For those of us over the age of 30, the thought of having such bad teeth that we have to go to hospital sounds truly dreadful. We can remember having the odd tooth pulled out when we were young, but it was done in the dentist’s chair. However, in 2000, the government banned dentists from using general anaesthetic for multiple teeth extractions and hospital became the only place where such procedures were permitted.
It is worth bearing this in mind when you see statistics about the number of children admitted to hospital with tooth decay. Nevertheless, it does seem that the numbers are rising. The Local Government Association is in the news today after publishing figures showing that the cost of removing children’s teeth in hospital has ‘soared by 66 per cent since 2010/11’. This appears to be largely the result of inflation and NHS inefficiency since the actual number of extractions has risen by considerably less than this (26 per cent) and yet the increase is still significant and worrying.
What’s driving it? Predictably enough, the Local Government Association blames fizzy drinks. It is lobbying for sugar content to be displayed in teaspoons and for sugar levels to be lowered. The LGA’s ‘community wellbeing spokeswoman’ says her figures prove that ‘we don’t just have a child obesity crisis, but a children’s oral health crisis too’.
But do we? We are no longer a nation of Austin Powers. ‘The dental health of the majority of British children has improved dramatically since the early 1970s,’ according to a 2005 study, which also noted that ‘levels of dental decay in UK children at five and 12 years are among the lowest in the world.’ A further study in 2011 also found that ‘since the 1970s, the oral health of the population, both children’s dental decay experience and the decline [in] adult tooth loss, has improved steadily and substantially’. This was confirmed in a report from the Faculty of Dental Surgery last year.
The Office for National Statistics has run the Children’s Dental Health Survey since 1983 and the figures are striking. The number of 12-year-olds who exhibited clear signs of tooth decay fell from 81 per cent in 1983 to 28 per cent in 2013. One in three kids of this age had a cavity in 1983 but by 2013 this had fallen to one in nine. The survey does not look at younger children but in Scotland the prevalence of tooth decay among four-year-olds nearly halved between 1994 and 2014, from 62 per cent in 1994 to 32 per cent in 2014.
The rise in hospital admissions for childhood teeth extraction does not, therefore, reflect a general rise in childhood tooth decay. Quite the opposite. Nor does it reflect a rise in the consumption of sugar or sugary drinks (both have been falling). So what is going on and what is to be done?
The Faculty of Dental Surgery (FDS) has suggested that hospitals are being used as a last resort for children who have not been registered with a dentist or are ‘seeking dental treatment when the caries [ie cavity] is already at an advanced stage so must be referred to specialist services’. This is certainly plausible. Tooth decay is most common in inner cities and among low-income families. More could be done to encourage ‘hard to reach’ groups, including the foreign born, to take their kids to the dentist. The FDS would like to see a public campaign to this effect, along with education about the effect of sugar on teeth and the promotion of water fluoridation.
Local authorities could do any of this without having to lobby central government. Instead it is grabbing headlines with Jamie Oliver-style anti-obesity policies which are unlikely to make a dent in obesity rates and are even less suited to reducing rates of tooth decay. Sugar is an important cause of tooth decay, but it is the frequency of consumption that matters, not the overall intake. Saliva naturally removes sugar from teeth within 20 minutes. Drinking a can of pop or scoffing a bag of sweets once a day might not be advisable from an obesity perspective but it is trivial in relation to tooth decay. The problem comes when you make the bag of sweets (or the piece of fruit) last all day. Reducing sugar content in individual items, as the LGA wants to do, would make no difference because the issue is the frequency, not the volume.
The bottom line is that there has been a dramatic improvement in children’s teeth in recent decades as a result of tooth-brushing, fluoridation and dental check-ups. If more kids visited the dentist and brushed their teeth, rates of tooth decay would fall further. Local authorities would have to do some work to achieve this behavioural change but, unlike putting little pictures of teaspoons on lemonade bottles, it would actually work.