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Scottish Health Boards' Dental Epidemiological Programme

Report of the 1997/98 Survey of 5 Year old Children

Prepared by:

NB Pitts, ZJ Nugent and PA Smith
Dental Health Services Research Unit, University of Dundee
Published by University of Dundee
ISBN 1 899809 111 2
1998

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 HealthBoard
	6.4	Tooth and Surface Results
	6.5	Trends in Caries Prevalence
	6.6	Skewed Distribution of Disease
	6.7	Oral Cleanliness
	6.8	Deprivation
7	The Future
Acknowledgements References

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 List of Tables on Appendices page.

List of Figures

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
7	Progress towards the National Target by DEPCAT score

See also List of Figures on 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	Greater Glasgow
Ayrshire and Arran	Highland
Borders	Lanarkshire
Dumfries and Galloway	Lothian
Fife	Orkney
Forth Valley	Shetland
Grampian	Tayside
	Western Isles

Co-ordinating Committee - Dental Epidemiology, Scotland

Mr MCW Merrett(1)	Calibration Course Organiser
Professor NB Pitts(2,3)	Calibration and Results Co-ordinator
Professor KW Stephen	Adviser
Miss MM Taylor	Representative of Consultants in Dental Public Health
Mr Patrick Sweeney	Representative of Senior Registrars in Dental Public Health

British Association for the Study of Community Dentistry (BASCD) Dental Epidemiology Programme

1 Service Co-ordinator, BASCD Dental Epidemiology Programme in Scotland
2 Scientific Co-ordinator, BASCD Dental Epidemiology Programme in Scotland
3 Scientific Co-ordinator, BASCD UK Dental Epidemiology Programme

1 Introduction

This Report has been prepared for those interested in the detailed results of the 1997/98 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 sixth 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; Pitts (ed) 1997). The programme provides results for each Health Board and allows comparison of individual Boards' 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. They illustrate the limited progress achieved since the National Target for this age-group (60% of 5 year olds "free" of caries experience by the year 2000) was set in 1991. The likely failure to reach this national target unless effective new initiatives are mounted was highlighted recently in the Scottish Office Department of Health consultation document Working Together for a Healthier Scotland (1998).

The aim of this year's survey was to determine current levels of tooth decay, to obtain a simple population measure of the level of oral cleanliness and to illustrate the impact of deprivation on the dental health of five year old children in Scotland.

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 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 generally within the required range given in the BASCD guidelines for examiner calibration (Pine, Pitts & Nugent, 1995). One potential examiner was excluded having failed to calibrate.

4 Dental Examinations

The dental examinations took place in November and December 1997 and January 1998. Table 1 shows the number of children sampled in each Board. A total of 6,954 children (89.6% of the sample) were examined; this represents 11% of the Primary I population, the same percentage as in 1995. As in the previous survey, Greater Glasgow employed 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 5.7% to 87.1.% 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. 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).

Table 1

Number of Children in a 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	586	541	9.8	5548
Ayrshire and Arran	383	348	7.3	4799
Borders	314	263	21.5	1225
Dumfries and Galloway	285	251	14.1	1774
Fife	475	405	9.4	4313
Forth Valley	325	280	7.8	3601
Grampian	743	688	10.2	6766
Greater Glasgow	1791	1557	13.7	11346
Highland	364	323	12.2	2653
Lanarkshire	432	379	5.7	6689
Lothian	971	900	10.1	8946
Orkney	249	244	87.1	280
Shetland	304	278	84.2	330
Tayside	379	344	7.4	4636
Western Isles	164	153	44.7	342
Totals	7765	6954	11.0	63248

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 1995/96 Report with the addition of a section dealing with deprivation. 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 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 "open" and "closed" cavities); unrestorable decay (C3 - a code employed by the examiners to signify advanced disease approaching the pulp which renders the tooth in need of either extraction or endodontic tretatment). 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).

Table 2

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)	5.27	5.21-5.47
d₃t (codes 1,2,3,4)	1.91	0.94-2.87
arrested dentinal caries C1	0.04	0-0.15
dentinal lesions C2	1.64	0.82-2.38
unrestorable decay C3	0.19	0.07-0.42
mt	0.56	0.32-0.77
ft	0.23	0.18-0.42
d₃ft	2.14	1.29-3.29
d₃mft	2.69	1.7-3.69
sealants / sealant restorations	0.05	0-2.05

	%	Range for Health Boards
"Free" of caries experience at the dentinal level, d₃mft*	43.3	30.7-58.9
With "caries experience", d₃mft>0 (as per BASCD)	56.7	41.1-69.3
With "current decay", d >0	51.6	33.8-64.7
Care Index (ft/d₃mft)	8.6	6.1-20.6
% of children with 1 or more sealants / sealant restorations	1.6	0-37.8

* National Target for the year 2000=60%

The overall mean estimate of caries experience (d₃mft) in 5 year olds in Scotland of 2.7 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 1995/96 (Pitts & Evans, 1997) produced an overall mean d₃mft of 1.8 (with 'regional' means ranging from 1.1 to 2.9). Results from the UK Survey of Children's 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 1995/96 (1997/98 results for England and Wales will not be available until March 1999).

The overall value for the proportion of the sample "free" of caries experience at the dentinal level (d₃mft=0) was 43.3%. 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 41.4% 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 without further initiatives is now recognised to be very unlikely as stated in the Scottish Office Department of Health consultation document "Working Together for a Healthier Scotland" (1998).

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 8.6% of the teeth with dentinal caries experience had been restored. This shows marginal improvement since the last survey but still discloses a significant need for restorative care as well as preventive care. The impact of the re-introduction of fee for item of payment for children in the revised dental contract of 1996 appears to have been minimal at this time and in this age group. As only approximately 50% of children starting school have attended a dentist, this contractual amendment will only have an impact if registration levels among "pre-schoolers" can be improved.

The figures for sealants and sealant restorations, both mean numbers and percentages of children in receipt of these preventive measures (Table 2), differ little from the last survey and 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 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 Western Isles and Greater Glasgow with mean d₃mft of 3.69 and 3.56 respectively do not compare well with Borders and Shetland where the means are 1.70 and 1.89 respectively. The variation in the percentage of children in each Health Board with one or more "unrestorable" cavities (%C3>0) is also striking (3.80%in Borders to 15.70% in Western Isles).

Table 3

Mean values per child for decayed (d₃), missing (m) and filled (f) teeth; percentage "free" of caries expreience (d₃mft=0); percentage with "unrestorable decay" (C3>0) and mean number of sealed teeth ($) per child (decay defined as decay into dentine).

Health Board	d₃	m	f	d₃ft	d₃mft	% d₃mft=0	% C3 > 0	$
Argyll & Clyde	1.92	0.62	0.23	2.15	2.77	41.0	11.5	0.01
Ayrshire & Arran	1.34	0.58	0.19	1.53	2.10	48.3	10.9	0.17
Borders	0.94	0.41	0.35	1.29	1.70	58.9	3.8	0.00
Dumfries & Galloway	1.72	0.73	0.26	1.98	2.71	46.6	4.4	0.00
Fife	1.52	0.47	0.20	1.72	2.18	48.1	8.4	0.02
Forth Valley	1.61	0.67	0.19	1.81	2.48	47.5	7.5	0.02
Grampian	1.35	0.37	0.22	1.57	1.94	51.6	6.7	0.00
Greater Glasgow	2.57	0.77	0.22	2.79	3.56	35.2	14.1	0.07
Highland	2.14	0.63	0.18	2.33	2.95	33.4	6.5	0.17
Lanarkshire	2.38	0.48	0.28	2.66	3.14	36.9	15.6	0.01
Lothian	1.80	0.32	0.20	2.00	2.31	46.9	7.3	0.00
Orkney	1.74	0.39	0.28	2.02	2.42	47.5	9.8	0.19
Shetland	1.02	0.49	0.38	1.40	1.89	56.8	10.1	2.01
Tayside	1.97	0.73	0.31	2.28	3.01	42.7	8.4	0.02
Western Isles	2.87	0.41	0.42	3.29	3.69	30.7	15.7	0.07

It is once more interesting to note the limited use of fissure sealants on deciduous teeth by the different Health Boards, as recorded in Table 3. Shetland remains the only region where this technique is employed widely for this age group.

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. The east/west pattern which showed up in 1995/96 is less clearly discernible with Tayside having fallen into a worse grouping.

Figure 1

Mean number of decayed, missing and filled teeth (d₃mft) per child for each Health Board (decay defined as decay into dentine).

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 1995/96 and 1997/98. The statistically significant decline in d₃mft values from 1993/94 shown by Greater Glasgow in the last survey was not mirrored this year. Ayrshire and Arran showed the biggest fall in values while both Tayside and Western Isles showed a rise.

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 (worse) grouping, three stayed in their previous grouping and nine moved into a lower (better) grouping, an improvement of three on the last survey.

Figure F2 (Appendix F) demonstrates the mean number of decayed surfaces (d₃s) with 95% confidence intervals for each Health Board over the same years. The significant decreases in d₃s observed in Greater Glasgow and Lothian in 1995/96 have not been repeated with both Boards showing a small increase. However, Dumfries and Galloway shows a marked fall with smaller improvements seen in Ayrshire and Arran, Fife and Grampian.

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. Nine Health Boards are within 15% of the target and Borders is only 2% short of reaching it; Lanarkshire, Greater Glasgow, Highland and Western Isles require great improvements. When examined statistically, Borders and Shetland samples did not differ significantly from the national target prevalence of 40%; the other health board samples did.

Figure 2

Percentage with dentinal caries or past caries experience (d₃mft > 0) 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 28% of upper Es and around 34% 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.

Figure 3

Distribution of dentinal decay and past caries experience by tooth (combined totals from fifteen Health Boards, appropriately weighted).

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 33% in approximal (mesial and distal) surfaces and 35% in free smooth surface sites (buccal and lingual surfaces).

Figure 4

Distribution of decay and filled surfaces, data from fifteen Health Boards, appropriately weighted.

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, 4.8 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 1998. 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 1983-1998 showing changing values for mean number 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 not affect 93-95-97 comparisons. Furthermore, it can be seen that the SHBDEP figure was at the lower 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 (smaller) and SHBDEP (larger).

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 minimal improvement in mean d₃mft has occurred since the start of this series of surveys. This year's figure of 2.14 shows little difference from the original figure of 2.22 in 1987.

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 of Europe (Marthaler et al, 1996). In England (which enjoys lower mean caries levels than Scotland) no improvement was seen between 1983 and 1993 (O'Brien, 1994). It is possible that, unless new initiatives are implemented, 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. The bottoming out of the Scottish results at a higher level than in England may reflect the general poorer health status of Scotland in relation to England, dietary habits and the greater burden of ill-health carried by Scotland in relation to other developed nations as discussed in the government consultation paper "Working together for a Healthier Scotland" (1998)

Figure 6

Trends in caries results for Scottish children 1983-1998 showing the percentage of children "free" 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 52% of the children while 9% of the sample had half of the decayed surfaces. The skew has worsened slightly to that observed two years ago with an unfortunate 10% of the children having all of the surfaces affected by unrestorable(C3) decay. The mean number of decayed and filled surfaces (d₃fs) was 24.0 for the worst 10% of the children in this survey, slightly less than the value of 25.3 observed in 1995/96.

Table 4

Skewed distribution of decay (decay defined as decay into dentine).

Proportion of Children	with	Proportion of Disease
3% of population	had	25% of untreated decayed surfaces (d₃s)
9% of population	had	50% of untreated decayed surfaces (d₃s)
52% of population	had	100% of untreated decayed surfaces (d₃s)

1% of population	had	33% of unrestorable surfaces (C3s)
2% of population	had	50% of unrestorable surfaces (C3s)
10% of population	had	100% of unrestorable surfaces (C3s)

Table 5 gives the level of disease for those with disease. In Scotland, for those with disease, the average was 4.8 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 28.4% of the decay experience falls into this category and 41.4% of those children with dentinal decay are suffering from this severe form of carious attack. These figures show only a marginal 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 d₃mft for children with d₃mft>0	% of d₃mft equal to C3 or m	% children with d₃mft>0 with C3 or m
Argyll & Clyde	4.70	30.9	45.8
Ayrshire & Arran	4.07	38.0	50.0
Borders	4.14	29.5	35.2
Dumfries & Galloway	5.07	30.1	40.3
Fife	4.21	27.6	38.1
Forth Valley	4.72	34.1	46.3
Grampian	4.01	26.6	36.0
Greater Glasgow	5.50	30.4	47.0
Highland	4.44	24.5	33.5
Lanarkshire	4.97	25.4	45.8
Lothian	4.36	19.8	29.5
Orkney	4.61	25.3	33.6
Shetland	4.38	34.2	50.0
Tayside	5.25	31.1	40.1
Western Isles	5.33	23.2	33.0
Scotland (weighted mean)	4.75	28.4	41.4

6.7 Oral Cleanliness

For the second 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, 61% were considered to have clean teeth. 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, particularly on the measure of "substantial" plaque (60%). Details of the assessment, the above correlations and inter-board comparisons are in Appendix H.

6.8 Deprivation

A clear link between postcode-related measures of social deprivation and caries in children has previously been established (Pitts & Nugent, 1995). An addendum to the last SHBDEP Survey of 5 year old children was produced investigating the relationship between socio-economic status as determined by postcode of residence and dental caries status (Sweeney et al, 1996). A similar addendum was produced for the most recent survey of 12 year old children (Sweeney et al, 1998). This year a section dealing with deprivation has been introduced to the main body of the report. (A full description of the methodology is contained in Sweeney et al 1996 & 1998)

Of the total 6954 children examined for this year's Survey, 6912 (99.4%) had full postcode data. Of these, 6384 (91.8%) were able to be subsequently linked to their respective DEPCAT scores.

Figure 7 graphically illustrates the yawning gap in dental health between 5 year olds residing in the most deprived areas (DEPCAT score 7) and their more fortunate contemporaries from DEPCAT groups 1 and 2. The latter have all but reached the National Target of 60% caries "free" in the year 2000, while those from DEPCAT group 7 fall well short with only 18% caries "free". These results are broadly similar to those from the 1995/96 Survey.

Figure 7

The percentage "free" of caries experience (d₃mft=0) by DEPCAT score.

Almost four and a half times as many children in DEPCAT groups 6 and 7 require extractions or endodontic treatment (ie. have "unrestorable decay") compared to children in DEPCAT groups 1 and 2. In most cases this means a requirement for a general anaesthetic with the attendant risks which this procedure entails.

7 The Future

The dental health of Scottish 5 year olds still 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 1995/96 survey (data is not yet available for 1997/98 for England and Wales).

The d₃mft results from this latest SHBDEP survey record a modest drop in caries levels for Scotland similar to the drop between 1993/94 and 1995/96, but little overall 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.

There is increasing recognition of the significance of deprivation in Scotland's poor record of oral health and the need to tackle its root causes as well as the skewed pattern of caries in the population. Water fluoridation would provide the most effective means of achieving the oral health improvements needed and this is acknowledged in the consultative paper "Working Together for a Healthier Scotland" (1998).

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.

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.

Marthaler T et al.Caries Prevalence in Europe. Caries Res 1996: 30; 237-255

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 (Ed) Community Dental Health 1997: Supplement 1. The BASCD coordinated NHS Dental Epidemiology Programme Caries Prevalence Surveys 1985/6 - 1995/6. Available on the BASCD website.

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, Binnie V, Gerrish AC, Stevenson J. Scottish Needs Assessment Programme Report - Dental Caries in Children. Scottish Forum for Public Health Medicine: Glasgow, 1998.

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 & Evans DJ. 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.

Pitts NB & Evans DJ. 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 1995/96. Community Dental Health 1997: 14; 47-52 Available on the BASCD website.

Working Together for a Healthier Scotland. A Consultation Document. Scottish Office Department of Health, 1998

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

Sweeney P, McColl D, Nugent ZJ, Davies JA. Deprivation and Dental Caries. A collaborative pilot study undertaken by Argyll & Clyde Health Board and Dental Health Services Research Unit, University of Dundee, based on results from the Scottish Health Boards' Dental Epidemiological Programme, 1995/96, survey of 5 year old children. University of Dundee, 1996.

Sweeney P, Allison D, Davies JA, Pitts NB. Deprivation and Dental Caries Among 12 year old children in Scotland. University of Dundee, 1998.

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.

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