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Scottish Health Boards' Dental Epidemiological Programme

Deprivation and Dental Caries Status Among 12-Year-Old Children in Scotland 1996/97

Executive Summary

Prepared by:

P C Sweeney
Argyll and Clyde Health Board and the
Dental Health Services Research Unit, University of Dundee

Introduction

Dental caries is a preventable multi-factorial disease associated with considerable morbidity and costs. The recently published results of the 1996/97 Scottish Health Boards' Dental Epidemiological Programme (SHBDEP) survey of 12 year old children(1) demonstrated some progress towards the Scottish Office target of a mean D3MFT of 1.5 by the year 2005(2).

Recent studies have demonstrated a strong association between increasing deprivation and increasing dental caries experience among 5 year old children examined in the 1995/96 SHBDEP survey(3,4). A commonly used measure of socio-economic status in Scotland is the Carstairs Score and its associated Deprivation Category (DEPCAT) score which are based on 1991 census data available by postcode of residence.

Aim:

The aim of this project was to investigate the relationship between socio-economic status as determined by postcode of residence and the dental caries status of 12 year old children examined in the 1996/97 SHBDEP survey using the Carstairs Score and Deprivation Categories.

Key Results:

Collection of postcode data and subsequent linkage to Carstairs information: Of the 6165 records from the 1996/97 12 Year Old Survey, 95% (5858) were successfully linked to their respective Carstairs and DEPCAT scores. The proportion of SHBDEP records linked with Carstairs socio-economic data ranged from a maximum of 100% for Borders Health Board to only 48% for Grampian Health Board.

Dental caries (D3MFT) experience in the 7 Carstairs Deprivation Categories for Scotland: The mean number of Decayed, Missing and Filled teeth increased from 1.05 for children resident in the most affluent postcode areas with a DEPCAT score of 1, to 3.05 for those resident in a DEPCAT 7 area. Twelve year old children resident in DEPCAT 1, 2 and 3 areas have already reached the Scottish Office target for the year 20052.

The proportion free of caries experience at the dentinal level (D3MFT=0) by DEPCAT Score: Only 21.4% of 12 year olds resident in a postcode area with a DEPCAT Score of 7 were 'free' of caries experience compared with a figure of 51.4% for their most affluent peers.

The association between dental caries status and deprivation as determined by the Carstairs Score: The D3, M and F components of D3MFT and mean D3MFT showed a strong positive association with increasing deprivation. The proportion of 12 year olds experiencing decay was also associated with a more deprived Carstairs score. although the F component showed a positive association with deprivation, the Care Index (ft/dmft) was low overall and was lowest (31%) in the DEPCAT 7 group.

D3=Decay into Dentine D3MFT=Number of Decayed, Missing and Filled Teeth

Refs:

1. PITTS N.B., DAVIES J.A. and FYFFE H.E. Scottish Health Board's Dental Epidemiological Programme: 12 Year Olds Report 1996/97. 1997. Dundee: University of Dundee.
2. THE SCOTTISH OFFICE. Scotland's Health, A Challenge to us all: The Oral Health Strategy for Scotland. Edinburgh: Her Majesty's Stationery Office, 1995; 3-36.
3. SWEENEY P.C., MCCOLL D., NUGENT Z. and PITTS N.B. Scottish Health Board's Dental Epidemiological Programme. Addendum to the 1995/96 Report on 5 Year Olds: Deprivation and Dental Caries 1996. Dundee: University of Dundee.
4. JONES C.M., WOODS K., and TAYLOR G.O. Social deprivation and tooth decay in Scottish schoolchildren. Health Bulletin 1997; 55: 11-15.
5. THE SCOTTISH OFFICE: Department of Health, Designed to Care: Renewing the National Health Service in Scotland. 1997: Edinburgh

Recommendations

1. These findings should be disseminated to Health Boards and Trusts for consideration when developing future Health Improvement Programmes and Trust Implementation Plans so that appropriately targeted preventive programmes can be formulated.
2. The results of this study should inform the development of plans addressing access to primary care dental services in Scotland.
3. The findings should also be communicated to NHS agencies who have a responsibility and role in improving the poor oral health record of the Scottish population. Primary Health Care Teams, in particular, are well placed to help identify children 'at risk' of developing dental disease.
4. The inequalities in dental health identified in this study should also be communicated to and discussed with other agencies identified in the Oral Health Strategy for Scotland2 and the recently published White Paper 'Designed to Care'5, as having an important role in improving oral, dental and general health.
5. The low Care Index (the proportion of decay which is treated) identified in this study, especially among the more deprived children, should continue to be monitored.
6. Further research should be undertaken to investigate those factors associated with deprivation which influence dental caries status in children.
7. This study should be repeated for the SHBDEP 14 year old survey to be undertaken in 1998/99, after which the need for further explorations of the association between dental caries and deprivation in national surveys should be reviewed.
8. Health Boards should seek to implement water fluoridation where this is feasible and cost effective with a view to reducing the inequalities in the prevalence of dental disease identified in this study and the previous study of 5 year olds in Scotland.

Figure 1.

1996/97 SHBDEP 12 Year Old Survey - Mean No. of Decayed, Missing and Filled Teeth by Deprivation Category (DEPCAT)

(The horizontal line represents the Scottish Office Target for the year 2005).

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