Oral Health Among Adults

This topic area covers statistics and information relating to oral health among adults in Hull including local strategic need and service provision. Information relating to Oral Health Among Children and Young People can be found within Health Factors under Children and Young People.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

In July 2022, Clinical Commissioning Groups (CCGs) ceased to exist and were replaced by the Integrated Care System. Data will still be available at CCG level for some time after July 2022 so this page continues to refer to CCGs and Hull CCG, and continues to present data at the CCG geographical level. Six local CCGs were also combined to form the Humber, Coast and Vale geographical area, which has also ceased to exist. It has been replaced by the Humber and North Yorkshire ICS. However, data will still be available at Humber, Coast and Vale geographical level, and will be presented within our JSNA.

Headlines

• Access to routine care and emergency treatment from March 2020 to the end of 2021 was severely impacted by the COVID-19 pandemic. To limit COVID-19 transmissions, dental practices were instructed to close and cease all routine dental care from the 25th March 2020 to 8th June 2020. However, in reality many practices did not offer routine appointments again until Spring / Summer 2021. Routine check-ups will pick up dental problems early, and it is likely that with no routine check-ups the numbers of people requiring further additional treatment or more severe treatment will increase. This will be compounded as most dental surgeries when they did open had a backlog of patients requiring check-ups and treatment.
• For 2021/22, Hull had 141 dentists which is quite high relative to England (54 versus 43 dentists per 100,000 population), although it is likely that a relatively high number of residents of neighbouring East Riding of Yorkshire use dental services in Hull. The fact that there are 34 dentists per 100,000 population in East Riding of Yorkshire supports this view.
• For 2021/22, national statistics quote that 48.8% of adults had attended a dental appointment within the last two years (compared to 36.9% for England). However, it is likely that the national figures are misleading as it is based on Hull residents and it is likely that a relatively high percentage of Hull dentists treat East Riding of Yorkshire residents. It is not known exactly how many East Riding of Yorkshire residents attend Hull dentists, but if the percentages are similar to those registered with Hull GPs (9%) then it is estimated that around 44.4% of adults living in Hull had a dental appointment in the last two years.
• For 2019/20, national statistics quoted that 65.4% of adults in Hull had attended a dental appointment within the last year (compared to 49.6% for England). With an ‘adjustment’ for East Riding of Yorkshire residents, this percentage fell to around 60% . So the impact of the COVID-19 pandemic is evident with substantially fewer adults having attended a dental appointment in the last two years.
• From a local survey in 2011, around 70% of men and 76% of women aged 16+ years had seen a dentist within the last two years.
• From the GP patient survey, the percentage of patients aged 18+ years who were registered with Hull GPs who had successfully obtained an NHS dental appointment in the last two years fell slightly from 96.7% to 94.2%. However, as stated above, access was more limited during the COVID-19 pandemic, and the percentage fell to 70.2% for 2020/21 (which was lower than England at 77.0%). As the data is for the percentage who had obtained an appointment in the last two years, it is possible that the majority of those who were successful had had an appointment prior to March 2020.

The Population Affected – Why Is It Important?

Dental caries is the one of the most common health problems in the world, although the national adult survey conducted during 2009 showed that there has been a “continuation of improvement in younger age groups, first detected over 20 years ago, are now evident up to age 45. However, for those who do have decay or gum problems, disease can be extensive, whilst for many people in old age and older middle age, dental needs are very complex. Good health behaviours, such as regular brushing, are shown to be associated with better health and a greater proportion of dentate adults than ever before are engaging in these behaviours. The large majority of adults also indicate that they are attending the dentist at least once every two years, and do not have problems accessing the NHS dental service.” Action on Smoking and Health also state that gingivitis and periodontitis (gum disease), tooth loss and tooth discolouration may also be caused or aggravated by smoking.

The NHS website explains that the state of a person’s teeth affects their overall health, with gum disease linked to lots of health problems in other parts of the body. Gum disease may increase their risk of health conditions such as stroke, diabetes, heart disease and heart attacks and rheumatoid arthritis. It has also been linked with problems in pregnancy and dementia.

Gum disease is an infection of the tissues that support the teeth and is mainly caused by bacteria from plaque build-up. In some people who are susceptible to gum disease, the body over-reacts to the bacteria around the gums and causes too much inflammation, and in others, the inflammation doesn’t clear up properly. The result of the intense gum inflammation is that it also affects the bloodstream, and is believed to slowly damage blood vessels in the heart and brain over a long period of time.

One factor that will make the biggest differences to people’s oral health is using appropriate levels of fluoride as it can strengthen tooth enamel making it more resistant to tooth decay and reduces the amount of acid that the bacteria on teeth produce. Fluoride occurs naturally in many foods and is present in water supplies (and is sometimes added to drinking water). It is also added to toothpaste and can be applied to teeth as varnishes or gels. The Oral Health Foundation state that adding fluoride to water has shown to reduce tooth decay by 40-60%.

The Hull Picture

Number of Dentists in Hull

For 2021/22, Hull has a relatively high number of dentists (who undertook at least some NHS work during the financial year) with 141 dentists in Hull which equates to 54 dentists per 100,000 population, compared to 43 dentists per 100,000 population for England. It is not known how many residents of neighbouring East Riding of Yorkshire use dental services in Hull, but it is likely that a sizeable proportion do so. The fact that there are 34 dentists per 100,000 population in East Riding of Yorkshire supports this view. Between 2011/12 and 2021/22, there have been between 51 and 59 dentists per 100,000 population in Hull.

Percentage Attending A Dental Appointment in Last Two Years

Based on the local adult Health and Lifestyle Survey 2011-12, around 70% of men and 76% of women had seen a dentist within the last two years. Three-quarters of respondents reported their last dental visit was to an NHS dentist, 15% had seen a private dentist while 6% did not know whether their dentist was NHS or private, and 2.5% said they had never been to a dentist.

National information is available on the number and percentage of adults who were seen by a dentist in the previous 24 months for 2021/22. It is likely that the numbers visiting a dentist within the last two years were affected by the COVID-19 pandemic.

For 2021/22, in Hull, 98,267 adults had seen a dentist within the last two years. They further estimate that this represents 48.8% of the adult population aged 18+ years (using the Office for National Statistics 2020 resident population estimate of 201,541 for Hull’s population aged 18+ years). This is fifth highest out of 106 Place Integrated Care Board geographical areas.

It is likely that this percentage is an over-estimate as it is likely that some adults seen by Hull dentists live in East Riding of Yorkshire. It is not known how many patients of Hull dentists live outside Hull, but from the general practice (GP) information (see Population Estimates under Population) around 27,000 residents of East Riding of Yorkshire are registered with Hull GPs (or around 9% of all registered patients). If the a similar number of East Riding of Yorkshire residents use Hull dentists as for GPs, then it is estimated that around 8,844 of the 98,267 dental patients would live in East Riding of Yorkshire (9%) and an estimated 89,423 patients would live in Hull. Using the population estimate of 201,541 residents aged 18+ years, this would give an adjusted attendance rate of 44.4% for Hull. It is not know how accurate this ‘adjustment’ is, but even with this adjustment, the percentage in Hull is considerably higher than England (36.9%). The number of dentists per 100,000 population mentioned above also supports the view that East Riding of Yorkshire residents are registered with Hull dental practices (54 dentists for Hull, 43 dentists for England and 34 dentists for East Riding of Yorkshire per 100,000 population for 2021/22).

In 2019/20, national statistics quoted that 65.4% of adults in Hull had attended a dental appointment within the last year (compared to 49.6% for England). With an ‘adjustment’ for East Riding of Yorkshire residents, this percentage falls to around 60%. So the impact of the COVID-19 pandemic is evident with substantially fewer adults having attended a dental appointment in the last two years for 2021/22 compared to 2019/20.

Access to Dental Services and Satisfaction

A total of 4,224 (34%) people in Hull (out of 12,458 invited) took part in the GP Patient Survey and answered questions on the dental section between January and March 2021. Data is reported at the Clinical Commissioning Group (CCG) geographical level as it includes patients registered with Hull GPs so will include some East Riding of Yorkshire residents. The response rate was considerably lower in Hull than England (47%).

Out of the 4,111 people answering the question, 12% had tried to obtain an NHS dental appointment for themselves in the last three months, 8% 3-6 months ago, 17% 6-12 months ago, 23% 1-2 years ago, 16% more than two years ago and 24% had never tried to get an NHS appointment. Of the 2,018 trying to get an appointment in the last two years, 84% were trying to get an appointment with a practice they had previously had an appointment and 9% with a new NHS practice (and 7% could not remember). Of the 2,409 who had tried to get an appointment in the last two years, 67% were successful in getting an appointment, 27% were not and 6% could not remember. These 2,407 people were asked about their overall experience of NHS dental services: 43% stated they were very good, 33% fairly good, 12% as neither good nor poor, 6% as fairly poor and 3% as very poor. Of the 1,520 people who hadn’t tried to get an NHS dental appointment in the last two years, 33% stated that they hadn’t needed to go to the dentist, 9% no longer had any natural teeth, 3% hadn’t had time to go to the dentist, 10% don’t like going to the dentist, 9% didn’t think they could get an NHS dentist, 1% stated they were on a waiting list for an NHS dentist, 5% stated they had stayed with their dentist when they changed from NHS to private, 14% prefer to go to a private dentist and 6% said NHS dental care is too expensive (and 11% provided another reason).

The most recent GP Patient Survey conducted during January and March 2022 included a dental health survey, but the results are presented for the entire Humber and Yorkshire Health and Care Partnership (Integrated Care System) and not for each ‘Place’ separately. Across the Humber and Yorkshire Health and Care Partnership, 21,107 completed forms were received (36% response rate which was higher than England at 29%), and 19%, 13%, 11%, 10%, 21% and 26% had tried to get an NHS dental appointment for themselves in the last 3 months, 3-6 months, 6-12 months, 1-2 years, more than two years and never tried to get an appointment respectively. Overall, 85% had tried to get an appointment the last time they tried to make an appointment with the same dental practice they had been to previously. Among those who had tried to get an NHS appointment in the last two years, 73% had obtained an appointment, 13% had not because no appointment were available, 8% had not because the dental practice was not taking on new patients, and 6% had not obtained an appointment for another reason (2% couldn’t remember). Among this cohort, 42%, 29%, 10%, 8% and 11% described their experience as very good, fairly good, neither good nor poor, fairly poor and very poor respectively. Of those who had not obtained an appointment in the last two years, 22% stated they hadn’t needed to visit the dentist, 6% didn’t like going to the dentist, 17% didn’t think they could get an NHS dentist, 3% were on a waiting list for a dentist, 30% preferred to go to a private dentist, 4% stated dental care is too expensive, and 18% gave another reason for not needed to make a dental appointment in the last two years.

The Office for Health Improvement & Disparities’ Fingertips gives the percentage of people who successful obtained a dental appointment in the last two years with the latest data for 2020/21 (from the GP Patient Survey mentioned above). In 2020/21, seven in ten had successfully obtained a dental appointment in the last two years in Hull which was lower than England (77%).

The percentage who had successfully obtained a dental appointment in the last two years in Hull has been marginally decreasing in Hull between 2015/16 from 96.7% to 94.2% in 2019/20. In those last three years, access to NHS dental services among patients aged 18+ years registered with Hull GPs was comparable or slightly lower than England.

However, it would appear that access to NHS dental services was worse in Hull during the COVID-19 pandemic as the decrease in access was greater in Hull compared to England or the Yorkshire and Humber region.

Impact of COVID-19 Pandemic

Access to routine care and emergency treatment from March 2020 to the end of 2021 was severely impacted by the COVID-19 pandemic. To limit COVID-19 transmissions, dental practices were instructed to close and cease all routine dental care from the 25th March 2020 to 8th June 2020. This included all routine dental care including orthodontics, all aerosol generating procedures, offering patients with urgent needs appropriate advice and prescriptions over the telephone, and ceasing all face-to-face urgent care. However, in reality, many practices did not offer routine check-up appointments again until Spring / Summer 2021. Routine check-ups will pick up dental problems early, and it is likely that with no routine check-ups the numbers of people requiring further additional treatment or more severe treatment will increase. This will be compounded as most dental surgeries when they did open had a backlog of patients requiring check-ups and treatment.

Strategic Need and Service Provision

Hull’s Oral Health Advisory Group was established to allow for partnership working between the local authority, NHS England, Hull CCG, The Office for Health Improvement & Disparities (formerly Public Health England), and the Local Dental Committee. Input from local dental providers and other key stakeholders in this group should also underpin the development of dental commissioning and oral health improvement strategies to ensure that local people’s oral health needs are met. These strategies should be based upon national evidence-based guidance.

Strategies and priorities include:

• To ensure that people have appropriate levels of fluoride (whether this is through toothpaste, fluoride varnishes, or fluoridation of the water).
• To ensure that everyone who needs it has access to good NHS dental services, and that sufficient information is provided to residents to allow them to understand the value of having regular check-ups.
• Support for prevention-orientated NHS dental services. It is necessary to explore equity of access and barriers to NHS dental services particularly for people from more vulnerable groups.

Maintaining good oral health throughout life and into older age improves general health and wellbeing, and plays an important part in helping people stay independent. The Care Quality Commission report Smiling Matters: Oral Health Care in Care Homes showed that too many people living in care homes were not being supported to maintain and improve their oral health. The report contained recommendations to improve the oral health of care home residents, including the implementation of the National Institute of Health and Clinical Excellence (NICE) guideline Oral Health for Adults in Care Homes.

It is recommended that:

• People who use services, their families and carers need to be made more aware of the importance of oral care.
• Care home services need to make awareness and implementation of the NICE guideline ‘Oral health for adults in care homes’ a priority.
• Care home staff need better training in oral care.
• The dental profession needs improved guidance on how to treat people in care homes.
• Dental provision and commissioning needs to improve to meet the needs of people in care homes.
• NICE guideline ‘Oral health for adults in care homes needs to be used more in regulatory and commissioning assessments.

It will be necessary to have plans in place to reduce the impact of the COVID-19 pandemic given that many people had no access to routine (or emergency) dental care for at least 18 months. This is also likely to impact on the most vulnerable groups.

Resources

NHS Digital. Adult Dental Health Survey 2009 – Summary report and thematic series: https://digital.nhs.uk/data-and-information/publications/statistical/adult-dental-health-survey/adult-dental-health-survey-2009-summary-report-and-thematic-series

Action on Smoking and Heath. https://ash.org.uk/

NHS. The health risks of gum disease: https://www.nhs.uk/live-well/healthy-body/health-risks-of-gum-disease/

Oral Health Foundation: https://www.dentalhealth.org/

Care Quality Commission. Smiling Matters: Oral Health Care in Care Homes. https://www.cqc.org.uk/publications/major-report/smiling-matters-oral-health-care-care-homes

National Institute of Health and Clinical Excellence. Recommendations: Oral Health for Adults in Care Homes. https://www.nice.org.uk/guidance/ng48/chapter/Recommendations

NHS Digital. https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics

Hull’s Health and Wellbeing Surveys

NHS England. GP patient survey dental statistics: https://www.england.nhs.uk/

The Office for Health Improvement & Disparities’ Fingertips: https://fingertips.phe.org.uk/

Hull Oral Health Advisory Group Terms of Reference: https://cmis.hullcc.gov.uk/CMIS/Document.ashx?czJ (Hull OHAG Terms of Reference)

Updates

This page was last updated / checked on 2 November 2022.

This page is due to be updated / checked in August 2023.