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. When practices did reopen, they had a backlog of patients requiring care. Furthermore, it is likely that the cost of living crisis has impacted adversely on oral health. From anecdotal evidence, access to dental care can be difficult with a relatively high percentage of people not registered with a dental surgery or on long waiting lists to register with an NHS dental surgery.
• For 2023/24, national statistics quote that 61.5% of under 18s in Hull had attended a dental appointment within the last year (compared to 55.4% for England). However, it is possible 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 (8%) and an adjustment is applied, then it is estimated that around 56.6% 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).
• Oral health survey were completed for three year olds in the 2019/20 academic year and among year 6 children (aged 10-11 years) in the 2022/23 academic year. Children in Hull did not participate in the survey, but overall for England, 10.7% of three year olds and 16.2% of year 6 children had evidence of tooth decay. However, half of Hull’s children live in the most deprived areas of England, and there were 16.6% of three year olds and 23.3% of year 6 children who had evidence of tooth decay among children living in the most deprived areas of England. It is likely that the percentages in Hull more resemble the figures for children living in the most deprived areas of England rather than the overall figure for England.
• 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.
• The rates of tooth extraction for dental decay are three times higher for the most deprived fifth of areas of England compared to the least deprived fifth of areas of England, and more than half of Hull’s children live in the most deprived fifth of areas of England. Despite the substantial higher levels of deprivation and high levels of tooth decay in Hull, there were fewer hospital admissions for tooth extractions for dental decay among children and young people aged 0-19 years in hospital that involved general anaesthetic compared to England and the region. However, it is felt that the data might not properly reflect Hull’s position fully. The reason for this is unknown but it could be associated with the way data is recorded or coded within hospital and/or the way in which services are commissioned in Hull, for instance, 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.

The dmft index is a commonly used indicator of tooth decay and treatment experience. It is obtained by calculating the average number of decayed (d), missing due to decay (m) and filled due to decay (f) teeth (t) in a population. In five-year-old children, this score will be for the first (primary) teeth and is recorded as dmft. In older children, it reports on adult teeth and is given in upper case (DMFT). The average dmft/DMFT is the average number of decayed, missing of filled teeth and is used as s measure of the severity of tooth decay experience in a population.

Dental caries or dental decay is the top most common reason for hospital admission among 5-9 year olds in England with 19,560 hospital episodes in 2022/23 (substantially higher than the next highest at 11,306 for acute tonsillitis). For children and young people aged 0-19 years, the total cost for all tooth extractions was £64.3 million in 2022/23 which included £40.7 million for tooth extractions due to tooth decay. Decay-related tooth extraction rates for 2022/23 were 234 per 100,000 population aged 0-19 years for England, but 381 per 100,000 population for children and young people living in the most deprived fifth of areas of England compared to 109 per 100,000 population for children and young people living in the least deprived fifth of areas of England.

The Hull Picture

Number of NHS Dentists in Hull

The number of dentists in Hull providing some NHS activity has decreased in the last few years in Hull, but are still similar to England for 2023/24 with 44 dentists per 100,000 resident population compared to 43 for England.

It is not known if the decrease represents a reduction in dentists overall or a reduction in the number of dentists providing some NHS care (with some dentists changing from offering some NHS care to offering an entirely private service).

Year	Total dentists	Population per dentist	Dentists per 100,000 resident population
2019/20	134	1,939	52
2020/21	141	1,838	54
2021/22	132	2,019	50
2022/23	119	2,259	44

However, it should be noted that the rates are given out of Hull’s resident population and this could be potentially misleading. It is not known how many residents of neighbouring East Riding of Yorkshire use dental services in Hull, but it is likely that a sizeable proportion do so. The fact that there are 30 dentists per 100,000 population in East Riding of Yorkshire who provided some NHS activity for 2023/24 lends support to this view. However, this is counterbalanced with the likelihood that there might be more dentists in East Riding of Yorkshire who are entirely private and register no NHS dental activity. Due to Hull’s increased deprivation relative to both England and East Riding of Yorkshire, it is likely that there are fewer (solely) private dentists in Hull.

The national figures above are given as the number of dentists who undertook at least some NHS work during the financial year, but not the number of full-time equivalent (FTE) posts so it is possible that there are differences in the number of hours worked or the number of people seen for each dentist. However, the above figures do give a guide as to the number of dentists working in each local area who are providing some NHS dental care.

Time Since Last Dental Appointment

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 8% of all patients registered with Hull general practices (GPs) live in East Riding of Yorkshire (around 25,000 patients in total), and it is possible that a similar pattern exists with regard to cross-boundary flows in dentistry. In the national dataset, 62,209 children aged under 18 years had attended a dental appointment in the last year during 2023/24. With an estimated resident population of 37,573 children aged under 18 years, this gives a percentage of 61.5% as quoted in the national dentistry dataset. If it is assumed that 3,006 of the 61,075 dental attendees live in East Riding of Yorkshire (8%) and 34,567 live in Hull, then this would give an ‘adjusted’ estimate of 56.6% 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 55.4%. The percentage for East Riding of Yorkshire is 52.1% in the national dataset, but would be 56.9% if the same adjustment was applied. The number of dentists per 100,000 population mentioned above also lends support to the view that East Riding of Yorkshire residents are registered with Hull dental practices, however, it is also recognised that people in East Riding of Yorkshire will be more likely to be registered for dental care privately.

Dental Decay Recorded From National Surveys

There have been national Oral Health Surveys among children 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). Not all local authorities participate for various reasons although the likely major reason is due to lack of finances and staff time.

The most recent survey involving three year olds was completed during the 2019/20 academic year, and the results were published by Public Health England in 2020 (now Office for Health Improvement & Disparities) in their Oral Health Survey of Three Year Olds 2020 report. The most recent survey involving children in school year 6 (aged 10-11 years) occurred during the 2022/23 academic year, and the results were published by the Office for Health Improvement & Disparities in their Oral Health Survey of Children in Year 6, 2023 report. Hull did not participate in either of these surveys, but a brief summary of the results for England overall are presented which may give an indication of tooth decay among three year olds and year 6 children. Half of Hull’s population live in areas that are the most deprived fifth of England, so it is likely that the higher prevalence of dental decay among children living in the most deprived areas of England better reflects the situation in Hull rather than the overall figures presented.

Oral Health Survey of Three Year Olds – Results for England

Across England, 19,479 three year olds participated in the survey in 2019/20 and 10.7% already had experience of dental decay despite having had their back teeth for just one or two years. Among the 10.7% of children with experience of tooth decay, each had on average 2.9 teeth affected (by three years of age, children normally have all 20 primary teeth). Children living in the most deprived areas of England were almost three times more likely to have experience of dental decay compared to children living in the least deprived areas (16.6% versus 5.9%). Children from other minority ethnic groups (20.9%) and Asian and Asian British children (18.4%) were more likely to have dental decay compared to other groups. In 2013, when the only previous survey of three year olds was completed, 11.7% had experience of dental decay.

Oral Health Survey of 10-11 Year Olds – Results for England

Across England, 53,073 children in school year 6 who were aged 10-11 years participated in the survey in the 2022/23 academic year. Overall, 16.2% had evidence of dental decay, each with an average of 1.8 teeth affected. There was also a strong association with deprivation among the year 6 children. Almost one-quarter (23.3%) of children living in the most deprived fifth of areas of England had evidence of dental decay compared to one in eight (12.6%) of children living in the least deprived fifth of areas of England. Children from other minority ethnic groups (22.2%) were more likely to have dental decay compared to other groups, and whilst Asian and Asian British children (17.8%) had the second highest percentage of dental decay, the percentage was not drastically different to the overall figure of 16.2%. Girls were more likely to have dental decay (16.9%) compared to boys (15.3%).

Oral Health Survey of Five Year Olds – Results for Hull

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 the 2021/22 academic year.

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 for Hull, 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. There is considerable overlap in the 95% confidence intervals for Hull between 2016/17 and 2021/22 and it is likely that there is not statistically significant change in the average number of decayed, missing or filled teeth in Hull between 2016/17 and 2021/22.

There is a large difference in the percentages between Hull and England for 2014/15, 2016/17 and 2018/19 although the difference has decreased over time. For 2021/22, whilst the average number of decayed, missing or filled teeth in Hull is higher than England, there appears to be no statistically significance between Hull and England.

The average number of decayed, missing or filled teeth among the subset of children who had some evidence of dental decay was higher in Hull for 2014/15, 2016/17 and 2018/19 but was higher in England for 2021/22.

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.

Tooth Extractions Occurring in Hospital

Information is also available on the number of tooth extractions of permanent teeth which occur in hospital under general anaesthetic for those aged 0-19 years (with numbers rounded to the nearest five with counts fewer than eight not presented). The majority of extractions are due to dental decay particularly among younger children.

There were 115 tooth extractions in 2022/23 among Hull children aged 0-19 years (25 among 5-9 year olds, 40 among 10-14 year olds, 45 among 15-19 year olds and fewer than 8 for 0-4 year olds). These gave extraction rates of 145, 230 and 278 per 100,000 population for children and young people in Hull aged 5-9, 10-14 and 15-19 years respectively with an overall rate of 173 per 100,000 population aged 0-19 years.

In Hull for 2022/23, there were 20 children aged 5-9 years, 20 children aged 10-14 years and 10 children aged 15-19 years who had tooth extractions for caries with fewer than eight for children aged 0-4 years, and a total of 55 for all children and young people aged 0-19 years. This gave rates of 116, 115 and 62 per 100,000 population for children and young people in Hull aged 5-9, 10-14 and 15-19 years respectively with an overall rate of 83 per 100,000 population aged 0-19 years. However, there were a further 20 children aged 10-14 years and 35 children aged 15-19 years (numbers fewer than eight for both 0-4 and 5-9 year olds) who had tooth extractions but the reason was not recorded, and it is possible that these could have been for caries.

If it was assumed there were five extractions for the ages where data was supressed, and that tooth extractions with missing information on caries were caries, then the rates for Hull would be 63, 145, 230 and 278 per 100,000 population for ages 0-4, 5-9, 10-14 and 15-19 years respectively with an overall rate of 180 per 100,000 population aged 0-19 years.

Overall in 2022/23, 48% of tooth extractions that occurred in hospital among Hull children were due to tooth decay but this differed by age being 80% among 5-9 year olds, 50% among 10-14 year olds and 22% among 15-19 year olds.

Age	Hull N	Hull rate	Hull N adjusted+	Hull rate adjusted+	Y&H rate	England rate
0-5	*	*	10	63	248	143
6-10	20	116	25	145	986	541
11-14	20	115	40	230	298	190
15-19	10	62	45	278	80	63
0-19	55	83	120	180	405	236

There is a strong association with deprivation nationally. In 2022/23, there were 381 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 109 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 (381, 270, 194, 160 and 109 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 rates in Hull in the lowest 20% of the rates among the 152 upper-tier local authorities in England, and this remains the case even if all the tooth extractions were caries are not mentioned are additionally assumed to be related to dental decay. It is felt that the data might not properly reflect Hull’s position fully. The relatively low rates of hospital admissions for tooth extractions among children in Hull are likely associated with the way data is recorded and coded within hospital and/or 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.

Impact of COVID-19 Pandemic, Cost of Living Crisis and Access to Dental Surgeries

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 25 March 2020 to 8 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 people requiring further additional treatment or more severe treatment will increase. This will be compounded as most dental surgeries when they did open had a backlog of patients requiring check-ups and treatment.

It is possible that the cost of living crisis has further impacted adversely on oral health. With an increasing number of people 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. Dental health care for adults – even on the NHS – incurs a cost, and 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.

From anecdotal evidence, access to dental care can be difficult with patients not being able to access care if their dentist leaves the profession and dental surgery struggles to recruit a replacement, other people have been left without a dentist if their dentist or dental surgery changes from providing NHS care to entirely private (and they chose not to remain with that dentist and pay privately), and there are people who are not registered with a dentist at all, or who are on long waiting lists to register with an NHS dental practice.

Strategic Need and Service Provision

Hull’s Oral Health Plan – Improving Oral Health for Local People – was produced through partnership working and underpins the local dental commissioning and oral health improvement strategies to ensure that local people’s oral health needs are met. There were five workstreams and activities described falling under:

1. Creating a supportive environment for health;
2. Re-orientating health services;
3. Developing personal skills;
4. Strengthening community action; and
5. Building healthy public policy.

National strategies, priorities and evidence-based guidance include:

• To ensure that people have appropriate levels of fluoride (whether this is through toothpaste, fluoride varnishes, or fluoridation of the water).
• To ensure that everyone who needs it has access to good NHS dental services, and that sufficient information is provided to residents to allow them to understand the value of having regular check-ups.
• Support for prevention-orientated NHS dental services. It is necessary to explore equity of access and barriers to NHS dental services particularly for people from more vulnerable groups.

Existing work commissioned by the Integrated Care Board (ICB) and Hull city council include:

• Flexible commissioning contracts commissioned by the ICB which emphasise prevention in practice.
• ICB-commissioned primary care dental access initiatives for those experiencing homelessness, and urgent dental access sessions within Hull, to increase access to dental services.
• ICB are piloting a level 2 paediatric primary care service model to support workforce development and utilisation of skill-mix. This is significantly improving Community Dental Service waiting times for those children requiring consultant-led care.
• Hull city council commissions an oral health promotion service. This includes supervised toothbrushing scheme to the most deprived areas, smoking cessation training to dental providers, workforce training (for those in care homes and early years), health visitor Brush for Life toothbrush and toothpaste packs.

There are other specific groups that are much more likely to have poorer oral health and access to dental services, and it is necessary to improve oral health and access to services for children in inclusion health groups and children in inclusion health groups.

Many existing public health initiatives link with oral health, and this should be considered in relation to improving oral health and physical health in general through opportunities related to delivering services provided by local and national government and the NHS. However, it is recognised that many service are already not provided or stretched due to the current financial setting, so it may not be possible to take advantage of such opportunities. Such links include promotion and access to nutritious food and reducing sugar intake, and promotion and improved access to, and addressing vaccine hesitancy in relation to the human papillomarvirus (HPV) vaccination which links to oral cancer.

The impact of the COVID-19 pandemic and its resulting backlogs, cost of living crisis, and access to NHS dental care, it is likely oral health has deteriorated in the last 3-4 years, and furthermore this will impact on inclusion health groups to a greater extent.

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

The Office for Health Improvement & Disparities’ Fingertips: https://fingertips.phe.org.uk/

NHS Digital. https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics

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

UK Government. All Our Health. https://www.gov.uk/government/collections/all-our-health-personalised-care-and-population-health#about-all-our-health

UK Government, 2021. Delivering Better Oral Health. https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention

The Office for Health Improvement & Disparities (previously Public Health England), 2014. Improving oral health: an evidence-informed toolkit for local authorities for children and young people. https://www.gov.uk/government/publications/improving-oral-health-an-evidence-informed-toolkit-for-local-authorities

The Office for Health Improvement & Disparities (previously Public Health England), 2016. Menu of Preventative Interventions. https://assets.publishing.service.gov.uk/media/5a8d9697e5274a5e64c54608/Local_health_and_care_planning_menu_of_preventative_interventions_DM_NICE_amends_14.02.18__2_.pdf

The Office for Health Improvement & Disparities (previously Public Health England), 2016. Improving the oral health of children: cost effective commissioning: https://www.gov.uk/government/publications/improving-the-oral-health-of-children-cost-effective-commissioning

National Institute of Health and Clinical Excellence. Public Health Guidance 55. Oral health, local authorities and partners. https://www.nice.org.uk/guidance/ph55

Updates

This page was last updated / checked on 5 September 2024.

This page is due to be updated / checked in August 2025.