Link between socio-economic status and tooth decay

Children attending schools classified as deprived were reported to have experienced more tooth decay than children in non-deprived schools, according to further analysis of the 2003 Children's Dental Health Survey by the Office for National Statistics.

In deprived schools, 60 per cent of five-year-olds and 70 per cent of eight-year-olds had experience of obvious decay in their primary 'milk' teeth, compared with 40 per cent of five-year-olds and 55 per cent of eight-year-olds attending non-deprived schools.

In permanent teeth, 55 per cent of 12-year-olds and 72 per cent of 15-year-olds attending deprived schools had experience of obvious decay compared with 42 per cent of 12-year-olds and 55 per cent of 15-year-olds in non-deprived schools.

The survey identified a relationship between socio-economic status and experience of obvious decay. For example, a lower proportion of five-year-olds (34 per cent) from managerial and professional occupational groups had experienced obvious decay in primary teeth than five-year-olds from routine and manual occupational groups (53 per cent). Among 15-year-olds, children from managerial and professional occupational groups had lower prevalence of obvious decay (47 per cent) compared with those from intermediate (66 per cent) and routine and manual (65 per cent) occupational groups.

Although few children had lost teeth due to decay, more 15-year-olds from routine and manual occupational groups (7 per cent) had teeth extracted because of decay than 15-year-olds from managerial and professional occupational groups (2 per cent).

Available free on the National Statistics website

The need for orthodontic treatment was also related to social factors. A larger proportion (25 per cent) of 15-year-olds in deprived schools had unmet orthodontic treatment needs compared with those in non-deprived schools (21 per cent). Unmet treatment need describes children who were not undergoing orthodontic treatment at the time of the survey but were assessed as having an orthodontic treatment need by the examining dentist.

Unmet orthodontic treatment need was twice as high (26 per cent) among 15-year-olds from routine and manual family backgrounds compared with those from managerial and professional family backgrounds (13 per cent).

There was no evidence of a relationship between social factors and Tooth Surface Loss or periodontal health.

The 2003 Children's Dental Health Survey, commissioned by the four UK Health Departments, is the fourth in a series of national children's dental health surveys that have been carried out every 10 years since 1973 in England and Wales and in the whole of the UK since 1983. Analyses from the 2003 survey on dentinal decay, periodontal health and non-carious conditions were published in July 2004. Further analyses of social factors and oral health, orthodontic condition, impact of oral health and patterns of care and service use are published today.

Other key findings include:

• More children are visiting the dentist at an earlier age than ever.
• The proportion of 5 and 8-year-olds making their first visit to the dentist before the age of two has more than doubled since 1993.
• In 1983, 7 per cent of 5-year-olds' parents reported that their children visited their dentist before the age of two. This increased to 15 per cent in 1993 and 31 per cent in 2003.
• Among 8-year-olds, 6 per cent made early visits in 1983. This doubled to 12 per cent in 1993, and increased to 33 per cent in 2003.
• The proportion of 5-year-olds reported to have never visited the dentist decreased from 14 per cent in 1983 to 10 per cent in 1993 to 6 per cent in 2003.

Dental check-ups or reminders from the dentist were the main reasons given for visits by between 82 per cent and 89 per cent of children across all age groups.

Among 8, 12 and 15-year-olds, the proportion of children reported to have had teeth extracted has decreased since 1983. The decrease was most pronounced among 12-year-olds: from 66 per cent in 1983, to 51 per cent in 1993, to 36 per cent in 2003. A larger proportion (20 per cent) of 15-year-olds was reported to have had extractions under general anaesthetic than any other age group.

In 2003, the majority of children were reported to have used the General Dental Services, either in isolation or in combination with Community Dental Services. Very few children, 1 to 2 per cent, were reported to have received dental treatment outside the NHS.

Around a fifth of parents of five and eight-year-olds (22 per cent and 20 per cent respectively) and around a quarter of parents of 12 and 15-year-olds (24 per cent and 26 per cent respectively) reported having difficulties accessing an NHS dentist willing to treat their child. The main cause given for difficulties in access by 76 per cent of affected parents was that their nearest family dentist would not accept any more NHS patients.

The 2003 Children's Dental Health survey compared children's reported oral problems over a period of 12 months with their usual dental attendance pattern. Among all age groups, children who attended the dentist regularly were less likely to be reported as having problems due to their oral condition than those who only visited the dentist when having trouble with their teeth.

Parents were asked whether their children had experienced any problems in the previous 12 months as a result of the condition of their teeth and gums. Parents of 22 per cent of five-year-olds reported at least one problem; as did the parents of 26 per cent of eight- year-olds, 34 per cent of 12-year-olds and 28 per cent of 15-year-olds. Among 15-year-olds, 25 per cent who were regular attenders had had trouble with their teeth compared with 39 cent of those who went to the dentist only when they actually had a problem.

More 15-year-olds were reported to be undergoing orthodontic treatment (wearing a brace) at the time of the survey: from 5 per cent in 1983, to 11 per cent in 1993, to 14 per cent in 2003.

Among 15-year-olds, the need for, and provision of, orthodontic treatment was associated with the deprivation status of the school children attended. Fifteen per cent of 15-year-olds attending non-deprived schools were wearing an appliance compared with 10 per cent in deprived schools.

Most orthodontic appliances worn were fixed. In children wearing appliances, the proportion of fixed appliances increased between 1993 and 2003 from 49 per cent to 72 per cent in 12-year-olds and from 68 per cent to 83 per cent in 15-year-olds. The proportion of children wearing removable appliances decreased over the same period.