Scotland's National Dental Inspections Programme 2003
NDIP 2003
Detailed Inspection Results
How has the dental health of Scottish five year olds fared over time?
Trends over time in the percentage of children who showed no signs of having decay or treatment of decay in any of their teeth are shown in Figure 5. The latest data from the current inspection appear to add to the overall picture of a bottoming out of the decline in the prevalence of decay seen in the nineteen-eighties, a phenomenon which is being increasingly observed in other areas of Europe[11]. In England, (where overall decay levels are lower than Scotland) the dental health of five year olds appears to be deteriorating, following a long plateau[12].
The similar trend being observed in the Scottish results at a higher level than in England may reflect the general poorer health status of Scotland compared to England and the greater burden of ill-health carried by Scotland in relation to other developed nations.
Figure 5. Trends in time in the percentage of 5-year-old children with no obvious decay experience
Figure 6 illustrates the changes in the number of obviously decayed and filled teeth for Scottish five year old children from 1983 to 2002. A large drop occurred between the 1983 Office of Population Censuses and Surveys (OPCS) Child Dental Health Survey[13] and the first SHBDEP survey of five year olds in 1987/88. The figure appears to have subsequently settled at around 2 decayed and filled teeth.
Figure 6. Trends over time in the number of decayed and filled teeth.
The importance of monitoring children's dental health and being able to make comparisons over a long period of time is illustrated by Figure 6 above. By viewing the results as a series, rather than making year on year comparisons, it can be seen that minimal improvement in the number of decayed and filled teeth has occurred since the mid 1980's. This year's NDIP inspection figure of 2.11 differs only a little from the SHBDEP survey figure of 2.22 in 1987
How do the results of the 2003 NDIP Inspection compare with the last SHBDEP survey in 1999?
When the data collected for the last SHBDEP survey in 1999[14] is compared with the current NDIP Inspection, the number of decayed, missing and filled teeth has increased significantly. This rise is largely due to an increase in the number of missing teeth. The proportion of the five year old population with extractions has not changed, but the number of missing teeth for those children who have had extractions has increased by 20%.
Although the number of decayed teeth has not changed overall, both the proportion of teeth with severe decay and the proportion of the Primary I population with severe decay has increased. This may be explained in part by the modest rise in the average age of the child participants this year.
number of decayed, missing, and filled teeth number of missing teeth number of teeth with severe decay number of missing teeth (for children with extractions) % of children with decayed teeth % of children with missing teeth % of children with severe decay
Table 3. Comparison of decay figures in 1999 (SHBDEP) and 2003 (NDIP)
How clean were the children's teeth?
Overall, 68% were considered to have clean teeth. Poor oral hygiene leads to thicker plaque deposits and this is associated with obvious decay[15]. Boys showed higher levels of plaque than girls, particularly on the measure of "substantial" plaque, where 60% of the children with substantial plaque (4.3% of the children in total) were boys.
Was the level of obvious decay spread evenly throughout the population of five year olds in Scotland?
Proportion of children Established decay 1% of population 11% of population 48% of population Severe decay 1% of population 4% of population 15% of population
Table 4. Skewed distribution of decay
These results clearly demonstrate how unevenly decay and severe decay are spread among Primary I children. For example, half of the teeth with severe decay were seen in just 4% of the children inspected.
Is there a link between social deprivation and poor dental health among Scottish five year olds ?
An approximate measure of social deprivation often used in Scotland is DEPCAT[16]. This is a scale of deprivation based on information gathered in the national census every ten years and describes the social composition of residents in a particular postcode sector. DEPCAT scores for each postcode area in Scotland are calculated from the percentage of unemployed males, over-crowded households, households without cars and people from social classes IV and V. The scale runs from DEPCAT 1 (most prosperous) to DEPCAT 7 (least prosperous). The index has been shown to be linked closely with measures of death, illness and health service use and a clear association between DEPCAT measured social deprivation and children's dental decay has been established[17].
Of the total 10,080 children examined in this NDIP Inspection, 98% were subsequently able to be linked to their respective DEPCAT scores.
Figure 7. Percentage of 5-year-olds with no obvious decay experience by DEPCAT
Figure 7 graphically illustrates the yawning gap in dental health between five year olds from the most deprived areas (DEPCAT group 7) and their more fortunate contemporaries from DEPCAT groups 1 and 2. The children from DEPCAT 1 have reached the National Target of 60% with no obvious decay experience in the year 2010 and have in fact met this within the original timeframe (the year 2000). Additionally, those from DEPCAT 2 are within two percent of meeting the target. Children from DEPCAT group 7 fall well short with only 21% with no obvious decay. These results have varied little since the measure was first used in relation to children's dental health in Scotland in the mid 1990s.
As well as bearing the overall brunt of dental decay, children from more socially deprived areas suffer more from severe decay. Nearly three times as many children in DEPCAT groups 6 and 7 need extractions or root treatment compared to children in DEPCAT groups 1 and 2. In most cases this means the child will be given a general anaesthetic with the attendant risks which this entails.
Continue to the third part of the detailed results or back to Contents List
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