Publications
Scottish Health Boards' Dental Epidemiological Programme
Report of the 1995/96 Survey of 5 Year Old Children
Table of Contents
- Executive Summary [New web page]
- Index to Report
- Appendices [New web page]
- The Programme
- Participating Health Boards
- Co-ordinating Committee
- List of Tables
- List of Figures
Return to Publications index page.
Index to Report
| 1 | Introduction | |
| 2 | Sampling | |
| 3 | Training and Calibration | |
| 4 | Dental Examinations | |
| 5 | Data Processing | |
| 6 | Results and Discussion | |
| 6.1 | Dental Caries Results for Scotland | |
| 6.2 | Dental Caries Experience by Health Board | |
| 6.3 | The Proportion "Free" of Caries Experience in each Health Board | |
| 6.4 | Tooth and Surface Results | |
| 6.5 | Trends in Caries Prevalence | |
| 6.6 | Skewed Distribution of Disease | |
| 6.7 | Oral Cleanliness | |
| 7 | The Future | |
List of Tables
| 1 | Number of children examined |
| 2 | Results for caries data for Scotland |
| 3 | Results for caries data for each Health Board |
| 4 | Skewed distribution of decay |
| 5 | Levels of disease and severe morbidity in those with disease |
See also a List of Tables on the Appendices page.
List of Figures
Note: Figures have been re-drawn for WEB presentation and may not appear as they did in the original publication.
| 1 | Decayed, missing and filled teeth, by Health Board |
| 2 | The proportion "with caries experience" by Health Board |
| 3 | Distribution of d3mf around the mouth |
| 4 | Distribution of d3 and f by surface |
| 5 | Trends in caries results for 5 year old Scottish children |
| 6 | Progress towards the National Target |
See also a List of Figures on the Appendices page.
The Programme
This programme of surveys is undertaken under the auspices of the Committee of Chief Administrative Dental Officers/Consultants in Dental Public Health Group (CADOs Group) and is a joint venture between all fifteen Scottish Health Boards and the Chief Scientist Office's Dental Health Services Research Unit based at the University of Dundee.
The results contained in this report have been obtained as a result of the unstinting efforts of a large team of people from all over Scotland to whom the organisers are very grateful. Appendix A lists the main participants.
Participating Health Boards
- Argyll and Clyde
- Ayrshire and Arran
- Borders
- Dumfries and Galloway
- Fife
- Forth Valley
- Grampian
- Greater Glasgow
- Highland
- Lanarkshire
- Lothian
- Orkney
- Shetland
- Tayside
- Western Isles
Co-ordinating Committee - Dental Epidemiology, Scotland
| Mr TR Watkins | (Co-ordinator) | |
| Professor NB Pitts1,2 | (Calibration and Results Co-ordinator) | |
| Mr MCW Merrett3 | (Calibration Course Organiser) | |
| Professor KW Stephen | (Adviser) | |
| Miss MM Taylor | (Representative of Consultants in Dental Public Health) |
British Association for the Study of Community Dentistry (BASCD) Dental Epidemiology Programme
1 Scientific Co-ordinator, BASCD Dental Epidemiology Programme in Scotland
2 Scientific Co-ordinator, BASCD UK Dental Epidemiology Programme
3 Service Co-ordinator, BASCD Dental Epidemiology Programme in Scotland
1 Introduction
This Report has been prepared for those interested in the detailed results of the 1995/96 survey. Readers seeking only a brief overview are referred to the Executive Summary. Key results and discussion are held in the body of the Report whilst further information and results can be found in the Appendices, printed on blue paper at the end of the Report.
This is the fifth survey of the dental health of 5 year old children undertaken in the Scottish Health Boards' Dental Epidemiological Programme (SHBDEP). This series of annual examinations of key age groups in Scotland is organised via the Chief Administrative Dental Officers and Consultants in Dental Public Health Group (CADOs Group) and the Chief Scientist Office's Dental Health Services Research Unit (DHSRU) at the University of Dundee, as a joint venture with all 15 Scottish Health Boards.
Standardised dental surveys are undertaken on randomly selected children across Scotland. The core timetable and criteria for age groups recommended by the British Association for the Study of Community Dentistry (BASCD) are followed (Mitropoulos, Pitts & Deery, 1992). The programme provides results for each Health Board and allows comparison of individual Boardsþ results and the monitoring of trends over time. It also allows comparison of the results for Scotland with those of other parts of the UK.
The results of these biennial surveys of 5 year olds, which commenced in 1987, are crucial for monitoring levels of dental health and thus illustrating the progress required in order to meet the National Target of 60% of 5 year olds "free" of caries experience by the year 2000, which was restated in the recently published Oral Health Strategy for Scotland (1995).
The aim of this year's survey was to determine current levels of tooth decay and, for the first time in this series of surveys of this age group, to obtain a simple population measure of the level of oral cleanliness achieved by 5 year old children.
2 Sampling
As outlined in the SHBDEP Protocol document (Watkins & Pitts, 1994), each Board was required to identify the number of schools needed to obtain a representative sample of a given size (dependent on Health Board size) from the Primary 1 population. The sample sizes utilised provide adequate numbers to allow meaningful inter-Board comparisons to be drawn.
3 Training and Calibration
The training and calibration courses were held immediately prior to the survey examinations. The courses were held in Perth; the organisation was undertaken by Mr MCW Merrett of Tayside Health Board while the training and calibration elements were provided by the DHSRU. Details of the courses can be found in Appendix B of the Report. Table C1 in Appendix C details the inter-examiner agreement recorded at the calibration sessions. Mean Kappa scores for teeth and surfaces fall in the range of "substantial agreement" as defined by Landis and Koch (1977) and are within the required range given in the BASCD guidelines for examiner calibration (Pine, Pitts & Nugent, 1995).
4 Dental Examinations
The dental examinations took place in November and December 1995 and January 1996. Table 1 shows the number of children sampled in each Board. A total of 7007 children (87.4% of the sample) were examined; this represents 11% of the Primary 1 population and is the largest number seen in any of the SHBDEP surveys to date. A large part of the increase was, on this occasion, due to Greater Glasgow employing a larger sample for local reasons (an option open to all Health Boards). The percentage of the Primary 1 population seen this year varied from 5.9% to 89.0% across the Health Boards. During the course of the survey 10% of the children were re-examined to allow assessment of intra-examiner agreement - these results are presented in Appendix C, Table C2.
Number of children in the sample, number and percentage examined and Primary 1 population in each Health Board.
| Health Board | Sample | Examined | Examined as % of Population | Primary 1 Population |
|---|---|---|---|---|
| Argyll and Clyde | 648 | 583 | 12.5 | 4647 |
| Ayrshire and Arran | 356 | 300 | 5.9 | 5043 |
| Borders | 303 | 251 | 20.0 | 1256 |
| Dumfries and Galloway | 286 | 244 | 12.9 | 1898 |
| Fife | 472 | 400 | 9.0 | 4449 |
| Forth Valley | 373 | 338 | 9.6 | 3522 |
| Grampian | 725 | 643 | 9.6 | 6703 |
| Greater Glasgow | 2013 | 1703 | 15.0 | 11328 |
| Highland | 305 | 273 | 10.1 | 2709 |
| Lanarkshire | 579 | 500 | 6.8 | 7358 |
| Lothian | 856 | 773 | 8.6 | 9028 |
| Orkney | 270 | 251 | 89.0 | 282 |
| Shetland | 303 | 273 | 81.3 | 336 |
| Tayside | 380 | 340 | 7.0 | 4888 |
| Western Isles | 152 | 135 | 36.9 | 366 |
| Totals | 8021 | 7007 | 11.0 | 63813 |
To adhere to BASCD guidelines and international epidemiological conventions, figures presented for "decay" only relate to dental caries which clinically appears to have penetrated dentine (d3). Less severe manifestations of decay, such as that which appears to be confined to enamel, are recorded as "sound" (see Appendix D).
In order to improve comparability of results across Regions and Countries and because of changes in the presentation of disease, the definition of decay used by BASCD was re-specified in 1991/92 to include lesions in which the disease process had obviously penetrated dentine despite there being no obvious cavitation (a "closed" cavity). This evolutionary change in criteria was introduced in order to prevent systematic underestimation of dentinal caries prevalence as a result of the changing manifestation of the disease process. The impact of this change was discussed in detail in Appendix J of the 1993/94 Report (Pitts, Fyffe & Nugent,1994).
5 Data Processing
Data processing, analysis and reporting were undertaken by the Dental Health Services Research Unit at the University of Dundee.
6 Results and Discussion
The format of this Report broadly follows that of the 1993/94 Report. Key results tables and figures relating to dental caries are included in the main body of the Report. The abbreviations used for the Health Boards in the figures are given in Appendix E. Comparison of Health Board results with those from the previous survey are given in Appendix F, more detailed results using the tooth surface as the unit for measurement can be found in Appendix G, results for oral cleanliness (plaque) are in Appendix H and maps showing the distribution of disease levels across Great Britain and Scotland are in Appendix I. All results relate to the deciduous dentition only.
6.1 Dental Caries Results for Scotland
Table 2
Table 2 shows the overall results for Scotland for decayed (d3), missing due to caries (m) and filled (f) deciduous teeth. The decay component has been subdivided as follows: arrested dentine caries (C1); dentinal lesions (C2 - including both þopenþ and þclosedþ cavities); unrestorable decay (C3). It should be appreciated that dental caries is measured at different levels in epidemiological surveys and clinical practice (SNAP report on Dental Caries in Children - Pitts et al, 1994).
Overall d3mft results for Scotland, incorporating data from the fifteen Health Boards, appropriately weighted (decay defined as decay into dentine).
| Weighted Means | Range of Means for individual Health Boards | ||
|---|---|---|---|
| Age (in years) | 5.28 | 5.25 - 5.40 | |
| d3t (codes 1, 2, 3 and 4) | 2.13 | 1.32 - 2.76 | |
| arrested dentinal caries | C1 | 0.04 | 0 - 0.12 |
| dentinal lesions | C2 | 1.79 | 0.95 - 2.32 |
| unrestorable decay | C3 | 0.26 | 0.07 - 0.44 |
| mt | 0.57 | 0.26 - 0.84 | |
| ft | 0.23 | 0.14 - 0.93 | |
| d3ft | 2.36 | 1.74 - 3.08 | |
| d3mft | 2.93 | 2.16 - 3.50 | |
| sealants / sealant restorations | 0.05 | 0 - 2.55 |
| % | Range for Health Boards | ||
|---|---|---|---|
| "Free" of caries experience at the dentinal level, d3mft=0* | 41.4 | 33.5 - 55.3 | |
| With "caries experience", d3mft>0 (as per BASCD) | 58.6 | 44.7 - 66.5 | |
| With "current decay", d3> 0 | 54.2 | 35.5 - 65.6 | |
| Care Index (ft/d3mft) | 7.8 | 4.4 - 27.9 | |
| % of children with 1 or more sealants / sealant restorations, $ or N > 0 | 1.7 | 0 - 39.9 |
* National Target for the year 2000 = 60%
The overall mean estimate of caries experience (d3mft) in 5 year olds in Scotland of 2.9 teeth per child is considerably higher than the corresponding values recorded recently for Great Britain or for the United Kingdom as a whole. The BASCD survey of 5 year olds across Great Britain conducted in 1993/94 (Pitts & Palmer, 1995) produced an overall mean d3mft of 1.9 (with "regional" means ranging from 1.1 to 3.2). Results from the UK Survey of Childrenþs Dental Health in 1993 (O'Brien, 1994) indicated that, for 5 year olds in the UK, the estimate of total caries experience for deciduous teeth (d3mft) was 2.0. The map reproduced as Figure I1 in Appendix I demonstrates the marked geographical variation in caries levels and Scotland's unsatisfactory position relative to other areas in 1993/94 (1995/96 results for England and Wales will not be available until March 1997).
The overall value for the proportion of the sample "free" of caries experience at the dentinal level (d3mft=0) was 41.4%. This measure is used in the National Target, which is that 60% of 5 year olds should be "free" of dentinal caries experience (d3mft=0) by the year 2000 (Scotland's Health - A Challenge To Us All, 1992; The Oral Health Strategy for Scotland, 1995). Although this year's figure is higher than the 38.2% recorded in the last survey, there has been no sustained improvement in this measure since the first SHBDEP survey of this age group in 1987/88, when a value of 42% was recorded. Caries prevention in the pre-fives is possible (Hesketh & Stephen, 1996) but meeting the National Target is going to be a difficult challenge given the considerable improvements that are required in the next few years (Wild, 1994).
As in the last survey of 5 year olds, the proportion of the sample with "caries experience" (d3mft>0, as defined by BASCD) is given, as is the proportion with "current decay" (d3>0), reflecting the proportion of children who had untreated dentinal decay at the time of the survey. All categories of dentinal decay (C1, C2, C3 and C4) are included in this measure.
The Care Index (ft/d3mft) expresses the proportion of the caries experience that has been treated restoratively. The Care Index result for Scotland as a whole (Table 2) indicates that only 8% of the teeth with dentinal caries experience had been restored. This shows no improvement since the last survey and discloses a significant need for restorative care as well as preventive care. Some may argue that not every carious lesion in young children should be restored, or that restoration may be delayed, but the finding that over 90% of the dentinal decay experience in 5 year olds is unrestored continues to give cause for concern.
The figures for sealants and sealant restorations, both mean numbers and percentages of children in receipt of these preventive measures (Table 2), indicate the low usage of these techniques in the deciduous dentition.
Detailed surface results are given in Appendix G, Table G1. Deciduous molars and canines which are not present are considered "missing due to caries". The ratio of "open" (code 2C) to "closed" (code 2V) cavities found in this survey was 3:2.
6.2 Dental Caries Experience by Health Board
Table 3
Table 3 shows in detail the dental caries results by Health Board. It gives a measure of the total caries experience (d3mft) and a breakdown of the figures for its constituent elements. The variation in disease levels and in the components of the d3mf index seen in earlier SHBDEP surveys remains evident in this year's survey; for example Dumfries and Galloway and Greater Glasgow with mean d3mft of 3.43 and 3.50 respectively do not compare well with Shetland and Orkney where the means are 2.16 and 2.17 respectively. The variation in the percentage of children in each Health Board with one or more "unrestorable" cavities (%C3>0) is also striking (4.8% to 19.0%).
It is interesting to note the limited use of fissure sealants on deciduous teeth by the different Health Boards, as recorded in Table 3; only in Shetland is this technique employed widely for this age group.
Mean values per child for decayed (d3), missing (m) and filled (f) teeth; percentage "free" of caries experience (d3mft=0); percentage with "unrestorable decay" (C3>0) and mean number of sealed teeth ($) per child (decay defined as decay into dentine).
| Health Board | d | m | f | dft | dmft | % dft = 0 | % dmft = 0 | % C3 > 0 | $ |
|---|---|---|---|---|---|---|---|---|---|
| Argyll & Clyde | 2.37 | 0.59 | 0.21 | 2.58 | 3.18 | 41.5 | 39.8 | 15.3 | 0.05 |
| Ayrshire & Arran | 2.05 | 0.65 | 0.34 | 2.40 | 3.05 | 43.3 | 41.7 | 15.7 | 0.04 |
| Borders | 1.61 | 0.34 | 0.37 | 1.98 | 2.32 | 47.8 | 45.0 | 6.4 | 0.01 |
| Dumfries & Galloway | 2.76 | 0.57 | 0.15 | 2.91 | 3.48 | 34.0 | 33.6 | 16.0 | 0.01 |
| Fife | 2.03 | 0.52 | 0.14 | 2.17 | 2.69 | 45.8 | 44.5 | 11.8 | 0.00 |
| Forth Valley | 2.16 | 0.59 | 0.17 | 2.33 | 2.92 | 44.7 | 42.9 | 16.6 | 0.04 |
| Grampian | 1.94 | 0.37 | 0.19 | 2.13 | 2.51 | 45.4 | 44.3 | 6.5 | 0.01 |
| Greater Glasgow | 2.46 | 0.84 | 0.20 | 2.66 | 3.50 | 36.0 | 33.5 | 15.1 | 0.07 |
| Highland | 2.18 | 0.53 | 0.32 | 2.50 | 3.03 | 41.4 | 39.2 | 10.3 | 0.15 |
| Lanarkshire | 2.55 | 0.68 | 0.20 | 2.75 | 3.43 | 36.6 | 34.0 | 19.0 | 0.01 |
| Lothian | 1.68 | 0.35 | 0.25 | 1.93 | 2.28 | 51.7 | 50.6 | 6.7 | 0.02 |
| Orkney | 1.33 | 0.41 | 0.43 | 1.76 | 2.17 | 52.6 | 51.4 | 4.8 | 0.20 |
| Shetland | 1.32 | 0.42 | 0.42 | 1.74 | 2.16 | 58.6 | 55.3 | 13.2 | 2.53 |
| Tayside | 1.77 | 0.48 | 0.24 | 2.01 | 2.49 | 50.6 | 49.1 | 10.0 | 0.03 |
| Western Isles | 2.15 | 0.26 | 0.93 | 3.08 | 3.34 | 37.8 | 36.3 | 14.8 | 0.11 |
Figure 1 shows the mean d3mft per child for each Health Board and the 95% confidence intervals associated with each mean value and highlights visually how little of the total caries experience in this age group is made up of fillings or missing teeth. The size of the vertical error bars indicates the limited extent to which the figure can be interpreted as a "league table". Thus, while there are real differences between the Boards at the right of the figure and those on the left, it is unwise to ascribe too much importance to minor variation in the detailed ranking positions of Boards adjacent to one another in the figure. The same data are expressed in the form of a map in Appendix I, Figure I2. An east/west pattern shows up clearly in this year's results.
Comparisons of this year's caries results with the previous survey are illustrated in Appendix F. Figure F1 shows the mean d3mft with 95% confidence intervals for each Health Board in 1993/94 and 1995/96. Only Greater Glasgow showed a statistically significant decline in d3mft values between the two surveys (having recorded a significant increase two years ago) but this result has to be viewed in the context of the reassessment of the 1993 Greater Glasgow sample as discussed in section 6.5.
However, some of the minor changes in d3mft values were sufficient to move Health Boards from one d3mft grouping to another in Figure I2 (Appendix I), thus giving a different look to the map if compared with the previous survey. Three Boards moved up to the next grouping, six stayed in their previous grouping and six moved into a lower (ie better) grouping.
Figure F2 (Appendix F) shows the mean number of decayed surfaces (d3s) with 95% confidence intervals for each Health Board over the same years. Significant decreases in d3s can be observed in two Health Boards - Greater Glasgow and Lothian.
6.3 The Proportion "Free" of Caries Experience in each Health Board
The proportion of children "free" of caries experience at the dentinal level (d3mft=0) for each Health Board are given in Table 3.
Figure 2 gives a graphical representation of the percentage of children in each Health Board with current dentinal decay or past caries experience (d3mft>0). The horizontal line represents the percentage required to meet the National Target for the year 2000 (60% with d3mft=0 or, conversely, 40% with d3mft>0). The varying values exhibited by the different Boards in this figure (and those for %d3mft=0 in Table 3) underscore the varying amounts of progress required in different parts of Scotland before this same target can be achieved by individual Health Boards. Some areas, such as Orkney, Shetland and Lothian, are within 10% of the target; at the other extreme, improvements of a much greater order will be needed if the target is to be achieved in Lanarkshire, Dumfries and Galloway and Greater Glasgow.
Percentage with dental caries or past caries experience in each Health Board.
6.4 Tooth and Surface Results
Figure 3 shows the distribution of dentinal decay and past caries experience by tooth type. The values shown are from the combined totals from 15 Health Boards, appropriately weighted. The dentinal decay component has been subdivided into unrestorable (C3) dentinal decay and restorable (non-C3) dentinal decay. From this figure it can be seen that just under 30% of upper Es and around 35% of lower Es (the second deciduous molars) show signs of decay or past caries experience. Figure 3 demonstrates the symmetry of caries attack and the preponderance of caries in deciduous molars and upper incisors.
Distribution of dentinal decay and past caries experience by tooth (combined weighted totals for 15 Health Boards).
The surfaces of the teeth which are most affected by decay and fillings are shown in Figure 4. The decay component has once again been subdivided into unrestorable (C3) and restorable (non-C3) dentinal caries. There is a three-way split in the distribution of disease, with approximately a third of the dentinal decay and fillings (32%) on the occlusal (or biting) surfaces of the deciduous teeth, a further 34% in approximal (mesial and distal) surfaces and 34% in free smooth surface sites (buccal and lingual surfaces).
The results for each Health Board using the surface as the unit of measurement are presented in Appendix G, Table G1. The decay component is expressed as the total dentinal decay and the mean number of surfaces with arrested dentinal decay (C1), "open" or "closed" dentinal cavitation (C2) and unrestorable (C3) decay. On average, 5.3 tooth surfaces per child were decayed and/or filled (d3fs). Table G2 gives the breakdown, by Health Board, for surfaces affected by unrestorable decay, total dentinal decay and fillings. These data were used to produce Figure 4.
6.5 Trends in Caries Prevalence
Figure 5 shows the changes in d3ft results for Scottish children from 1983 to 1996. A large drop in d3ft occurred between the 1983 Office of Population Censuses and Surveys (OPCS) Child Dental Health Survey (Todd & Dodd, 1985) and the first SHBDEP survey of 5 year olds in 1987/88. The following two surveys of 5 year olds (1989/90 and 1991/92) showed no significant alteration in d3ft levels which appeared to have bottomed out at a d3ft of 2.2-2.3.
Figure 5 Trends in caries results for Scottish children 1983-1996 showing changing values for mean numbers of decayed and filled teeth (d3ft).
Some of the increase in d3ft results seen in 1993/94 will have been due to the additional recording of "closed" cavitation (see Appendix J of the 1993/94 Report), which will also affect this year's results. Furthermore, it can be seen that the SHBDEP figure was at the high end of the 95% confidence interval for the Scottish figure from the OPCS Child Dental Health Survey of the UK carried out in 1993 (O'Brien, 1994). (The differences in the width of the confidence intervals is related to the different sample sizes employed by OPCS and SHBDEP.)
No matter how sophisticated a sampling procedure is adopted, it is an inherent feature of the process that some samples taken will not be fully representative of the population in question. Usually it is not known that such a sample has been taken, but sometimes, by studying repeated sampling processes, some pattern (or lack of pattern) may emerge.
Thus, the 1993/94 sample from Greater Glasgow, when viewed in conjunction with both prior and later data, appears to have shown a higher than expected level of disease and this may have been due to the sampling process. As Greater Glasgow accounts for 20% of the 5 year old population, this would have had an adverse impact on the overall result for Scotland. Thus, the difference between the 1993/94 situation and the years both preceding and following may not be as marked as would at first appear. By viewing the results as a series, rather than making year on year comparisons, it can be seen that no improvement in mean d3mft has occurred since the start of this series of surveys.
Figure 6 offers an alternative view of the trend in caries prevalence, using the percentage "free" of caries experience (d3mft=0). The latest data from the current survey appear to add to the overall picture of a bottoming out of the decline in caries prevalence seen in the eighties, a phenomenon which is being increasingly observed in other areas. In England (which enjoys lower mean caries levels) no improvement was seen between 1983 and 1993 (O'Brien, 1994). It is possible that, unless new initiatives are feasible, the improvements attributed to the widespread use of fluoride toothpaste have now reached "saturation" and that further improvement in the caries status of 5 year olds will be very difficult to make. However, it is difficult to explain why Scottish results have currently bottomed out at a higher level than in England.
Figure 6 Trends in caries results for Scottish children 1983-1996, showing the percentage of children þfreeþ of dentinal caries experience (d3mft=0) and the level that this percentage must reach to meet the National Target for the year 2000.
6.6 Skewed Distribution of Disease
Table 4 shows the skewed distribution of disease in this representative sample of 5 year old Scottish children. All of the decayed surfaces were found in 54% of the children while 10% of the sample had half of the decayed surfaces. An unfortunate 13% of the children had all of the surfaces affected by unrestorable (C3) decay. These results are similar to those observed two years ago. The mean number of decayed and filled surfaces (d3fs) was 25.3 for the worst 10% of the children in this survey, similar to the value of 26.3 observed in 1993/94.
Table 4
Skewed distribution of decay (decay defined as decay into dentine).
| Proportion of Children | with | Proportion of Disease |
|---|---|---|
| 1% of population | had | 10% of decayed surfaces |
| 10% of population | had | 50% of decayed surfaces |
| 54% of population | had | 100% of decayed surfaces |
| 1% of population | had | 29% of unrestorable surfaces |
| 4% of population | had | 67% of unrestorable surfaces |
| 13% of population | had | 100% of unrestorable surfaces |
Table 5 gives the level of disease for those with disease. In Scotland, for those with disease, the average was 5.0 deciduous teeth decayed, missing or filled. The percentage of total decay (d3mft) which is made up of unrestorable decay (C3) or teeth extracted because of decay (mt) is a measure of severe dental morbidity and is indicative of children likely to have required or to need dental general anaesthetics. At present 28% of the decay experience falls into this category and 43% of those children with dentinal decay are suffering from this severe form of carious attack. These figures show no improvement from two years ago.
Table 5
Levels of disease (mean d3mft) and severe dental morbidity (% of d3mft equal to C3 or m) in those with disease, and percentage of children with d3mft>0 who have unrestorable decay (C3) or missing (m) teeth, by Health Board (decay defined as decay into dentine).
| Health Board | mean dmft for children with dmft>0 | % of dmft equal to C3 or m | % of children with dmft>0 with C3 or m |
|---|---|---|---|
| Argyll & Clyde | 5.28 | 30.45 | 47.0 |
| Ayrshire & Arran | 5.23 | 30.38 | 52.0 |
| Borders | 4.22 | 22.17 | 27.5 |
| Dumfries & Galloway | 5.25 | 26.71 | 43.8 |
| Fife | 4.84 | 28.18 | 45.0 |
| Forth Valley | 5.11 | 30.29 | 46.1 |
| Grampian | 4.50 | 19.43 | 31.6 |
| Greater Glasgow | 5.27 | 33.27 | 50.2 |
| Highland | 4.98 | 22.37 | 37.3 |
| Lanarkshire | 5.19 | 32.56 | 51.2 |
| Lothian | 4.62 | 21.41 | 31.4 |
| Orkney | 4.47 | 22.02 | 29.5 |
| Shetland | 4.84 | 36.10 | 50.8 |
| Tayside | 4.90 | 27.63 | 38.7 |
| Western Isles | 5.24 | 15.30 | 31.4 |
| Scotland (weighted mean) | 5.00 | 28.28 | 43.4 |
6.7 Oral Cleanliness
For the first time in this series of surveys of 5 year old children, data were collected on a simple measure of oral cleanliness. Training was given in the use of this new measure, but examiners were not calibrated (as the nature of the measure precludes this) and so the results may reflect a certain level of examiner variability. Overall, more than half of children (55%) were considered to have clean teeth, 40% had a little plaque visible and 5% were considered to have a substantial amount of plaque. There was a significant association between level of plaque and d3mft score, which may reflect the usage of fluoride toothpaste and other factors. Other studies have indicated a weak positive association between plaque and caries and this issue is discussed in some detail by Sutcliffe (1996). Boys showed higher levels of plaque than girls. Details of the assessment, the above correlations and inter-board comparisons are in Appendix H.
7 The Future
The dental health of Scottish 5 year olds remains poor in comparison with the rest of Great Britain, as illustrated in the map in Figure I1, Appendix I based on results from the 1993/94 survey (data is not yet available for 1995/96 for England and Wales). The d3mft results from this latest SHBDEP survey record a modest drop in caries levels for Scotland as a whole compared with the last survey, but little significance can be attached to such a small change. Indeed, the lack of progress shown in Figure 5 and Figure 6 indicates that major initiatives are needed if any impact is to be made on the current levels of disease in 5 year old children. Water fluoridation would provide the most cost-effective prospect of achieving the improvements needed, but if this is not achievable then alternative strategies are urgently required (SNAP report on Dental Caries in Children - Pitts et al, 1994).
A clear link between postcode-related measures of social deprivation and caries in children has previously been established (Pitts & Nugent, 1995). Work is currently underway to explore this aspect of the results of this year's survey.
The recently published Oral Health Strategy for Scotland (1995) outlines the range of actions that need to be undertaken in the areas of diet, health promotion, fluoridation and prevention if improvements in the dental health of 5 year olds are to be made - this is, indeed, a challenge to us all.
Acknowledgements
The Co-ordinating Committee, the authors and the Dental Health Services Research Unit are indebted to all the children who took part in the survey, and their parents. Special thanks go to Mrs E Matheson and Mr P Pierson, Headteachers of Letham Primary School and North Muirton Primary School in Perth, and to the staff and pupils, for accommodating the essential training and calibration exercises.
Thanks also go to the Community Dental Officers and Dental Surgery Assistants who undertook the fieldwork as examining teams (see Appendix A); to the fifteen Health Boards for their financial support of the Programme and to the Chief Scientist Office of the Scottish Office Department of Health who fund the Dental Health Services Research Unit. The authors would also like to acknowledge the willing support given by their colleagues at the Dental Health Services Research Unit, especially Miss HE Fyffe, Mrs P Smith and Dr L Broumley.
The opinions expressed in this report are those of the authors and not necessarily of the Scottish Office.
References
Hesketh EA & Stephen KW. Dental Caries Prevention for the Under Fives. An Educational Pack for General Dental Practitioners, Health Visitors, General Medical Practitioners and Community Pharmacists. University of Dundee, 1996.
Landis JR & Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977: 33; 159-174.
Mitropoulos C, Pitts NB & Deery C. BASCD Trainers' Pack for Caries Prevalence Studies, 1992/93. University of Dundee, 1992.
O'Brien M. Children's dental health in the United Kingdom 1993. London: HMSO, 1994.
Pine C, Pitts N & Nugent Z. BASCD Guidance on the Statistical Aspects of Training and Calibration of Examiners for Surveys of Child Dental Health. University of Dundee, March 1995.
Pitts NB, Binnie V, Gerrish AC, Mackenzie NM & Watkins TR. Scottish Needs Assessment Programme Report - Dental Caries in Children. Scottish Forum for Public Health Medicine: Glasgow, 1994.
Pitts NB, Fyffe HE & Nugent Z. Scottish Health Boards' Dental Epidemiological Programme, 1993/94 Report. University of Dundee, 1994.
Pitts NB & Nugent Z. Capitation registration in Scottish 5 year olds related to caries prevalence and deprivation scores. Journal of Dental Research 1995: 74(3); 857.
Pitts NB & Palmer J. 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 Health 1994: 11; 42-52.
Pitts NB & Palmer J. The dental caries experience of 5-year-old children in Great Britain. Surveys coordinated by the British Association for the Study of Community Dentistry in 1993/94. Community Dental Health 1995: 12; 52-58.
Scotland's Health - A Challenge To Us All. Scottish Office Home and Health Department, 1992.
Sutcliffe P. Oral cleanliness and dental caries. In: The Prevention of Oral Disease. Ed. JJ Murray. Oxford: Oxford University Press, 1996.
The Oral Health Strategy for Scotland. The Scottish Office Department of Health, 1995.
Todd JE & Dodd T. Children's Dental Health in the United Kingdom, 1983. London: HMSO, 1985.
Watkins TR & Pitts NB. Scottish Health Boards' Dental Epidemiological Programme. Protocol. 1994/95 Version. Stirling, 1994.
Wild JR. From the Chief Dental Officer. Health Bulletin 1994: 52; 147-148.
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