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. There is some information relating to oral cancers within Cancer under Health Factors under Adults.

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).

Headlines

• Access to routine care and emergency treatment from March 2020 to the end of 2021 was severely impacted by the COVID-19 pandemic. When practices did reopen, they had a backlog of patients requiring care. Furthermore, it is likely that the cost of living crisis has impacted adversely on oral health. From anecdotal evidence, access to dental care can be difficult with a relatively high percentage of people not registered with a dental surgery or on long waiting lists to register with an NHS dental surgery.
• For 2023/24, Hull had 119 dentists who provided some NHS activity which is similar to England (44 versus 43 dentists per 100,000 resident population), although it is likely that some residents of neighbouring East Riding of Yorkshire use dental services in Hull. The fact that there are 30 NHS dentists per 100,000 population in East Riding of Yorkshire lends support to this view, although it is also possible that there are more private dentists in East Riding of Yorkshire who provide no NHS dental care. There is one dentist per 2,259 population in Hull for 2023/24.
• The number of dentists in Hull providing some NHS dental care has fallen relatively sharply in the last 2-3 years. In 2020/21, there were 141 dentists in Hull who provided some NHS activity giving a rate of 54 dentists per 100,000 population. It is not known if the decrease represents a reduction in dentists overall or a reduction in the number of dentists providing some NHS care (with some dentists changing from offering some NHS care to offering an entirely private service).
• For 2023/24, national statistics quote that 51.3% of adults had attended an NHS dental appointment within the last two years (compared to 40.3% for England and 36.6% for neighbouring East Riding of Yorkshire). However, it is possible that the national figures are misleading as it is based on Hull residents and it is likely that some 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 (8%) then it is estimated that around 47.2% of adults living in Hull had a dental appointment in the last two years. With Hull’s high levels of deprivation, it is likely that a higher percentage of Hull’s residents seek dental care from the NHS rather than privately compared to England or East Riding of Yorkshire residents, which will influence the percentages attending an NHS dental appointment.
• 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.
• The GP Patient Survey includes information on dental health, however, since 2021, the results are only presented at Integrated Care Board level and not for Hull (at sub ICB level). From the GP Patient Survey (January to March 2024), for the Humber and North Yorkshire Integrated Care Board level (which covers Hull, East Riding of Yorkshire, North Lincolnshire, North East Lincolnshire, Vale of York and North Yorkshire), 54% had tried to obtain an NHS dental appointment in the last two years with 20% trying more than two years ago and 26% having never tried to get an NHS dental appointment. Of those who had tried to obtain an NHS dental appointment in the last two years, 71% were successful in getting an appointment, although the success rate differed depending on whether or not the person had attended that specific NHS dental surgery previously with a much lower success rate if the person had not attended that dental surgery previously (83% versus 21%). Of those who had not tried to obtain an NHS dental appointment in the last two years, 17% stated they hadn’t needed a dentist, 5% stated they didn’t like going to the dentist, 25% thought they couldn’t get an NHS dentist, 5% were on a waiting list for an NHS dentist, 29% preferred to go to a private dentist, 4% thought dental care was too expensive, and the remaining 15% stated there was another reason they hadn’t needed to make an NHS dental appointment in the last two years.

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 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 a pathological inflammatory response that arises in the tissues supporting teeth in response to bacteria in plaque. 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. Gum disease contributes to loose teeth, teeth falling out and bad breath, but it can also affect the bloodstream, and is believed to slowly damage blood vessels in the heart and brain over a long period of time. 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.

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 NHS Dentists in Hull

The number of dentists in Hull providing some NHS activity has decreased in the last few years in Hull, but are still similar to England for 2023/24 with 44 dentists per 100,000 resident population compared to 43 for England.

It is not known if the decrease represents a reduction in dentists overall or a reduction in the number of dentists providing some NHS care (with some dentists changing from offering some NHS care to offering an entirely private service).

Year	Total dentists	Population per dentist	Dentists per 100,000 resident population
2019/20	134	1,939	52
2020/21	141	1,838	54
2021/22	132	2,019	50
2022/23	119	2,259	44

However, it should be noted that the rates are given out of Hull’s resident population and this could be potentially misleading. 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 30 dentists per 100,000 population in East Riding of Yorkshire who provided some NHS activity for 2023/24 lends support to this view. However, this is counterbalanced with the likelihood that there might be more dentists in East Riding of Yorkshire who are entirely private and register no NHS dental activity. Due to Hull’s increased deprivation relative to both England and East Riding of Yorkshire, it is likely that there are fewer (solely) private dentists in Hull.

The national figures above are given as the number of dentists who undertook at least some NHS work during the financial year, but not the number of full-time equivalent (FTE) posts so it is possible that there are differences in the number of hours worked or the number of people seen for each dentist. However, the above figures do give a guide as to the number of dentists working in each local area who are providing some NHS dental care.

Percentage Who Have Seen an NHS Dentist in Last Two Years

National information is available on the number and percentage of adults who were seen by a dentist in the previous 24 months for 2023/24. However, the recent numbers visiting a dentist have been greatly affected by the COVID-19 pandemic and the resulting backlogs.

In 2023/24, in Hull, 108,237 adults had seen a dentist in the previous two years and with an adult resident population of 210,867 for the Hull, this represents 51.3% of Hull’s adult population having seen an NHS dentist in the last two years. This percentage is ranked 31 highest out of the 295 lower-tier local authorities in England. The percentage is higher than England (40.3%) and neighbouring East Riding of Yorkshire (36.6%).

It is likely that this percentage is an over-estimate as it is likely that some adults seen by Hull’s NHS 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) over 25,000 residents of East Riding of Yorkshire are registered with Hull GPs (or 8% of all registered patients). If a similar number of East Riding of Yorkshire residents use Hull dentists as for GPs, then it is estimated that around 8,659 of the 108,237 people who have seen an NHS dentist in the last two years would live in East Riding of Yorkshire (and 99,578 people would live in Hull). Based on the mid-year 2022 population estimate for Hull, it is estimated that there are 210,867 adults living in Hull. This would give an adjusted attendance rate of 47.2% 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 (40.3%) although applying the adjustment to East Riding of Yorkshire would increase its percentage to 39.6%. The number of dentists per 100,000 population mentioned above also lends support to the view that East Riding of Yorkshire residents are registered with Hull dental practices, however, it is also recognised that people in East Riding of Yorkshire will be more likely to be registered for dental care privately.

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 2023/24 compared to 2019/20.

State of Oral Health

Detailed oral health survey information is not available for Hull, but a national adult oral health survey have been completed in England with the latest one in 2021. This survey can give an indication of the oral health and care needs of adults in England and elsewhere. Women, people aged 35+ years, people living in the East of England or South West England, and people who lived in the least deprived three-fifths of areas of England were more likely to participate which could impact on the generalisability of the findings. The results were weighted to tempted to adjust for the differential in response rates between these groups. However, it is also more likely that people who were more interested in the topic including people who have had more oral health problems would be more likely to participate in an oral health survey.

In the national survey conducted during early 2021, 6,343 adults participated from 4,429 households (24% of eligible addresses took part and 76% of individuals took part within participating households). Two-thirds of adults reported they had very good or good oral health, with 26% reporting fair oral health and 7% reporting they had bad or very bad oral health. Almost all of those surveyed (95%) had at least one tooth (were dentate), and on average dentate adults had 25.4 natural teeth. Just over three-quarters (77%) brushed their teeth at least twice a day and more than half (59%) used an electronic toothbrush. Almost two-thirds (63%) went to the dentist for regular check-ups, 15% went for occasional check-ups and 18% only went to the dentist when they had problems. One-third stated that the cost of dental care had affected the type of dental care or treatment they had received, and one-quarter had delayed treatment due to cost. Nearly half (47%) had experienced one or more oral health impacts in the previous year, with being self-conscious (28%), finding it uncomfortable to eat any foods (24%) and having had painful aching in their mouth (20%) were the most commonly reported impacts. One in five (21%) reported at least one severe oral impact that had affected their daily life in the last year.

Access to Dental Services and Satisfaction Across Humber and North Yorkshire

Information on access and satisfaction with local dental services is collected within the GP Patient Survey. This survey is conducted regularly with an update relating to dental services available every year covering survey responders completing the survey between January and March. However, since 2021, the information is no longer available for Hull, and is presented at an Integrated Care Board level with information presented for the Humber and North Yorkshire Integrated Care Board level (which covers Hull, East Riding of Yorkshire, North Lincolnshire, North East Lincolnshire, Vale of York and North Yorkshire).

For the January and March 2024 survey, a total of 54,698 survey forms were distributed the Humber and North Yorkshire Integrated Care System geographical area with 18,639 forms received giving a response rate of 34% which was higher than England (27%). Response rates are generally lower among younger populations and for people living in more deprived areas, so it is likely that the responses for Hull are underrepresented within the ICB geographical area.

Of the 20,184 answering the question (not sure why this is higher than the number of forms returned), 21% had tried to get an NHS dental appointment for themselves in the last three months, 14% 3-6 months ago, 12% 6-12 months ago, 7% 1-2 years ago, 20% more than two years ago and 26% had never tried to get an NHS appointment. Of the 10,930 people who tried to get an NHS dental appointment in the last two years who answered the question, 83% were trying to get an appointment with a practice they had previously had an appointment and 14% with a new NHS practice (and 3% could not remember). Of the 11,289 who had tried to get an appointment in the last two years who answered the question, 71% were successful in getting an appointment, 2% could not remember and the remaining stated they were not successful as there were no appointments (9%), the dentist was not taking on new patients (13%) or for another reason (6%). Of the 10,907 who had tried to get an appointment in the last two years who answered the question, 41% stated that their experience was very good, 26% fairly good, 11% as neither good nor poor, 7% as fairly poor and 15% as very poor.

Of the 9,038 people who tried to get an NHS dental appointment in the last two years and had been to the dental surgery previously, 83% were successful in obtaining an appointment, 1% could not remember, 7% stated no appointments were available, 5% stated their dentist was not taking on new patients, and 6% gave another reason why they were not successful in obtaining an appointment. Of the 1,525 people who tried to get an NHS dental appointment in the last two years and had not been to that dental surgery previously, 21% were successful in obtaining an appointment, 3% could not remember, 22% stated no appointments were available, 59% stated the dentist was not taking on new patients, and 8% gave another reason why they were not successful in obtaining an appointment.

Of the 9,022 people who hadn’t tried to get an NHS dental appointment in the last two years who answered the question, 17% stated that they hadn’t needed to go to the dentist, 5% stated that they don’t like going to the dentist, 25% stated they didn’t think they would be able to get an NHS dentist, 5% stated they were on a waiting list for an NHS dentist, 29% prefer to go to a private dentist, 4% said NHS dental care is too expensive, and 15% provided another reason for not trying to get an appointment.

Oral Cancer

Routine dental check-ups generally include screening for other oral health conditions including oral cancers. Hull has a relatively high incidence oral cancer, and further information can be found within Cancer under Health Factors under Adults. Other public health programmes of work link with oral health which include vaccinations for human papillomarvirus (HPV) as well as initiatives around tobacco and smoking. Further information can be found within Screening and Vaccinations under Health Factors under Children and Young People, and within Smoking and Vaping under Lifestyle Factors under Adults.

Impact of COVID-19 Pandemic, Cost of Living Crisis and Access to Dental Surgeries

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.

It is possible that the cost of living crisis has further impacted adversely on oral health. With an increasing number of people having problems affording to heat their home and provide adequate food for their family, it is likely that there will be more people not buying toothpaste or new toothbrushes, and not accessing dental health care. Dental health care for adults – even on the NHS – incurs a cost, and despite dental health care being free for children, it may incur additional costs in terms of taking time off work to accompany children and travel costs.

From anecdotal evidence, access to dental care can be difficult with patients not being able to access care if their dentist leaves the profession and dental surgery struggles to recruit a replacement, other people have been left without a dentist if their dentist or dental surgery changes from providing NHS care to entirely private (and they chose not to remain with that dentist and pay privately), and there are people who are not registered with a dentist at all, or who are on long waiting lists to register with an NHS dental practice.

Whilst it is not possible to know how many adults in Hull had an oral health problem and needed advice or treatment during the pandemic, the national adult survey conducted in England in early 2021 sheds some light on this and may give an indication of the relative numbers of people involved although it is likely that people who have oral health problems were more likely to participate in the survey compared to those who did not have any oral health problems. From this survey, just over one-third (35%) stated that they had needed treatment or advice during the pandemic for an oral health issue, although this ranged from 22% for those aged 16-24 years to 45% for those aged 75+ years. The most common reasons were for a broken or decayed tooth (36%), and toothache or a pain in the mouth (31%). Almost seven in ten (68%) contacted their usual dental practice for advice or treatment. The problem was completed treated in half of cases by a dental professional or doctor with a further 15% having temporary treatment such as a temporary filling or crown, 15% were given advice on how to manage on their own such as pain relief, 11% were given antibiotics and 4% were given a prescription of pain relief with 10% not receiving any professional help and 14% receiving some other help (sums to more than 100% as some people may have given more than one response). Among those who did not seek help, 9% stated the problem got better without help, 9% didn’t know how to access dental advice or treatment, 7% couldn’t find a dentist that would treat them, 5% couldn’t travel to a dentist, 13% couldn’t afford to pay for treatment, 23% were worried about contracted COVID-19 or were shielding, 3% had COVID-19 or were self-isolating, 30% stated there was some other reason why they did not seek help, 3% stated they didn’t know and 17% preferred not to answer (sums to more than 100% as some people may have given more than one response).

Strategic Need and Service Provision

Hull’s Oral Health Plan – Improving Oral Health for Local People – was produced through partnership working and underpins the local dental commissioning and oral health improvement strategies to ensure that local people’s oral health needs are met. There were five workstreams and activities described falling under:

1. Creating a supportive environment for health;
2. Re-orientating health services;
3. Developing personal skills;
4. Strengthening community action; and
5. Building healthy public policy.

National strategies, priorities and evidence-based guidance 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.

Existing work commissioned by the Integrated Care Board (ICB) and Hull city council include:

• Flexible commissioning contracts commissioned by the ICB which emphasise prevention in practice.
• ICB-commissioned primary care dental access initiatives for those experiencing homelessness, and urgent dental access sessions within Hull, to increase access to dental services.
• ICB are piloting a level 2 paediatric primary care service model to support workforce development and utilisation of skill-mix. This is significantly improving Community Dental Service waiting times for those children requiring consultant-led care.
• Hull city council commissions an oral health promotion service. This includes supervised toothbrushing scheme to the most deprived areas, smoking cessation training to dental providers, workforce training (for those in care homes and early years), health visitor Brush for Life toothbrush and toothpaste packs.

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.

There is an increased challenge related to older people because many have heavily restored dentition, and it becomes more difficult for people to maintain their oral health with dementia and frailty, and being medically compromised significantly impacts on oral health. The percentage of the population who are older is due to increase due to the ageing population and generally higher life expectancy (although often with a higher proportion of time in poor health). There is on-going regular training for care home staff in relation to oral health, but an increased number of older people receive care within their own homes so not all who help with the care of older people receive oral health training, although the more vulnerable older people such as people with dementia and severe frailty rare more likely to live in care homes.

There are other specific groups that are much more likely to have poorer oral health and access to dental services, and it is necessary to improve oral health and access to services for inclusion health groups. In Hull, there is a fixed-term Integrated Care Board commissioned primary dental care initiative to provide dental services for people experiencing homelessness which also includes an element of outreach prevention. However, there is much more that could be done, and such initiatives need to be extended where possible so that all inclusion health groups can improve their oral health and have access to good dental services.

Many existing public health initiatives link with oral health, and this should be considered in relation to improving oral health and physical health in general through opportunities related to delivering services provided by local and national government and the NHS. However, it is recognised that many service are already not provided or stretched due to the current financial setting, so it may not be possible to take advantage of such opportunities. Such links include:

• Stop Smoking Service through the links with oral cancer and gum disease;
• Alcohol and drug services through the links with oral cancer, maxillofacial trauma, tooth wear and decay, and generally poorer oral among people who use drugs);
• Promotion and access to nutritious food including working with Hull Food Partnership through links with reducing sugar and the prevalence of excess weight which both impacts on diabetes and other conditions as well as gum disease, and through improving poor nutrition which links to oral cancer;
• Promotion and improved access to, and addressing vaccine hesitancy in relation to the human papillomarvirus (HPV) vaccination which links to oral cancer;
• Reducing sugar intake which assist in both reducing caries and diabetes.
• Promoting weight management and access to weight management services with links to diabetes which is strongly associated with gum disease.
• Addressing the wider commercial determinants of health to reduce sugar, poor nutrition, tobacco and alcohol.

The impact of the COVID-19 pandemic and its resulting backlogs, cost of living crisis, and access to NHS dental care, it is likely oral health has deteriorated in the last 3-4 years, and furthermore this will impact on inclusion health groups to a greater extent.

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

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

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

UK Government. All Our Health. https://www.gov.uk/government/collections/all-our-health-personalised-care-and-population-health#about-all-our-health

UK Government, 2021. Delivering Better Oral Health. https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention

The Office for Health Improvement & Disparities (previously Public Health England), 2016. Menu of Preventative Interventions. https://assets.publishing.service.gov.uk/media/5a8d9697e5274a5e64c54608/Local_health_and_care_planning_menu_of_preventative_interventions_DM_NICE_amends_14.02.18__2_.pdf

The Office for Health Improvement & Disparities (previously Public Health England), 2018. Commissioning Better Oral Health: vulnerable older people. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/738722/CBOH_VOP_V16_Final_WO_links.pdf

National Institute of Health and Clinical Excellence. Public Health Guidance 55. Oral health, local authorities and partners. https://www.nice.org.uk/guidance/ph55

The Office for Health Improvement & Disparities, 2021. Adult oral health survey 2021 https://www.gov.uk/government/statistics/adult-oral-health-survey-2021

The Office for Health Improvement & Disparities, 2022. The impact of COVID-19 on access to dental care. https://www.gov.uk/government/statistics/the-impact-of-covid-19-on-access-to-dental-care

Updates

This page was last updated / checked on 5 September 2024.

This page is due to be updated / checked in August 2025.