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Scottish Health Boards' Dental Epidemiological Programme (SHBDEP)

Report of the 1994/95 Survey of 14 Year old Children

Executive Summary

Prepared by:

NB Pitts, HE Fyffe and Z Nugent
Dental Health Services Research
Unit, University of Dundee

Background

The Scottish Health Boards' Dental Epidemiological Programme (SHBDEP) is a joint venture between the fifteen Scottish Health Boards, represented through the Chief Administrative Dental Officers and Consultants Group (CADOs Group), and the Chief Scientist Office's Dental Health Services Research Unit based at the University of Dundee. Standardised surveys of dental health are undertaken on randomly selected samples of children across Scotland following the criteria and timetable laid down by the British Association for the Study of Community Dentistry (BASCD). This allows Health Boards to compare their results not only with other areas in Scotland but also with other parts of Great Britain. The significant changes made in 1990 to contractual arrangements for the provision of dental primary care, together the Government's recent statement according priority to children's dental health and declaring an intent to modify the capitation arrangements for children, make the monitoring of dental disease levels and patterns of care increasingly important at this time.

Aim

The aim of this year's survey was to determine current levels of tooth decay (dental caries measured clinically at the dentinal level) in 14 year old children in Scotland; these results are summarised below. Information was also collected on oral cleanliness, developmental defects of enamel, fissure sealants and supra-gingival calculus from this large, representative sample of Scottish 14 year olds. Details of these other aspects of the survey can be found in the full report.

Key Results

Dental caries experience (DMFT) for Scotland: The overall result, a mean number of decayed, missing and filled teeth (DMFT) of 3.1, represents a modest overall improvement from the figure of 3.6 recorded in the previous survey of Scotland's 14 year olds in 1990/91, although it was still higher than the mean values reported in 1991 for most other areas of Great Britain. The map opposite (Appendix J2 of the Report) shows the variation in the distribution of dentinal caries experience across Scotland.

Dental caries experience (DMFT) for individual Health Boards: The Figure, opposite, shows the mean number of decayed, missing and filled teeth (DMFT) for each Health Board and the 95% confidence intervals associated with each mean. The size of the error bars indicate the very limited extent to which the figure can be interpreted as a simple league table of disease experience; differences falling within the limits of the error bars are not statistically significantly different from one another. The horizontal bars at the base of the Figure show that in most cases there are no significant differences between values for "blocks" of 7 "adjacent" Boards.

The proportion "with caries experience" and the pattern of attack: Three-quarters (74%) of 14 year olds were found to have already experienced decay at the "caries into dentine" level of detection (that is decay penetrating beyond the enamel surface of the teeth). The majority of the decay experience (58%) was found in the first permanent molars, although a further 19% had occurred already in recently erupted second permanent molars. Almost half (47%) of the dentinal decay and fillings were found on the occlusal (or biting) surfaces of the back teeth. Further consideration of the use of fissure sealants is therefore warranted.

Trends over time: The modest overall fall in caries experience, although encouraging, represents a slowing of the improvement in dental health in this age group as the large reduction in caries levels observed at the beginning of the 1980s is no longer being seen. This is in line with the trend observed previously through the most recent surveys of 5 and 12 year olds in Scotland. The reduction in DMFT observed (despite the broadening of the diagnostic criteria) masks changes in the individual components of the index. Decay (D) appears to have risen substantially, but this is largely due to the change in criteria for measuring decay introduced, for consistency across Great Britain, in 1992 by BASCD. (When the criteria change is taken into account there has been little change in the percentage of children with decayed teeth over the four years.) The mean missing teeth (MT) component (0.3) has shown no real change whilst the filled teeth (FT) component has fallen by 37% from 2.6 to 1.6. The relative amount of restorative care provided ([FT/DMFT] x 100, the "Care Index") has fallen from 73% to 52%, and whilst some of this decrease can be accounted for by the criteria change, this deterioration is still a cause for concern.

Uneven distribution of decay: The skew in the distribution of the decay must be appreciated, as although over half of the children (53%) are free from dentinal decay (DT=0), small groups have very high levels of disease. 47% of the children have all of the decay with half of the decayed surfaces being found in an unfortunate 8% of the children examined. Targeting of dental services at these high risk groups should therefore become a priority.

More detailed information can be obtained in the full Report.

Return to Report of the 1994/95 Survey of 14 Year old Children index.