Introduction

The previous JSNA chapter for oral health in Nottinghamshire focused on children and young people’s oral health. It has been nearly five years since that chapter was last amended. The refreshed chapter seeks to understand current and future demands, trends and pressures, looking at oral health across the whole life course. The JSNA chapter will be used to inform local oral health strategy via the Nottinghamshire Oral Health Strategy Group.

Definitions and overall approach

The World Health Organisation (WHO) defines oral health as “a state of being free from chronic mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing.”

National surveys of both adults’ and children’s oral health indicate improvements in dental health over time, shown by reductions in decayed, missing and filled teeth in children, and by adults keeping teeth longer as they age. However, inequalities persist associated with socio-economic background. For example, more people from managerial and professional occupation households had good oral health (91%) compared with people from routine and manual occupation households (79%) (Adult Dental Health Survey (ADHS), 2009). In children, those eligible for free school meals were less likely to be in good overall oral health (29%) compared to those not eligible (40%) (Children’s Dental Health Survey (CDHS), 2013).

Overall Nottinghamshire County is generally similar or better than the rest of the country when considering oral health outcomes; however, there are variations at a sub-county level. For example, five-year-old children in Broxtowe and Rushcliffe had better oral health than the England average. Five-year-old children in Mansfield and Ashfield showed greater prevalence of tooth decay compared with other districts in Nottinghamshire (National Dental Epidemiology Programme, 2017). There were larger numbers of child admissions for hospital dental extractions for districts in the north of the County than for the districts in the south (PHE, 2018).

Oral health diseases continue to be widespread despite being highly preventable. Simple measures such as improved oral hygiene practices, improved diet, use of and access to fluoride, along with attending the dentist for regular check-ups to identify problems early, can all help to prevent, or at least reduce, the burden of oral diseases. A common risk factor approach also supports oral health improvement, because the most common oral diseases – tooth decay and gum disease – as well as oral cancers, share many of the same common risk factors (e.g. smoking, alcohol misuse, obesity and poor diet) as other common diseases, such as cardiovascular disease and other cancers – so addressing these risk factors can benefit more than one aspect of health. 

Unmet need and gaps

The following unmet needs and service gaps have been identified:

• Certain groups have been identified as having particularly poor oral health, being at increased risk of oral health problems, experiencing difficulties in accessing services, or being less likely to visit the dentist. Groups identified as having poor oral health include children from deprived backgrounds, who are less likely to visit the dentist than children from less deprived backgrounds, and older people. Groups at increased risk of oral health problems include people with learning disabilities and with serious mental illness, people who are homeless or who frequently relocate, such as gypsy, Roma and traveller (GRT) communities, people who misuse drugs or who drink alcohol at levels posing a risk to health, prisoners, and frail older people who may have difficulties maintaining good oral hygiene. Some of these groups also experience difficulties accessing dental services, such as GRT communities, homeless people, and frail older people.
• Anticipated changes in demography and in the way in which older people’s care is delivered are likely to lead to increased need for older people’s dental services and potential changes to the way in which services are delivered.
• There is a need to integrate oral health promotion within wider social policies (e.g. housing, planning) and other care pathways, to maximise the opportunities for delivering oral health messages.
• There is a need to systematically follow up children who are admitted to hospital for oral health problems, to reduce the risk of problems occurring in the future.

These are explored further in section 8 of this JSNA chapter

Recommendations for consideration by commissioners

The recommendations below are reproduced from section 10 and identify key changes needed to address the oral health needs of people in Nottinghamshire.

Geoff Hamilton, Senior Public Health and Commissioning Manager

Kay Massingham, Public Health and Commissioning Manager