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 2021/22 national survey, 300 children five year olds participated in the survey in Hull and 32.4% had at least one tooth that was decayed, missing (extracted due to dental decay) or filled equating to 97 children. This percentage was considerably higher than England (23.7%). In the 2018/19 survey, 31.4% had at least one tooth that was decayed, missing or filled, so there has been a marginal increase for Hull (and for England too which increased from 23.4%), although a substantial improvement since 2014/15 when it was 37.8%. Despite the relatively large decrease between 2014/15 and 2021/22, the difference was not statistically significant.
• The average number of teeth that was decayed, missing or filled in Hull among five year olds was 1.06 (0.90 decayed, 0.04 missing and 0.12 filled) which was statistically significantly higher than England at 0.80 (0.72 decayed, 0.05 missing and 0.06 filled). There has been a substantial reduction over time. In 2014/15, the average number of teeth that was decayed, missing or filled in Hull was 1.55 (and 1.13 for both 2016/17 and 2018/19). The reduction from 2014/15 to 2021/22 is likely to be statistically significant.
• Among the cohort that had at least one tooth that was decayed, missing or filled, the average number of teeth affected was 3.26 in Hull (2.78 decayed and 0.11 missing), and whilst fewer children in England were in this cohort, among those who had at least one tooth that was decayed, missing or filled, the number of teeth affected for England was higher at 3.54.
• The number of five year old children with substantial amounts of plaque (a precursor to tooth cavities or caries) was higher in Hull compared to England (4.7% versus 3.0%) and a higher percentage had enamel decay – an early stage of tooth decay that ordinarily would be counted as being free from obvious decay – in Hull compared to England (23.3% versus 13.6%). Furthermore, a higher percentage of children in Hull had other oral conditions resulted from untreated caries (visible pulp, ulceration, fistula or abscess) with 3.6% of children affected in Hull compared to 2.0% for England. It is not possible to sum these percentages as it is possible that some of the same children are included in these three groups.
• Between 2014/15 and 2021/22, in general, the dental health of five year olds has improved in Hull with fewer having decayed, missing or filled teeth, and among those who have one or more decayed, missing or filled teeth, the number of teeth affected was lower. It also appears that decayed or missing teeth were more likely to be decayed rather than missing in 2021/22 compared to earlier years.
• 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?

Cavities, also called tooth decay or caries, are caused by a combination of factors, including bacteria in the mouth, frequent snacking, sugary drinks and not cleaning your teeth well. Dental plaque is a colourless, sticky film that covers the surface of the teeth made up of bacteria, food particles and saliva. If teeth are not cleaned properly, dental plaque can build up. It can also harden to form tartar, and the presence of tartar can protect bacteria making bacteria more difficult to remove. Tooth enamel is mostly made up of minerals, and the initial stage of tooth decay is when the enamel protecting the tooth loses its minerals due to the acids within plaque bacteria. If the enamel is weakened, small holes or cavities or caries can form. The next layer of the tooth under the enamel is dentin and this is softer than enamel, and tooth decay can progress at a faster rate when it reaches the dentin. Dentin also contains the tubes that lead to the nerves of the tooth, and because of this when dentin is affected by tooth decay, sensitivity to hot or cold foods or drinks can result. Pulp is the inner most layer of the tooth containing the nerves and blood vessels that help keep a tooth healthy. When damage to the pulp happens, it may become irritated and start to swell, and this can cause pain due to pressure on the nerves as there is no space for the swelling. As tooth decay advances into the pulp, bacteria can invade and cause an infection, increasing inflammation in the tooth and can lead to a pocket of pus forming at the bottom of the tooth called an abscess. Tooth abscesses can cause severe pain.

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.

From the national survey, 23.7% of five year olds in England had experience of dental decay, but this varied dramatically across geographical areas, and children living in the most deprived areas of England were nearly three times more likely to have had experience of dental decay (35.1%) compared to five year olds living in the least deprived areas of England (13.5%). At a national level, there was also differences by ethnic group, which was statistically significantly higher in the ‘other ethnic group’ (44.8%) and the Asian or Asian British ethnic group (37.7%). The majority of experience of dentinal decay in this age group was obvious, untreated dentinal decay.

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 relative to England (43 dentists per 100,000 population). East Riding of Yorkshire had 34 dentists per 100,000 population which supports the view that some 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 latest national oral health survey among three year olds was undertaken during 2019/20. However, Hull was one of 30 upper tier local authorities that did not participate in the survey. Therefore, the most recent data for Hull dates from the 2012/13 survey. 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 it is 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

There have been oral health surveys of five year olds completed for a number of years generally once every two years, although the latest survey was one year later due to the COVID-19 pandemic. Not all local authorities participate in the survey, and the response was unusually low across local authorities (particularly across the Yorkshire and Humber region) for 2021/22.

The Office for Health Improvement & Disparities’ Fingertips gives a summary measure of the percentage of five year olds with experience of visually obvious dentinal decay and the average number of teeth that were decayed, missing or filled, including trends over time (although the latter measure is only available up to 2018/19).

More detailed information is available from the national datasets, and further details are presented below for the latest two surveys conducted in 2018/19 and 2021/22, as well as the trends over time between 2014/15 and 2021/22.

Among five year olds surveyed in Hull in 2021/22, almost one-third (32.4%) had one or more decayed, missing of filled teeth in Hull compared to just over one-fifth in England (23.7%).

In 2018/19, on average, children in Hull had 1.13 teeth that were decayed, missing or filled compared to 0.80 for England.

Whilst the percentage of five year olds with visually obvious dental decay is considerably higher in Hull than England, the percentage has fallen sharply in Hull between 2007/08 and 2021/22 by 24%. The relative decrease for England over the same period has been virtually identical though so the inequalities gap remains unchanged.

In 2014/15, the average number of decayed, missing or filled teeth among five year olds in Hull was 1.55 teeth, but fell to 1.13 teeth for the 2016/17 survey and remained the same in the 2018/19 survey. For 2021/22, the percentage has fallen further to 1.06 teeth but has not been updated on Fingertips.

Survey completed in 2018/19

Examining the more detailed national reports and datasets for the 2018/19 survey, it was noted that 245 five year olds were examined in Hull (approximately 70% of the sample drawn which was higher than England at 61%).

Overall, 31.4% of five year olds had experience of visually obvious dentinal decay compared to 23.4% for England. 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).

Survey completed in 2021/22

The national dental survey was also completed in 2022 among five years olds. In Hull, it was estimated that there were 3,353 five year olds living in the city and 300 took part in the survey representing 8.9% of all five year olds.

In 2021/22, 32.4% of five year olds had experience of visually obvious dentinal decay compared to 23.7% for England. This equates to 97 out of the 300 five year olds participating in the survey in Hull. Across all five year olds, the average number of dentinally decayed teeth, missing teeth that had been extracted due to dental decay and filled teeth was 1.06 which was higher than England at 0.84. This was made up of 0.90 decayed teeth, 0.04 missing teeth and 0.12 filled teeth.

Among the children that did have decayed, missing or filled teeth, the average number of decayed, missing or filled teeth was 3.3 teeth (comprising 2.8 decayed teeth and 0.1 filled teeth).

Three in ten of five year olds had one or more teeth that was dentinally decayed and among those that did, the average number of teeth that was affected was 2.90 teeth. The percentage was much higher than the England average where 21.8% had one or more teeth that was dentinally decayed, although among those children in England that were in this situation the average number of teeth affected was slightly higher at 3.32 teeth.

Only 1.8% of children had one or more teeth that had been extracted due to tooth decay, and among these children who did have missing teeth, the average number of teeth that had been extracted was 2.90 teeth.

Overall, 4.7% of children in Hull had substantial amounts of plaque which was higher than England (3.3%), a much higher percentage of children in Hull had enamel decay which is an early stage of decay who would ordinarily be counted as being free of obvious decay (23.3% versus 13.6%), and children in Hull were also more likely to have other oral conditions resulted from untreated caries (visible pulp, ulceration, fistula or abscess) compared to England (3.6% versus 2.0%). With 300 Hull children participating in the survey, this equates to around 14 children with substantial amounts of plaque, 70 children with enamel decay, and 11 children with visible pulp, ulceration, fistula or abscess from untreated caries. It is not possible to sum these numbers as it is possible that some of the same children are included in these three groups.

Slightly fewer children in Hull had incisor caries compared to England (6.1% versus 6.5%) and a higher percentage of children in Hull had decayed teeth where there was pulp evident (6.5% versus 4.1%).

One in nine children in Hull (11.4%) who had dentinally decayed, missing or filled teeth had been treated through fillings which was higher than England (7.4%), although in Hull fewer of these children had been treated through having teeth extracted due to the dental decay compared to England (3.4% versus 6.4%).

Dental measure	Hull %	England %
Average number of dentinally decayed, missing or filled teeth	1.06	0.84
Average number of untreated dentinally decayed teeth	0.90	0.72
Average number of missing teeth (extracted due to dental decay)	0.04	0.05
Average number of filled teeth	0.12	0.06
Percentage of children with dentinally decayed, missing or filled teeth	32.4	23.7
Average number of dentinally decayed, missing or filled teeth among those with some dentinally decayed, missing or filled teeth	3.26	3.54
Average number of dentinally decayed teeth among those with some dentinally decayed, missing or filled teeth	2.78	3.05
Average number of filled teeth among those with some dentinally decayed, missing or filled teeth	0.11	0.23
Percentage of children with dentinally decayed teeth	30.9	21.8
Average number of dentinally decayed teeth among those with some dentinally decayed teeth	2.90	3.32
Percentage of children with missing teeth (extracted due to dental decay)	1.8	1.6
Average number of missing teeth among those with some missing teeth (extracted due to dental decay)	2.00	3.31
Percentage of children with substantial amounts of plaque	4.7	3.0
Percentage of children with either visible pulp, ulceration, fistula or abscess	3.6	2.0
Percentage of children with incisor caries	6.1	6.6
Percentage of children with enamel caries	23.3	13.6
Percentage of children with enamel and any caries among those with some dentinally decayed, missing or filled teeth	39.5	29.3
Percentage with enamel caries for those with no dentinal caries among those with some dentinally decayed, missing or filled teeth	7.2	5.6
Percentage of children with one or more teeth with decay involving pulp	6.5	4.1
Care Index (percentage of dentinally decayed, missing or filled teeth that have been treated / filled)	11.4	7.4
Extraction Index (percentage of dentinally decayed, missing or filled teeth that have been extracted due to decay)	3.4	6.4

Trends Over Time

It is possible to compare the results of the 2021/22 survey with previous surveys. Standard dental abbreviations have been used in the table with small letters denoting deciduous teeth only. Dentinally decayed is noted as d3, missing due to dental decay is noted by m, and filled teeth by f, with teeth denoted by t. The majority of the measures have been collected throughout all surveys but there have been more measures of dental decay recorded in the more recent surveys.

The following summary findings were noted:

• The average number of dentinally decayed, missing or filled teeth has substantially reduced among five year olds in Hull from 1.55 teeth in 2014/15 to 1.06 teeth in 2021/22, and the average number of decayed teeth and missing teeth over this time has reduced, although there was no reduction in the average number of decayed teeth between 2018/19 and 2021/22 which increased from 0.89 to 0.90.
• In 2014/15, 37.8% of five year olds had one or more decayed, missing or filled teeth, but this reduced to just under one-third for subsequent years equating to a 15% reduction in the percentage between 2014/15 and 2021/22, although a slight increase of 3% from last time the survey was undertaken.
• Among those who did have one or more decayed, missing or filled teeth, the number of teeth affected has also reduced over time from 4.10 teeth in 2014/15 to 3.61 teeth in 2018/19 and to 3.26 teeth in 2021/22. This represents a 20% decrease from 2014/15 and a 10% decrease between 2018/19 and 2021/22.
• The percentage of children with at least one decayed tooth has remained relatively constant between 28% and 31% across the four surveys, although among those with at least one decayed tooth, the average number of teeth affected has reduced substantially from 3.78 teeth in 2014/15 to 2.90 teeth in 2021/22.
• The percentage of children with at least one missing tooth extracted due to decay is the lowest it has been at 1.8% for 2021/22, and among those with at least one missing tooth, the average number of teeth affected has reduced from 3-5 teeth to 2 teeth in 2021/22. However, the number of children with missing teeth due to dental decay is small, so there is considerably year-on-year variability and the results should be treated cautiously.
• The percentage of children with substantial plaque has increased substantially with fewer than 1% for the 2014/15 and 2016/17 surveys compared to 3.5% in 2018/19 and 4.7% in 2021/22. With such a large change, it is possible that the definition or the way it has measured has been changed. Nevertheless, there has been a considerable increase of one-third between 2018/19 and 2021/22.
• Fewer children had incisor cavies and the percentage more than halved between 2014/15 and 2021/22. The percentage of children with decay to an extent that the pulp was visible has also reduced from 8.7% in 2016/17 to 6.5% in 2021/22.
• In 2014/15, 17% of all children with at least one tooth that was decayed, missing or filled, had filled teeth. This was considerably lower for subsequent years, and was 11% for the latest survey denoting an increase of one-third on 2014/15 although a substantial increase from 2018/19 when it was only 6.5%.
• In 2018/19, 15% of children at least one tooth that was decayed, missing or filled, had missing teeth, but this was much lower for the latest survey reducing by 77% to 3.4% in 2021/22.

Dental measure	2014/15	2016/17	2018/19	2021/22	Change 2014/15 to 2021/22 (%)	Change 2018/19 to 2021/22 (%)
Number of children surveyed	251	261	245	300
Average d3mft	1.55	1.13	1.13	1.06	-31.9	-6.9
Average d3t	1.20	0.87	0.89	0.90	-24.8	0.9
Average mt	0.09	0.15	0.17	0.04	-57.9	-78.6
d3mft > 0 (%)	37.8	32.8	31.4	32.4	-14.5	2.9
Average d3mft (d3mft > 0)	4.10	3.45	3.61	3.26	-20.4	-9.5
d3t > 0 (%)	31.6	28.3	28.0	30.9	-2.1	10.6
Average d3t (d3t > 0)	3.78	3.09	3.19	2.90	-23.2	-8.8
mt > 0 (%)	2.8	4.4	3.4	1.8	-35.4	-46.7
Average mt (mt > 0)	3.07	3.49	4.99	2.00	-34.9	-59.9
Substantial plaque (%)	0.7	0.9	3.5	4.7	526	33.9
Incisor cavies (%)	12.7	8.0	7.7	6.1	-51.8	-20.2
Decay with pulp (%)		8.7	8.3	6.5		-22.4
Care Index (%)	17.4	9.2	6.5	11.4	-34.3	74.7
Extraction Index (%)			14.8	3.4		-77.0

Despite around 7% (and 9% for latest year) of all five year olds who live in Hull participating in the survey, the numbers are relatively small overall, and as a result there is uncertainty around the levels of dental decay in Hull among five year olds (see Small Numbers for more information). To obtain some indication of the degree of uncertainty around these measures of dental decay, it is possible to calculate confidence intervals. These give a range of values where the true value is likely to fall, and if the confidence intervals are wide this denotes that there is more uncertainty around the figures produced from the survey (see Confidence Intervals for more information).

The trends over time in the percentage of children who have one or more dentinally decayed, missing or filled teeth together with 95% confidence intervals is given below. This shows that there is considerable overlap between the 95% confidence intervals over time, and a statistical test (see Statistical Testing and Statistical Significance for more information) reveals that the difference in the percentage of five year olds with decayed, missing or filled teeth in Hull between 2014/15 and 2021/22 is not statistically significant (p=0.18). However, there is a clear difference the confidence intervals between Hull and England, denoting that the percentages of children with decayed, missing or filled teeth in Hull has been consistently statistically significantly higher than England between 2014/15 and 2021/22.

There is less of an overlap in the 95% confidence intervals for Hull between 2014/15 and 2021/22 and it is likely that the difference is statistically significant, however, it is not possible to perform a statistical test on the data without having the individual number of decayed, missing or filled teeth for all individuals for both periods for both Hull and England.

Background to Five Year Old Surveys

The Office for Health Improvement & Disparities (previously Public Health England) facilitate and co-ordinate the surveys, but local authority teams commission the surveys locally and liaise with the participating schools. Schools are randomly chosen to take part in the survey, and among those that agree to take part, a list of all five year olds is drawn up at the selected schools. For small schools, every five year old is invited to participate and in larger schools it is 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 generally agree to take part.

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

Healthline. The stages of tooth decay: what they look like. https://www.healthline.com/health/dental-and-oral-health/tooth-decay-stages

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

Oral health survey of 5 year old children 2022: https://www.gov.uk/government/statistics/oral-health-survey-of-5-year-old-children-2022

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 11 September 2023.

This page is due to be updated / checked in September 2024.