Tooth decay is predominantly preventable and is often linked to high levels of consumption of sugar-containing food and drink, which also contribute to obesity. The British Medical Association (BMA) has stated that ‘tooth decay [is] continuing to represent a significant public health threat in socially deprived areas’. Oral diseases can cause pain and discomfort, sleepless nights, loss of function and self-esteem and in turn disrupt family life and lead to time off work. Experiencing tooth decay or having missing teeth or ill-fitting dentures can lead to an individual becoming socially isolated; this may negatively affect their confidence and employment chances. A survey commissioned by the British Dental Association found that 64% respondents felt that applying for public or client facing roles with visibly decayed teeth or bad breath would be at a disadvantage getting a job, 60% considered visibly decayed teeth or bad breath would disadvantage someone getting promoted at work.
The oral health of adults has improved over the last 50 years and more are likely to keep some of their teeth throughout their lives. Adults who keep their teeth for life will be more likely to need complex dental care to restore and maintain their teeth. A recent review of NHS dentistry described three distinct groups of adults with differing care needs:
- post-retirement group - a proportion of whom will have no teeth, will require treatment and maintenance of complete dentures
- 30 to 65-year-olds who experienced high levels of disease and have fillings and high maintenance needs - this group has been called the ‘heavy metal generation’
- under the age of about 30 with lower levels of decay than their parents, lower restorative needs and will require support to maintain this oral health status
In 2014, the NHS in England spent £3.4 billion per year on primary and secondary care dental services, with over 1 million patient contacts within NHS dental services in England each week.
Dental health of children
Poor oral health in children impacts on the children themselves and on their family and society. Children who have toothache or who need treatment may have pain, infections and difficulties with eating, sleeping and socialising. They may have to be absent from school and their parents may also have to take time off work to take their children to a dentist or to hospital.
Dental caries is the most common reason for 5 to 9 year olds in England to be admitted to hospital. Nationally, over 63,000 children aged 0 to 19 years were admitted to hospital for tooth extractions in between 2014 and 2015, with hospital trusts spending £35 million on the extraction of multiple teeth for under 18s.
One of the indicators in the Public Health Outcomes Framework is the proportion of 5 year old children free from dental decay. In 2014/15, 59.0% of Herefordshire’s five-year-olds were free from dental decay, a significantly lower proportion than nationally (75.2%) and regionally (76.6%). The proportion was no better than in 2007/08 (61.3%), and it is significantly worse than in Herefordshire’s comparator group of local authorities.
The mean number of decayed, missing or filled teeth in five-year-olds in Herefordshire was 1.43, much higher than nationally (0.84) and regionally (0.72). Herefordshire is also the worst performing authority of its comparator group for this indicator and is performing poorly compared to other areas where the water supply is not fluoridated.
The 2015 National Dental Epidemiology Programme survey of five-year-olds surveyed Hereford and Leominster ward clusters. Higher levels of decay experience were clustered slightly more in the Leominster ward cluster than the Hereford ward cluster, although levels of decay were higher in Hereford.
 ‘Fluoridation of water: A briefing from the BMA Board of Science – February 2009’, British Medical Association,
 Guidance: Adult Oral Health - applying All Our Health, Public Health England, 2017.
 Water fluoridation: health monitoring report for England 2018. Public Health England, 2018.
 Oral health of children in England: a call to action! Archives of Disease in Childhood, J. Godson, J. Csikar, and S. White, S, Archives of disease in childhood, Vol.103, No.1, pp. 5-10.
 Guidance: Health matters: child dental health, Public Health England, June 2017.
 Oral health of children in England: a call to action! Archives of Disease in Childhood, Godson, J, Csikar, J, and White, S, Archives of disease in childhood, Vol.103, No.1, pp. 5-10.
 Guidance: Child oral health: applying All Our Health, Public Health England, February 2018.