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.
Dental health of adults
The oral health of adults has improved over the last 50 years, and are now 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
Tooth decay is a predominantly preventable disease and is often linked to high levels of consumption of sugar-rich food and drink, a factor which contributes to other public health concerns in children, particularly childhood obesity. In February 2018, the Herefordshire Health and Well-being Board made the oral health (along with healthy weight) of children one of its strategic priorities.
The oral health of children in Herefordshire is consistently poor compared to the rest of England and has not changed significantly over the last ten years. Almost a third of five year-olds have some signs of tooth decay, with an average of 1.08 decayed, missing or filled teeth. Both of these figures are amongst the highest 25% in the country.
National evidence points to a connection between socio-economic deprivation and poor oral health, and also ethnicity – particularly eastern European. There is no current evidence of an overall association between area deprivation and the oral health of children across Herefordshire, but levels of tooth decay are particularly high in South Wye West and Leominster – which are also amongst the most deprived areas in the county.
Access to an NHS dentist has previously been cited as a common barrier to dental care in Herefordshire, but latest data indicates that access is as good as nationally. A Healthwatch consultation suggests that current barriers include the appreciation of parents as to the importance of a child’s oral health, the awareness of the availability of free child dental care, and transport in rural areas. 
In order to improve oral health in Herefordshire, a recently completed Oral Health Needs Assessment has recommended that a range of interventions and actions are delivered locally.
 ‘Fluoridation of water: A briefing from the BMA Board of Science – February 2009’, British Medical Association, 2009.
 Guidance: Adult Oral Health - applying All Our Health, Public Health England, 2017.
 Water fluoridation: health monitoring report for England 2018. Public Health England, 2018.
 Health and care leaders set their priorities to maximise health benefits. Herefordshire Council, 2018.
 GP patient Survey. National Health Service, 2019.
 Healthwatch Herefordshire Children’s Dental Health Report, Healthwatch Herefordshire, April 2018.