Sharp increase in hospital admissions for children's dental care

Researchers from Peninsula Dental School and the UCL Eastman Dental Institute have used data from the Hospital Episodes Statistics resource to identify a marked increase in the number of hospital admissions for children with caries and other dental conditions, between 1997 and 2006.

The study, which is to be published in the British Dental Journal on 11th April 2009, revealed that there were 517,885 NHS 'episodes of care' for children with dental conditions in the nine-year period. Of these, over half were for dental caries and 80 per cent involved extractions.

There was a year-on-year increase in the number of episodes during the period covered by the statistics, averaging out at 29,676 admissions a year - most of which would have required a general anaesthetic. Extractions for caries rose by 66 per cent between April 1997 and March 2006.

The increase in the number of general anaesthetics for children and dental treatment goes contra to desired best practice and may put children at risk - general anaesthetic in children is at best unpleasant, at worst potentially life threatening.

The research team emphasises that further investigation into the reasons why more children are presenting at hospital for dental treatment is needed, but suggested reasons include: the move post-2000 away from the delivery of general anaesthetic to children in the primary care sector to the secondary care setting; and a possible reduction in restorative care provided for children in the primary care sector, either through lack of training, inadequate recompense or the failure of children and their parents to attend appointments.

One key finding of the research was the huge difference in instances of dental caries and disease in children from different socioeconomic backgrounds. Twice as many treatments were provided to children in the most deprived sector of society compared with those from the most affluent. Children in more affluent areas were 33 per cent less likely to present as a dental care emergency than those living in more deprived areas, and they were 75 per cent less likely to develop caries than their less well-off counterparts.

David Moles, Professor of Oral Health Services Research at Peninsula Dental School, commented: "The findings of our study are very worrying - one poor child was admitted to hospital for extractions on seven separate occasions in the nine-year period of the statistics. If rates of caries and other dental infection are steady, why is there such a marked increase in the number of children being admitted to hospital for dental treatment? And why is it that more and more children are being electively admitted to hospital for extractions? Clearly these questions need to be answered in order to cut the number of admissions, improve dental care for children and ultimately reduce the financial burden to the NHS."

Dr. Paul Ashley, Head of Paediatric Dentistry at the UCL Eastman Dental Institute, added: "Two aspects of the study are particularly worrying - the rise in the number of general anaesthetics being given to children, and the widening gulf in dental health between social classes. General anaesthetic can be fatal to children, which is why post-2000 the administration of general anaesthetic to children was moved from the primary care sector to secondary care, where there is back-up should anything go wrong. Priority must be given to research that examines the reasons why the issues highlighted by our study occur, and this is to be our next step."