Oral Health

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Joint Strategic Needs Assessment (healthysomerset.co.uk/JSNA)

What is Oral Health?

Oral health refers to the health of people’s teeth, gums, supporting bone, and soft tissues of the mouth, tongue and lips. Poor oral health can exacerbate existing health conditions, impact on wellbeing by causing pain, difficulties with speaking, eating and socialising as well as being an indicator of neglect or difficult social circumstances. Oral Cancers are also considered within the context of Oral Health. Poor oral health is almost entirely preventable.

Oral Health Needs Assessment

The latest Oral Health Needs Assessment for South West England was published in 2021, and is available here.

How can Oral Health be improved?

• Risk factors include smoking, poor diet, stress, alcohol consumption, poor hygiene and injuries. Using a common risk factor approach to address the underlying determinants of poor oral health will help ensure that services can prevent or improve a wide range of conditions
• Interventions with individuals and communities through all important life stages, with a focus on early year’s prevention, will help develop good oral health behaviours and reduce inequalities in oral health outcomes throughout the life-course

Action services, organisations and individuals can take to promote oral health in Somerset

Populations at risk of poor oral health include children and young people and some adult groups

Public Health England found in a 2009 review of NHS dentistry 3 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

Vulnerable groups include those:-

• from a lower socioeconomic group
• who are socially isolated or excluded, for example, Gypsy and Traveller communities, those in prison or the homeless
• who are old and frail or geographically isolated
• who have physical and/or learning disabilities or autistic spectrum disorder
• who have a mental health condition, including dementia
• who smoke or drink heavily or misuse other substances
• children of parents with the above risk factors and children in care
• from some Black, Asian and minority ethnic groups (specifically where language is a barrier to accessing services)
• with certain clinical conditions such as Diabetes and congenital heart problems, and pregnant women

Somerset - Adults

57% of adults (250,000) in Somerset visited the dentist in the two year period ending June 2017, slightly above the England average (51%).

Somerset - Children and young people

• Although decay in five year olds has reduced over time, 23% of children of this age experience tooth decay, slightly below the national average (25%).
• However, the severity of decay varies across the county; children in Sedgemoor children are more likely to have at least one missing, filled, or decayed tooth.
• The prevalence of tooth decay in twelve year olds in Somerset is slightly higher than that seen nationally (37% v 33%). The figures are relatively high in West Somerset (46%), Taunton Deane (41%) and Sedgemoor (39%). More severe decay is also evident in West Somerset and Sedgemoor.
• 60% of children aged 0 to 17 in Somerset (65,700) were seen by NHS dentists in the year ending June 2017, slightly above the national average (58%).
• The most common age group for dental extraction is in 5-9 year olds. Within Somerset the proportion admitted for dental extraction in this age group ranges from 0.9% in Sedgemoor to 0.2% in South Somerset. The 'Getset' catchment area rates are highest in Sedgemoor South, Taunton North and East and Quantock West. (Somerset Oral Health Strategy, 2015-2018)

Oral health in Somerset

• Somerset has 89 NHS dental practices.
• There were 430,400 courses of treatment (CoT) delivered by NHS dentists in Somerset in 2016/17. This was about 11,000 fewer than in 2015/16. These figures exclude orthodontic treatment.
• The 2016/17 figure represents a rate of 78,911 per 100,000 population, above the England average.

Proportion of people registered with an NHS dentist by 5 year age band

Source: Public Health England, ONS Mid-Year Population Estimates (2016)

For details of the 2015 Oral Health Survey of 5 year-olds, please see the Public Health England Dental Health website.

For more survey results and details of planned research, please see the Dental Public Health Intelligence Programme.

Improving Oral Health in Somerset

A strategy for Improving Oral Health in Somerset (2019) focuses on several key themes:-

• Improving diet and reduce the consumption of sugary foods, drink, alcohol and tobacco
• Increasing the availability of fluoride
• Improving oral hygiene
• Addressing inequalities in oral health
• Increasing access to dental services

Somerset has an oral health improvement service; it was launched in April 2016. This is a universal and targeted service that aims to improve the oral health of Somerset’s children, young people and adults.

The Primary Care Dental Service is commissioned by Somerset County Council and run by Somerset Partnership NHS Foundation Trust. The service provides community-based fluoride varnish applications in selected early years settings and children’s centres, oral health care training sessions for selected groups, and the distribution of toothbrush and toothpaste packs universally in collaboration with Public Health Nurse, Health Visitors.

The service have supported Somerset County Council to develop a series of two oral health eLearning modules for anyone in a care or supporting role enabling children, young people or adults to maintain good oral health and wellbeing.

Additional information

• Mouth cancer can appear in different forms and can affect all parts of the mouth, tongue and lips. Mouth cancer can appear as a painless mouth ulcer that does not heal normally. A white or red patch in the mouth can also develop into a cancer, as can any unusual lumps or swellings. Be mouthaware and look for changes in the mouth. It is important to visit your dentist if these areas do not heal within three weeks. http://www.mouthcancer.org/
• Dental caries and obesity: their relationship in children https://www.gov.uk/government/publications/dental-caries-and-obesity-their-relationship-in-children (Published October 2015)