are the stages of tooth decay?

Dentists use specific technical terms for different stages of tooth decay. Simpler terms are given in Figure 1.

What definitions of decay are used by the dentists conducting the NDIP Detailed Inspection?

The definitions of decay used are in accordance with the British Association for the Study of Community Dentistry (BASCD) guidelines and international epidemiological conventions, thus allowing comparisons to be made with other countries in Europe and beyond.

The figures presented for decay only relate to dental decay which clinically appears to have penetrated dentine (the inside of the tooth). This is a different level from that used by many dentists examining patients in a dental surgery. The detailed Inspection measures obvious decay into dentine seen under school (rather than dental surgery) conditions.

Go to NDIP 2003 Detailed Inspection Results or back to Contents List