The oral health of adults attending dental practices in England in 2018: a report of a novel method and findings

Questionnaire and clinical examination data were collected from 16,572 (65% of respondents) and 14,270 (56% of respondents) patients, respectively. This involved 1,173 dental practices (almost all NHS: 25%; fully private: 10%; mixed practices: 65%), from 107 of the 152 upper-tier LAs and 212 of the 326 lower-tier LAs in England. Response rates varied by geographical location, with the highest in the East Midlands (66.8%) and the lowest in the East of England (34.5%).

Although the survey was limited to dental participants, the demographics of participants were similar to the general population of Englandnumber 17 Socioeconomic deprivation in terms of gender, age, ethnicity and area of ​​residence (data not provided but available in the full report).18

Only 0.9% of participants had no teeth of their own, 15.0% wore dentures (partial or full), and 10.0% had bridges or implants to replace missing teeth. The majority (81.9%) had a “functional dentition” (including 21 or more natural teeth); however, almost all patients (90.2%) had at least one filling (average 7.2 fillings), and approximately half ( 46.5%) had at least one crown. The majority (70.5%) were assessed as having a current need for treatment. The proportion of participants with functional dentition varied by age but also by ethnicity and area of ​​residential deprivation (Fig. 1).

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Proportion of participants with functional dentition by age, race and poverty level

More than a quarter (27.0%) of the population had untreated dentin caries, affecting an average of 2.1 teeth. This varied by age and poverty level, but not race. People living in the most deprived areas were more likely to have untreated caries than those living in the least deprived areas (36.2% vs 19.9%) (Figure 2).

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Proportion of participants with one or more untreated cavities, by age, race and poverty level

A similar trend emerged in the proportion reporting oral pain (overall, 18.3% reported currently being in pain) (Figure 3), with those experiencing one or more effects of poor oral health (Overall, 17.7% reported that the impact was “quite” or “very” frequent in the previous year) (Figure 4), and those with identifiable pulpal involvement, ulceration, fistulas, and abscesses (PUFA) conditions patients (7.2% overall) (Fig. 5).

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Figure 4

Proportion of participants reporting current oral pain, by age, race and poverty level

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Proportion of participants reporting oral health impacts fairly or often in the previous year, by age, race and deprivation level

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Proportion of participants with one or more signs of PUFA by age, race and poverty level

More than half (52.9%) of the visits had gingival bleeding during probing. Although this varied by age and race, there was a socioeconomic gradient, with those who attended more recently being more likely to have gum bleeding than those who attended more recently (60.9% vs 52.1%). Those with non-urgent and urgent treatment needs also differed little by age and race, but there was also a socioeconomic gradient (data not provided but available in the full report).18

The majority of participants (83.6%) reported visiting a dentist within the past 12 months. For those who have not seen a doctor in the past two years (7.9%), the most common reasons are: “No need to see a dentist/I have no problem with my teeth/I don't have natural teeth” (28.2%); “Afraid of going to the dentist/Don't like going to the dentist” (27.6%); and “Keep forgetting/don’t have time to deal with it” (23.9%). Overall, 6.8% of participants reported having a disability or long-term illness that limited their ability to participate. Not surprisingly, the proportion reporting disability increases with age, and there is also a socioeconomic gradient (data not presented but available in the full report).18 The most common attendance limitations were inability to climb stairs (47.0%) and inability to sit in the dental chair (14.3%). Another 5.7% said they were often unable to leave home.

Perceived barriers to dental care were explored by asking participants how difficult they thought it would be for their neighbors to obtain care. A total of 46% believed they had no problems accessing NHS care. Among those who identified barriers (49.5%), the most common reports were: “few dentists accept new NHS dentists” (52.9%); “long waiting times for care” (40.9%); and high costs Care costs (40.3%).

Overall, 52.2% of participants paid all NHS charges and 12.9% were completely exempt from charges (Table 1).

Table 1 Dental care payment categories of participants (n = 16,392)

Of the 16.7% who only received private care, 34.7% chose to continue practicing after stopping NHS care, 25.9% thought private dental care was better, and 14.9% reported that there was no NHS care dentist nearby.

Participants receiving NHS care were asked about their ability to pay Tier 2 and Tier 3 costs (£56 and £244 respectively at the time of the survey). For Tier 2 fees, 28.7% were unable or had difficulty paying. For Level 3 charges, 46.4% were unable or had difficulty paying. As expected, affordability follows a socioeconomic gradient (Figure 6).

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Participants by depriving them of their ability to pay for Band 3 NHS patients

In terms of health behaviors and prevention, more than half (54.7%) said they had never smoked and 14.0% were currently smoking. The majority of participants (71.2%) reported drinking on two or fewer days in the previous week, and 8.4% reported drinking on five or more days in the previous week. The majority of people accepted prevention advice (89.5%), and this varied by gender, ethnic group or deprived area (data not provided but available in the full report).18 Advice on oral hygiene was most common (80.2%) and advice on alcohol consumption was the least common (32.0%).

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