Scotland's National Dental Inspections Programme 2003
NDIP 2003
Detailed Inspection Results
What proportion of Primary I children in Scotland have no obvious decay experience in 2003?
The target set by the Scottish Executive in 1999[7] is that 60% of Scottish five year old children will have no obvious decay experience by the year 2010. Currently, 45% of Scottish five year olds fall into this category. The situation varies across Scotland with some Health Boards having already achieved or come close to this dental health target and others with some way to go.
Figure 2. Proportion of Scottish 5-year-olds with no obvious decay experience in 2003
What levels of decay are seen in Primary I children in 2003?
A more detailed picture of decay results is presented in Table 2. This year it was found that boys had, on average, more decayed teeth than girls.
No obvious decay experience Care index (proportion of obvious decay which has been filled) Obvious decay -
(average)(decayed, missing, and filled teeth) decayed teeth missing teeth filled teeth decayed, missing, and filled teeth for children with obvious decay * no significant difference
Table 2. Overall decay results for primary I children is Scotland 2003
It is important to note that although the average number of obviously decayed, missing and filled teeth across all Primary I children was two and three quarters, the average number for the 55% with obvious decay experience was 5 teeth. Figure 3 opposite shows such a typical mouth for an average child with obvious decay.
Are we on track to meet the 2010 target?
Figure 4. Improvement needed in order to meet 2010 target.
There has been no meaningful improvement in the proportion of five year old children free of obvious decay experience since the late 1980s. The improvements that had occurred prior to this were probably due to more children using fluoride toothpaste and it is possible that this and its attendant benefits have penetrated as far as possible under current conditions in Scottish society.
The poor level of dental health among Scottish children is part of a larger picture of unsatisfactory general health in Scotland and it may be that a more positive attitude to overall health in Scottish society is needed before larger strides are made towards reducing levels of dental decay.
Issues that impact on general health such as the sugary food and drinks favoured by many Scottish children[8] have clear implications for oral health and the Scottish Executive's initiatives towards improving the diet of Scottish children may help bring advances towards meeting the target.
Dental decay is a disease of lifestyle with multiple causes. Improvements in oral hygiene and fluoride availability are also needed to make progress. It is clear that more direct and also more innovative methods of delivering preventive care than have been used in the past are necessary if advances are to be made towards reaching the 2010 target.
What proportion of obvious decay among five year olds was treated with fillings?
The Care Index is used to describe the level of restorative care (the number of filled teeth divided by the number of obviously decayed, missing and filled teeth and multiplied by 100%). For Scotland as a whole (Table 2, page 6), only 9% of teeth with decay had been filled and some concern has been expressed that this high level of unrestored decay may indicate a failure in primary dental care provision.
With only approximately 50% of children in Primary I registered with a dental practice there remains scope for improvement in this area. Furthermore the process does not end with simply registering with a dental practice. As dental registration differs from joining a medical practice (in that it lapses if the patient does not attend within a fifteen month period), there is additional effort needed from parents to maintain their child's enrolment with the family dentist and to help children combat tooth decay.
To encourage families, locally co-ordinated community health improvement programmes promoting children's dental registration and projects supported by the NHS in Scotland such as Starting Well in Glasgow, and the GETCaPPP research project in Dundee (Development and Evaluation of Generalisable Evidence-based, Targeted Caries Prevention for Pre-school children by integrated Primary care teams, funded by NHS R&D) are encouraging parents to seek and maintain professional dental care for very young children as part of a holistic approach to improving children's health.
The low Care Index figure highlights the issue of how best to treat dental decay in young children, currently the source of debate within the dental profession. The traditional approach is that all holes in teeth must be restored by conventional fillings and this view is still strongly supported by one school of thought[9]. However, recent debate has emphasised the view that consideration must be made of the maturity and emotional state of the child and the effect of previous dental treatment, together with medical and socio-economic factors[10]. The process of placing a filling may be considered too traumatic in some cases for a small child and some dentists fear that it may result in an aversion to dental treatment later in life. However, whichever practice is followed, preventive care is still needed.
Regardless of the approach taken, the initial step is to consult a dentist so that assessment of the child's condition can be made. Efforts by the Scottish Executive and Health Boards to improve registration rates are thus a vital move in ensuring that children in Scotland receive appropriate treatment. However, once in contact with primary care it is important that essential preventive services are commenced promptly and maintained thereafter.
Continue to second part of detailed results or back to Contents List
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