Oral health reflects the standard of the oral and related tissues, which enables an individual to eat, speak and socialise without active disease, discomfort or embarrassment. Good oral health is therefore integral to an individual’s overall health, well-being and quality of life. Although the oral health of both children and adults in England has improved significantly over the last forty years marked inequalities remain and many people continue to experience the negative physical, emotional and social impacts associated with poor oral health and oral disease.
Poor oral health can cause significant pain and discomfort, making it difficult to eat, drink, communicate and socialise normally. In addition, it places a considerable financial burden on individuals and wider society as treating oral diseases is often complex and costly, and those experiencing poor oral health are more likely to be absent from education or employment.
Oral health in 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. In the 24 months prior to June 2019 there were 74,000 adults patients were seen by Herefordshire NHS dental services.
The Adult Dental Health Survey is completed every 10 years with data available at a regional level. The results of the last survey,  which was undertaken in 2009, indicate that 91% of adults in the West Midlands were dentate (i.e. had teeth), compared to 94% across England as a whole, while the average number of natural teeth of dentate adults in the West Midlands was 25.1 compared to 25.7 nationally (a functional number of teeth is assessed as being 21).
Oral health in 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. In the 12 months prior to June 2019 there were 21,000 children were seen by Herefordshire NHS dental services.
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.
To inform local priorities and action an oral health needs assessment  was undertaken in 2019 which describes the standard of oral health of people living in Herefordshire and provides an overview of local oral health care services and incorporates recommendations which have been informed by national policy and guidance.
 Choosing Better Oral Health: An Oral Health Plan for England, Public Health England. 2005. Available from: http://www.dh.gov.uk/AboutUs/
 Oral health, general health and quality of life. Sheiham A., Bull World Health Organ, 2005; 83:644–644.
 Tackling poor oral health in children: local government’s public health role, Local Government Association. 2016.
Delivering better oral health: an evidence-based toolkit for prevention, Public Health England, 2017.
 Water fluoridation: health monitoring report for England 2018, Public Health England. 2018.
 NHS Dental Statistics: 2018-19, NHS Digital.
Adult Dental Health Survey 2009 - Summary report and thematic series, NHS Digital, 2011.
 GP Patient survey, NHS, 2019.
 Children’s Dental Health Report, Healthwatch Herefordshire, 2018.
Oral Health Needs Assessment, Herefordshire Council, 2019.