Oral Health Among Children and Young People

This topic area covers statistics and information relating to oral health among children and young people in Hull including local strategic need and service provision. Further information relating Oral Health Among Adults is given under Lifestyle Factors within 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. 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 children and young people requiring further additional treatment or more severe treatment will increase. This has been compounded as most dental surgeries – when they did re-open – had a backlog of patients requiring check-ups and treatment. Furthermore, there is anecdotal evidence that it is increasingly difficult to register with a new dental surgery or obtain an appointment for those not already registered with a surgery.
• The impact of the recent cost of living crisis could have an adverse impact on children’s oral health. With an increasing number of people – from anecdotal evidence – 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. 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.
• For 2021/22, national statistics quote that 51.5% of under 18s in Hull had attended a dental appointment within the last year (compared to 46.2% for England). However, it is likely 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 (9%) then it is estimated that around 46.5% of children and young people aged under 18 years living in Hull had attended a dental appointment in the last year. This represents a decrease compared to prior to the COVID-19 pandemic (69.4% from national figures and 63.1% ‘adjusting’ for East Riding of Yorkshire residents compared to 58.4% for England).
• From Hull’s Health and Wellbeing Survey conducted during 2016, over 80% of secondary school pupils in Hull had attended a dental appointment in the last six months, and 90% had done so in the last year. However 1.6% of boys and 0.9% of girls stated they had never been to the dentist, and a further 2.6% of boys and 2.5% of girls stated they had been to the dentist more than two years ago.
• In the 2018/19 national survey, 31.4% of five year olds in Hull had at least one tooth that was decayed, missing (extracted generally due to decay) or filled compared to 23.4% for England. Children in Hull had more teeth that were decayed, missing or filled overall compared to England, but also more teeth that were missing relative to filled.
• Despite the substantial high levels of tooth decay in Hull, there were substantially fewer hospital admissions for tooth extractions among children and young people. However, it is likely that this is associated with the way services are commissioned in Hull, with tooth extractions being undertaken within specialist dental services in the community.

The Population Affected – Why Is It Important?

Poor dental health impacts not just on the individual’s health but also their wellbeing and that of their family. Children who have toothache or who need treatment may have pain, infections and difficulties with eating, sleeping and socialising.

Poor dental health among children can affect speech, learning to talk and smiling, and as a result can have huge consequences on self-esteem and confidence. There are also associations with poor dental health and other problems such as nutritional deficiencies.

Nationally, a quarter of five year-olds have tooth decay. Children who have toothache or who need treatment may have to be absent from school and parents may also have to take time off work to take their children to a dentist or to hospital.

Oral health is therefore an important aspect of a child’s overall health status and of their school readiness.

The Hull Picture

Time Since Last Dental Appointment

From the local Young People Health and Wellbeing Survey conducted during 2016, over 80% of secondary school pupils had attended a dental appointment in the last six months, and this ranged from 79.6% for year 7 boys (aged 11-12 years) to 84.0% for year 9 boys (aged 13-14 years) and from 80.3% for year 7 girls to 87.4% for year 9 girls.

Over 90% of secondary school pupils had attended a dental appointment in the last year, and this was lowest in the youngest pupils and oldest in year 11 (aged 15-16 years).

Around 1.6% of boys and 0.9% of girls stated they had never been to the dentist, and a further 2.6% of boys and 2.5% of girls stated they had been to the dentist more than two years ago.

National information is available on the percentage of children who have attended a dental appointment in the last year for each local authority. The numerator is the number attending a dental appointment for dental practices within the local authority boundary, but the denominator is the estimated resident population for that local authority. In Hull, it is highly likely that East Riding of Yorkshire residents are registered with Hull dentists and are included in the numerator. However, they are not included in the denominator. Around 9% of all patients registered with Hull general practices (GPs) live in East Riding of Yorkshire (around 27,000 patients in total), and it is possible that a similar pattern exists with regard to cross-boundary flows in dentistry. In the national dataset, 29,442 children aged under 18 years had attended a dental appointment in the last year during 2021/22. With an estimated resident population of 57,585 children aged under 18 years, this gives a percentage of 51.1% as quoted in the national dentistry dataset. If it is assumed that 2,650 of the 29,442 dental attendees live in East Riding of Yorkshire (9%) and 26,792 live in Hull, then this would give an ‘adjusted’ estimate of 46.5% for the percentage of under 18s in Hull attending a dental appointment in the last year. With the adjustment, this percentage is similar to England at 46.2%.

For 2021/22, Hull had 141 dentists which equates to 54 per 100,000 population. This is high relatively to England (43 dentists per 100,000 population). East Riding of Yorkshire had 34 dentists per 100,000 population which supports the view that East Riding of Yorkshire residents are registered with Hull dental practices.

Dental Decay Recorded From National Surveys

There have been national Oral Health Surveys among three, five and twelve year olds undertaken previously where results are presented at local authority level, but only the survey among five year olds is regularly completed (generally every two years).

Oral Health Survey of Three Year Olds

The last survey completed among three year olds was undertaken during 2012/13. It is not known if the situation in 2012/13 reflects the current state of dental health among three year olds or not. It would be hoped that dental health would have improved since 2012/13, although likely that health inequalities still exist.

In 2012/13, 84.6% of three year olds in Hull were free of dental decay compared to 88.4% in England. Thus, 15.4% of three year olds in Hull had some dental decay compared to 11.6% for England. On average, three year olds in Hull had 0.32 teeth that were decayed, missing, filled compared to 0.36 for England. A missing tooth in this context denotes a tooth missing because it has been extracted (due to dental decay).

The numbers surveyed in Hull were relatively small with only 66 three year olds participating in the survey (out of an estimated 3,469 three year olds living in Hull at the time). It is not known how representative the sample of three year olds was in relation to all three year olds living in Hull at the time particularly as it is not very easy to survey this age group. It is likely that during 2012/13, three year olds who were attending nurseries might be different to those who did not attend nurseries which could bias the results and make the findings not representative of all of Hull’s three year olds at the time. Therefore, results should be interpreted cautiously.

Oral Health Survey of Five Year Olds

A summary measure of the Oral Health Survey among five year olds is given on The Office for Health Improvement & Disparities’ Fingertips. Among five year olds surveyed in Hull in 2018/19, almost one-third (31.4%) had one or more decayed, missing of filled teeth in Hull compared to just over one-fifth in England (23.4%). On average, children in Hull had 1.13 teeth that were decayed, missing or filled compared to 0.80 for England.

Further data on this survey is also available at local authority level from the national report and datasets. On average, children in Hull had 1.13 teeth that were decayed (0.89 or 79%), missing (0.17 or 15%) or filled (0.07 or 7%) compared to 0.80 for England (0.63 or 79% decayed, 0.09 or 11% missing, and 0.08 or 10% filled). Thus children in Hull had more teeth that were decayed, missing or filled overall, but also more teeth that were missing relative to filled. Among the children that had at least one decayed, missing or filled teeth, on average, these children had 3.6 decayed, missing or filled teeth compared to 3.4 for England. In Hull, 3.5% of five year olds had substantial plaque compared to 1.2% in England, 1.7% had oral sepsis (1.0% in England) and 7.7% had incisor caries (5.2% in England).

In Hull, during the 2018/19 survey, 245 five year olds were examined (approximately 70% of the sample drawn which was higher than England at 61%). So the overall numbers surveyed in Hull is relatively small, and it is not known if those examined (70% of sample selected) differed from those who were not examined (30% of the sample selected). Schools are randomly chosen to take part in the survey. Lists of all five year olds were drawn up at the selected schools. For small schools, every five year old was invited to participate and in larger schools it was one in every two, or one in every three or four children. Schools can refuse to take part and if schools in more deprived areas refuse to take part this could bias the findings. Furthermore, parents can refuse permission to participate and/or the children themselves can refuse to take part, and it is likely that five year olds with poor dental health or who have not regularly attended a dental appointment will be more likely to not want to participate in the dental examination. This could bias the findings, but in general, it is likely that the findings are reasonably representative of Hull’s five year olds especially in Hull as most schools approached agreed to take part.

Fingertips also presents some information in relation to the trends over time. The percentage of children with experience of visually obvious dental decay among five year olds has improved in Hull between 2007/08 and 2018/19. In the surveys conducted during 2007/08 and 2011/12, more than four in ten of the five year olds had dental decay compared to around three in ten for England.

The average number of teeth that were decayed, missing or filled in 2014/15 in Hull was 1.55, but this had fallen to 1.13 for both 2016/17 and 2018/19. The average number for England for the three years was around 0.8 teeth considerably lower than Hull.

Oral Health Survey of Twelve Year Olds

The last survey completed among twelve year olds was undertaken during 2008/09. As the survey was undertaken more than a decade ago, it is likely that it does not reflect the current state of dental health among 12 year olds. It would be hoped that the situation would have improved. Whilst it might not be sensible to examine the findings in relation to the actual levels of decay, it is likely that the health inequalities to this extent still exist between Hull and England.

In 2008/09, among 12 year olds, 60.9% of children were free from dental decay in Hull compared to 66.4% for England. Thus, 39.1% of 12 year olds in Hull had some dental decay compared to 33.6% for England. On average, 12 year olds in Hull had 0.84 teeth that were decayed, missing or filled compared to 0.74 teeth in England. It was estimated that there were 3,089 12 year olds living in Hull in 2008, and a sample of 269 of them were drawn to participate in the dental survey but only 159 (59%) of them did so. It is not known how representative the sample of 12 year olds surveyed are in relation to all the 12 year olds living in Hull at the time. It is possible that they were reasonably representative of 12 year olds at the time, but the fact that the survey was undertaken so long ago means that results should be interpreted very cautiously.

Tooth Extractions Occurring in Hospital

Information is also available on the number of tooth extractions of permanent teeth which occur in hospital for those aged 0-19 years. The majority of extractions are due to dental decay particularly among younger children.

There were 35 tooth extractions for caries in 2020/21 among Hull children aged 0-19 years and a further 40 tooth extractions with no diagnosis of caries which occurred in hospital during 2020/21.

There is a strong association with deprivation nationally. In 2020/21, there were 177 admissions for teeth extractions due to caries per 100,000 population for the most deprived fifth of areas of England and the rate steadily decreased to 56 admissions per 100,000 population among children living in the least deprived fifth of areas of England. There was a strong trend over the five groups (177, 120, 93, 78 and 56 for the five deprivation fifths).

Despite the substantial high levels of tooth decay in Hull and the strong association between deprivation and admissions, there were substantially fewer hospital admissions for tooth extractions among children aged 0-19 years in Hull compared to the region or England. The very low rates of hospital admissions for tooth extractions among children in Hull are likely associated with the way the services are commissioned in Hull, and tooth extractions are being undertaken within specialist dental services in the community rather than as hospital admissions.

For 2020/21, for tooth extractions that occurred in hospital among Hull children, two-thirds were due to tooth decay among those aged 0-5 years and three-quarters were due to tooth decay among those aged 6-10 years (data was suppressed for older age groups due to the small number of extractions) with 50% of all tooth extractions across those aged 0-19 years due to tooth decay. For all children in the Yorkshire and Humber region, 89%, 86%, 51% and 27% of tooth extractions were due to tooth decay among those aged 0-5, 6-10, 11-14 and 15-19 years respectively (75% overall). For England, these percentages were 83%, 84%, 40% and 24% (65% overall).

Age	Hull N	Hull rate	Y&H rate	England rate
0-5	10	50.2	231	113
6-10	15	87.8	441	215
11-14	*	*	95.3	60.3
15-19	*	*	36.6	28.1
0-19	35	54.8	212	110

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 children and young people requiring further additional treatment or more severe treatment will increase. This has been compounded as most dental surgeries – when they did re-open – had a backlog of patients requiring check-ups and treatment. Furthermore, there is anecdotal evidence that it is increasingly difficult to register with a new dental surgery or obtain an appointment for those not already registered with a surgery.

Impact of Cost of Living Crisis

The impact of the recent cost of living crisis, with a high inflation rate and increased costs particularly relating to energy and food, could have an adverse impact on children’s oral health. With an increasing number of people – from anecdotal evidence – 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. 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.

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 Clinical Commissioning Group (and its successor), 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. Strategies for children’s oral health promotion are based on evidence-based national guidance for local authorities. An oral health needs assessment is currently being completed by Hull’s public health team which will aim to identify gaps in service provision and identify strategic needs.

Existing strategies and priorities for children’s oral health improvement include:

• To ensure that children have appropriate levels of fluoride (where necessary facilitated through supervised tooth-brushing or provision of dental packs including fluoride toothpaste by health visitors and fluoride varnishes).
• To ensure that everyone who needs it has access to good NHS dental services, and that parents are supported and provided with information to emphasise the importance of their child having regular check-ups. There should be support for prevention-orientated NHS dental services.
• It is necessary to explore equity of access and barriers to NHS dental services particularly for children from more vulnerable groups.

Despite the high levels of tooth decay in Hull, there were substantially fewer hospital admissions for tooth extractions (based on national hospital data) among children aged 0-14 years, although rates were higher among young people aged 15-19 years, they were still considerably lower than England. The low rates of hospital admissions for tooth extractions in Hull are likely associated with the way the services are commissioned in Hull, with some tooth extractions are being undertaken in specialist dental services in the community.

There is a strong association with deprivation and hospital admissions for tooth extractions among children nationally, and as Hull has high levels of deprivation it is expected that tooth extractions would be higher. Further information about tooth extractions in Hull may then help to inform the local Oral Health Strategy.

It will be necessary to have plans in place to reduce the impact of the COVID-19 pandemic given that many children and young 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 of children and young people. The cost of living crisis is also likely to have an adverse impact on children’s oral health and measures should be in place to minimise this impact.

Resources

The Office for Health Improvement & Disparities (formerly Public Health England) Health Matters blog on oral health in children

https://www.gov.uk/government/publications/health-matters-child-dental-health/health-matters-child-dental-health

Hull’s Young People Health and Wellbeing Survey 2016

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

Oral health survey of 5-year-old children 2019: https://www.gov.uk/government/statistics/oral-health-survey-of-5-year-old-children-2019

The Office for Health Improvement & Disparities (formerly Public Health England): Hospital tooth extractions of 0 to 19 year olds. www.gov.uk

Updates

This page was last updated / checked on 5 December 2022.

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