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Dental public health epidemiology programme

Oral health survey of five-year-old and
12-year-old children attending special
support schools 2014
A report on the prevalence and severity
of dental decay
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
1
About Public Health England
Public Health England exists to protect and improve the nation’s health and wellbeing,
and reduce health inequalities. It does this through world-class science, knowledge and
intelligence, advocacy, partnerships and the delivery of specialist public health services.
PHE is an operationally autonomous executive agency of the Department of Health.
Public Health England
Wellington House
133-155 Waterloo Road
London SE1 8UG
Tel: 020 7654 8000
www.gov.uk/phe
Twitter: @PHE_uk
Facebook: www.facebook.com/PublicHealthEngland
Prepared by: Dental Public Health Epidemiology Team
For queries relating to this document, contact: Nick.Kendall@PHE.gov.uk
© Crown copyright 2015
You may re-use this information (excluding logos) free of charge in any format or
medium, under the terms of the Open Government Licence v3.0. To view this licence,
visit OGL or email psi@nationalarchives.gsi.gov.uk. Where we have identified any third
party copyright information you will need to obtain permission from the copyright holders
concerned. Any enquiries regarding this publication should be sent to
Nick.Kendall@PHE.gov.uk
Published: September 2015
PHE publications gateway number: 2015218
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
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Contents
About Public Health England 1
Contents 2
Executive summary 3
Introduction 5
Section 1 Methodology 6
Section 2 Results 7
Participation in the survey 7
Prevalence, severity and extent of dental decay at age five 11
Prevalence, severity and extent of dental decay at age 12 16
Severity of decay among children with caries experience at age five and 12 21
Comparison with children attending mainstream schools 22
Correlation of decay prevalence and severity with deprivation 28
Prevalence of extraction experience at age five 30
Measures of decay for different types of disability 30
Prevalence of caries affecting incisors 33
Children with sepsis at the time of the examination 34
Children with substantial amount of plaque at the time of examination 34
Assessing factors and associations with disease 35
Section 3 Implications of results 36
Variation and inequality 36
Putting this information to use 37
Commissioning clinical care for children with extra needs 38
Section 4 References 39
Section 5 Supplementary tables 41
Appendix A Summary results of five-year-old children 42
Appendix B Summary results of 12-year-old children 43
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
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Executive summary
This report presents summarised results from the Public Health England (PHE) Dental
Public Health epidemiology programme (DPHEP) survey of five and 12-year-old
children attending special support schools, 2014.
i Estimates for disease prevalence and
severity are reported at national, government regional, PHE centre and where
appropriate, upper-tier local authority level. Where comparisons can be made with the
2013 Child Dental Health survey (CDHS) or with the PHE DPHEP survey data these are
shown. The survey has provided information for targeting activities to address the dental
indicator (tooth decay in children aged five) included in the public health outcomes
framework (PHOF) and for planning services to suit the specific needs of this group.
This is the first time a national dental survey has been undertaken for this population
group.
Summary tables can be found in Appendices A and B of this report. Full tables of results
are available from www.nwph.net/dentalhealth/
Overall, of the five-year-old children in England whose parents gave consent for their
participation in this survey, 22% had experienced dental decay. On average, these
children had 3.90 primary teeth that were obviously decayed, missing or filled. The
average number of decayed, missing or filled teeth (d3mft) in the whole sample
(including the 78% who were free of obvious decay) was 0.88.
For this age group, overall severity and prevalence were slightly lower than for children
attending mainstream schools, but those who have experience of decay have more
teeth affected on average. This age group were twice as likely to have had one or more
teeth extracted than their mainstream-educated peers.
Among the 12-year-old children in England whose parents gave consent for their
participation in this survey, 29% had experienced dental decay. On average, these
children had 2.37 permanent teeth that were obviously decayed, missing or filled. The
average number of decayed, missing or filled teeth (D3MFT) in the whole sample
(including the 71% who were decay free) was 0.69.
For 12-year-old children, again, overall severity and prevalence was lower than for
children attending mainstream schools but those who had decay had it more severely
with more teeth being affected on average.
At the government regional level, the five-year-old children’s results revealed variation
in the prevalence and severity of dental decay. The North West had the highest
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
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prevalence and severity (33%, 1.49) compared with the lowest in the South West (10%,
0.33). At PHE centre level there was also variation with the highest prevalence of caries
experience affecting 42% of children in Cumbria and Lancashireii and 5% in Devon,
Cornwall and Somerset.
ii Severity ranged from greater than 1.50 d3mft in two PHE
centres to below 0.20 d3mft in one other PHE centre.
The results for 12-year-old children also revealed a variation at the government regional
level in the prevalence and severity of dental decay. The North West again had the
highest prevalence and severity (41%, 1.04) compared with the lowest prevalence in the
South East (22%) and the lowest severity in London (0.47). At PHE centre level the
highest prevalence of caries experience was in Greater Manchester where 44% of
children were affected and the lowest prevalence of caries experience affecting 18%
was in Kent, Surrey and Sussex.
ii Severity ranged from 1.23 D3MFT in Greater
Manchester to below 0.50 D3MFT in London, South Midlands and Hertfordshire, and
Kent, Surrey and Sussex.
This report highlights the results of more detailed analysis of the possible relationships
between dental status and other factors in these children.
Local authorities are now responsible for improving health and reducing inequalities,
including oral health.
1
This report provides baseline and benchmarking data that can be
used in joint strategic needs assessments and to plan and commission oral health
improvement interventions. PHE produced ‘Local authorities improving oral health:
commissioning better oral health for children and young people: an evidence-informed
toolkit for local authorities’ in June 2014,
2 which provides guidance regarding
commissioning evidence-informed oral health improvement interventions.
National Institute for Health and Care Excellence (NICE) also published guidance ‘Oral
health: approaches for local authorities and their partners to improve the oral health of
their communities’ in October 2014 and this focusses on vulnerable groups, which
include children with disabilities.
3
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
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Introduction
This report presents summarised results of the oral health of five and 12-year-old children
attending special support schools who were surveyed in the academic year 2013 to 2014. This
is the first national dental survey of this population age group in England.
Since 1985 standardised and coordinated surveys of child dental health have been conducted
across the UK which provided robust, comparable information for use at local, government
regional and national levels. In England these surveys are now part of the PHE Dental Public
Health epidemiology programme (DPHEP), supported by the Dental Public Health
epidemiology team (DPHET) and the Knowledge and Intelligence team North West (KIT NW).
The surveys follow UK wide standards set down by the British Association for the Study of
Community Dentistry (BASCD).
6
The standards that refer to school-based surveys normally
exclude special support schools from the sampling frame so knowledge about children
attending special support schools was only known in a few areas where additional ad hoc
surveys were undertaken. The national survey reported here took place during the year when
the fifth decennial survey of child dental health was being completed. This allows for
comparisons to be made between the results of the Child Dental Health survey 2013 (CDHS)
15
and those from the most recent PHE DPHEP surveys.
A national protocol was prepared which was based, as far as possible, on the protocol for the
2012 survey of five-year-olds and the 2008 survey of 12-year-olds with adjustments to allow for
the special circumstances of the survey children. These adjustments related to sampling
methods, examination position, lighting and partial examinations.
It is acknowledged that many children with medical, behavioural, cognitive and communicative
special needs attend mainstream schools, with or without support. The proportion of these
varies from one local authority area to another depending upon local policies. Most authorities
have some special educational provision for children with severe problems. These children may
make greater demands on specialist dental treatment services in the short or long term which
need to be estimated for planning purposes. The planning process should also ensure that
these children, alongside their mainstream-educated peers, have equitable access to oral
health improvement services to support achievement and maintenance of good oral health.
From 1 April 2013 the responsibility for commissioning dental public health functions
transferred to local authorities1
as set out in Statutory Instrument 3094 (2012).
4
This survey
aims to support this responsibility by providing information on a particular sub-group of
vulnerable children. The survey also provides relevant information relating to the dental
indicator (tooth decay in children aged five) in the public health outcomes framework (PHOF).
5
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
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Information produced from PHE-coordinated surveys of child dental health provides key
information for local oral health needs assessments, which are used by local authorities and
NHS England when commissioning preventive and therapeutic services.
Section 1. Methodology
This survey was based on a national protocol which aligned as closely as possible with
previous protocols for caries surveys of five and 12-year-old children and which was based on
standards set by BASCD.
7 Adjustments were made to allow for the special circumstances of
the survey children with regard to sampling methods, examination position, lighting and partial
examinations.
The survey was undertaken during the academic year 2013 to 2014. The sampling frame was
children attending state provided or independent, non-residential special support schools of all
types which provide education for five-year-old and/or 12-year-old children. Funding of
education at special support schools is, in most cases, provided by the state. The primary
sampling unit was upper-tier local authorities and no sampling of schools was required as there
are so few in each upper-tier local authority.
Data was collected by trained and calibrated examiners employed by NHS trusts providing
community dental services. The training and calibration of examiners was carried out using the
methodology described by Pine et al6
and BASCD criteria for clinical examination, described by
Pitts et al,
7 were employed. This involves a visual only examination for missing teeth (mt and
MT), filled teeth (ft and FT) and teeth with obvious dentinal decay (d3t and D3T). The d3mft (for
primary teeth) or D3MFT (for permanent teeth) is produced. The subscript 3 indicates that decay
into dentine is recorded, which is widely accepted in the literature, acknowledging that it
provides an underestimate of the true prevalence and severity of disease. The presence and
absence of plaque and oral sepsis were also recorded.
The protocol required that positive consent was obtained before the survey from the child’s
parent or from someone with the competence to give consent on behalf of the child. Requests
for consent for sampled children were sent to parents and followed by a second request where
no response was made to the first.
Data was collected using the Dental SurveyPlus 2 computer program. Electronic files of the
raw, anonymised data were sent from fieldwork teams to dental epidemiology coordinators
(DECs) and on to the PHE DPHET via a secure web portal. Data cleaning, quality checks and
initial analyses were undertaken before the data was linked via the child’s home postcode to
look-up tables for geographic allocation and for scores from the index of multiple deprivation
2010 (IMD 2010) which have been adjusted for the 20119
census. The DPHET and the KIT NW
worked jointly on the analyses, result collation, report compilation and quality assurance.
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
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No weighting of the sample data was undertaken because there is some evidence that a
number of disabilities and conditions are more prevalent in more deprived populations.
10 It
would therefore produce incorrect estimates of dental disease prevalence from this population if
the data were weighted to reflect the distribution of deprivation levels in total local authority.
Confidence limits were calculated and are presented as errors bars on charts in this report and
in the tables available from www.nwph.net/dentalhealth. The 95% confidence limits are the
lower and upper levels of a range of values, around the estimate, within which we can say with
95% confidence that the true value for the population lies. Larger sample sizes result in smaller
confidence interval ranges, thus values are more likely to be true. When comparing results, if
the lower and upper confidence intervals of sample estimates do not overlap, then it can be
assumed there is a significant difference between the estimates.
Section 2. Results
Headline results are presented here along with an indication of the range of results and some
high-level illustrations with comparisons with same age children attending mainstream schools.
Full tables and charts of results at upper-tier local authority (where sufficient numbers were
involved), PHE centre, government regional and national levels are available at
www.nwph.net/dentalhealth.
Participation in the survey
In total, 149 upper-tier local authorities out of 152 took part in the survey. However, in only 14
local authorities were enough five-year-old children examined to produce valid estimates for
individual LAs, and only 55 examined enough 12-year-old children to enable this. It was
anticipated that there would be insufficient data to report results for a large number of local
authorities. However, reporting at government regional and PHE centre levels was possible and
comparison with other child cohort surveys at these levels was also possible.
A total of 89% of consented children were examined, representing 66% of five-year-old children
and 50% of 12-year-old children attending special support schools. Simple non response to the
request for consent was the most common reason for no consent, despite two requests and
schools actively seeking returned forms. Only 3% of five-year-old children and 5% of 12-yearold children with consent declined to take part on the day of examination. Absenteeism
accounted for a further loss of 8% of five-year-old and 7% of 12-year-old consented children.
The proportion of five-year-old children who participated in the survey varied between PHE
centres, from 49% in Kent, Surrey and Sussexii to 88% in Anglia and Essex. Among 12-year-
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
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old children representation varied from 40% in Cumbria and Lancashireii to 73% in Thames
Valley.
A total of 1,415 completed dental charts were included in the final five-year-old caries analysis
which represented 73% of those children seen, 23% (450) had only a partial examination and
for 4% (71) no examination was possible. There was a completed plaque assessment for 95%
(1,834) of five-year-old children seen and 94% (1,813) had a completed sepsis assessment.
In the 12-year-old analysis a total of 3,055 completed dental charts were included in the caries
analysis which represented 88% of those children seen, 10% (349) had only a partial
examination and for 2% (55) no examination was possible. There was a completed plaque
assessment for 98% (3,385) of 12-year-old children seen and 97% (3,362) had a completed
sepsis assessment.
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
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Table 1: Number of special support schools and number of children attending them
(source: Edubase 2013*), number of children seen and % of those attending by PHE
centres
PHE centre
5-year-olds 12-year-olds
Special
support
schools
N
Children
attending
N
Children
examined
N
Examined
% of
children
attending
Special
support
schools
N
Children
attending
N
Children
examined
N
Examined
% of
children
attending
Anglia and Essex 39 136 119 88 51 420 271 65
Avon, Gloucestershire and
Wiltshire 23 118 92 78 29 248 148 60
Cheshire and Merseyside 27 125 98 78 39 331 192 58
Cumbria and Lancashireii 31 79 63 80 40 336 134 40
Devon, Cornwall and
Somersetii 20 59 33 56 32 210 107 51
East Midlands 43 135 112 83 53 392 171 44
Greater Manchester 28 194 135 70 39 442 187 42
Kent, Surrey and Sussexii
47 299 146 49 78 634 257 41
London 85 500 286 57 110 986 472 48
North East 29 187 127 68 36 458 202 44
South Midlands and
Hertfordshire 26 165 117 71 38 363 219 60
Thames Valley 25 100 62 62 27 211 153 73
Wessex 28 129 107 83 31 334 221 66
West Midlands 65 466 308 66 78 935 421 45
Yorkshire and the Humber 47 249 131 53 59 573 304 53
England 563 2,941 1,936 66 740 6,873 3,459 50
*Numbers on Edubase may differ from actual numbers in schools.
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
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Table 2: Examination status of five- and 12-year old children by PHE centres
PHE centre
5-year-olds seen 12-year-olds seen
Full
examination
%
Partial
examination
%
No
examination
possible
%
Full
examination
%
Partial
examination
%
No
examination
possible
%
Anglia and Essex 74 22 4 92 7 1
Avon, Gloucestershire and Wiltshire 87 13 0 82 18 0
Cheshire and Merseyside 74 21 4 93 7 0
Cumbria and Lancashireii 68 19 13 77 13 10
Devon, Cornwall and Somersetii 61 39 0 89 11 0
East Midlands 80 18 2 96 4 0
Greater Manchester 67 30 3 92 7 1
Kent, Surrey and Sussexii 72 16 12 85 8 7
London 75 22 2 89 10 1
North East 71 24 5 87 12 1
South Midlands and Hertfordshire 85 15 0 92 8 0
Thames Valley 61 39 0 81 19 0
Wessex 71 26 3 84 15 1
West Midlands 72 25 4 91 8 1
Yorkshire and the Humber 66 31 3 87 12 2
England 73 23 4 88 10 2
This shows that the majority of children, 73% of five-year-olds and 88% of 12-year-olds, were
able to undergo a full examination in school. However, a significant minority (23% and 10%)
could only co-operate sufficiently to have a partial examination. In all but two centres the
proportions of children who could not be examined at all was fewer than 5%. This gives some
idea of the proportion of children attending special support schools who would need specialised
clinical services to enable a full examination to be carried out. While it can be deduced that
more than 27% of five-year-olds and 12% of 12-year-olds attending special support schools
would need specialised services for the provision of clinical treatment, these are minimum
figures. It cannot be known what proportion of those children who complied with full
examination would also be sufficiently compliant to safely accept more active treatment.
Full examination was least often completed for five-year-old children with severe learning
disability (68%) and most often completed among those attending schools that specialise in
hearing or visual disability (96%) (Table 5). Among 12-year-olds full examination occurred with
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
11
96% of those with moderate learning disabilities and was lowest at 74% among those with
profound and multiple learning disabilities (Table 6).
Prevalence of dental decay at age five
In England, 22% of five-year-old children attending special support schools had experience of
obvious dental decay (caries), having one or more primary teeth that were decayed to dentinal
level, extracted or filled because of caries (%d3mft>0). The remaining 78% were free from
visually obvious dental decay. Across the government regions, estimates ranged from 33% in
the North West to 10% in the South West (Figures 1 and 2).
This compares with a prevalence of 28% found in the 2012 DPHEP survey of children attending
mainstream schools (Table 3).
Figure 1: Percentage of five-year-old children attending special support schools with
decay experience (d3mft > 0) in England by government region, 2014.
Error bars represent 95% confidence limits
0 5 10 15 20 25 30 35 40 45
North West
Yorkshire and The Humber
London
North East
England
South East
East of England
West Midlands
East Midlands
South West
% d3mft > 0
Government region
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
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Figure 2: Percentage of five-year-old children attending special support schools with
decay experience (d3mft > 0) in England by government region, 2014.
At the PHE centre level there were variations, ranging from Cumbria and Lancashireii where
42% were affected, to Devon, Cornwall and Somersetii where 5% had experience of dentinal
decay (Figure 3).
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
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Figure 3. Percentage of five-year-old children attending special support schools with
decay experience (d3mft > 0) in England by Public Health England centre, 2014.
Error bars represent 95% confidence limits
Severity of dental decay at age five
In England, the average number of primary teeth affected by decay (decayed, missing or filled
teeth (d3mft) per child attending special support schools was 0.88. At the government regional
level this ranged from 1.49 in the North West to 0.33 in the South West (Figure 4).
The figure is slightly lower than the mean of 0.94 found in the 2012 DPHEP survey of
mainstream five-year-olds11
(Table 3).
The number of teeth with obvious, untreated dentinal decay (d3
t) made up 60% of the d3mft
index in this age group, compared with 78% in mainstream schools.
0 5 10 15 20 25 30 35 40 45 50 55 60
Cumbria and Lancashire
Greater Manchester
Thames Valley
Cheshire and Merseyside
Yorkshire and the Humber
London
North East
South Midlands and Hertfordshire
England
Kent, Surrey and Sussex
Wessex
West Midlands
Anglia and Essex
East Midlands
Avon, Gloucestershire and Wiltshire
Devon, Cornwall and Somerset
% d3mft > 0
PHE centre
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
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Figure 4: Average number of dentinally decayed, missing (due to decay) and filled
primary teeth (d3mft) among five-year-old children attending special support schools in
England by government region, 2014.
Error bars represent 95% confidence limits
Figure 5: Average number of dentinally decayed, missing (due to decay) and filled
primary teeth (d3mft), with components, among five-year-old children attending special
support schools in England by government region, 2014.
Error bars represent 95% confidence limits
0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1.80 2.00
North West
Yorkshire and The Humber
London
North East
England
South East
East of England
West Midlands
East Midlands
South West
Average d3mft
Government region
0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1.80 2.00
North West
Yorkshire and The Humber
London
North East
England
South East
East of England
West Midlands
East Midlands
South West
Average d3mft
Government region
England
Avg d3
t
Avg mt
Avg ft
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
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There was variation in mean d3mft across PHE centres, ranging from 1.63 in Greater
Manchester to 0.15 in Devon, Cornwall and Somersetii (Figure 6).
Figure 6: Average number of dentinally decayed, missing (due to decay) and filled
primary teeth (d3mft) among five-year-old children attending special support schools in
England by Public Health England centre, 2014.
Error bars represent 95% confidence limits
Extent of dental decay at age five
In England, the average number of primary tooth surfaces affected by decay (decayed, missing
or filled surfaces, d3mfs) per child attending special support schools was 1.91, this compares
with an average of 2.14 d3mfs among mainstream-educated children. At the government
regional level this ranged from 3.34 in the North West to 0.83 in the South West (Figure 7).
Those affected by decay experience in special support schools had an average 8.51 d3mfs
compared to those in mainstream education with decay experience who had on average 7.71
surfaces affected. Further analysis reveals that decayed teeth in both groups had a similar
number of surfaces affected by decay.
0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1.80 2.00 2.20 2.40
Greater Manchester
Cumbria and Lancashire
Cheshire and Merseyside
Thames Valley
Yorkshire and the Humber
London
North East
England
South Midlands and Hertfordshire
West Midlands
Wessex
Anglia and Essex
Kent, Surrey and Sussex
East Midlands
Avon, Gloucestershire and Wiltshire
Devon, Cornwall and Somerset
Average d3mft
PHE centre
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
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Figure 7: Average number of dentinally decayed, missing (due to decay) and filled
primary surfaces (d3mfs) among five-year-old children attending special support schools
in England by government region, 2014.
Error bars represent 95% confidence limits
Prevalence of dental decay at age 12
In England, 29% of 12-year-old children attending special support schools had experience of
obvious dental decay (caries), having one or more permanent teeth that were obviously
decayed to dentinal level, extracted or filled because of caries (%D3MFT>0). The remaining
71% were free from visually obvious dental decay. Across the government regions, estimates
ranged from 41% in the North West to 22% in the South East (Figures 8 and 9).
This compares with 33% of 12-year-old children attending mainstream schools as found in the
2008/09 survey of 12-year-olds (Table 4).
12
0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50
North West
Yorkshire and The Humber
London
North East
England
East of England
South East
West Midlands
East Midlands
South West
Average d3mfs
Government region
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
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Figure 8: Percentage of 12-year-old children attending special support schools with
decay experience (D3MFT > 0) in England by government region, 2014.
Error bars represent 95% confidence limits
Figure 9: Percentage of 12-year-old children attending special support schools with
decay experience (D3MFT > 0) in England by government region, 2014.
0 5 10 15 20 25 30 35 40 45 50
North West
North East
East Midlands
South West
Yorkshire and The Humber
England
West Midlands
East of England
London
South East
% D3MFT > 0
Government region
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
18
At the PHE centre level there were variations, ranging from Greater Manchester where 44%
were affected to Kent, Surrey and Sussexii where 18% had experience of dentinal decay
(Figure 10).
Figure 10: Percentage of 12-year-old children attending special support schools with
decay experience (D3MFT > 0) in England by Public Health England centre, 2014.
Severity of dental decay at age 12
In England, the average number of permanent teeth affected by decay (decayed, missing or
filled teeth (D3MFT) per child attending special support schools was 0.69. At the government
regional level this ranged from 1.04 in the North West to 0.47 in London (Figure 11).
This compares with a mean of 0.74 found in the 2008/09 survey of 12-year-olds attending
mainstream schools (Table 4).
The number of teeth with obvious, untreated dentinal decay (D3
T) made up 44% of the D3MFT
index in this age group, compared with 43% in mainstream schools.
0 5 10 15 20 25 30 35 40 45 50 55 60
Greater Manchester
Cheshire and Merseyside
North East
Cumbria and Lancashire
Devon, Cornwall and Somerset
East Midlands
Yorkshire and the Humber
Avon, Gloucestershire and Wiltshire
England
West Midlands
Anglia and Essex
Wessex
Thames Valley
South Midlands and Hertfordshire
London
Kent, Surrey and Sussex
% D3MFT > 0
PHE centre
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
19
Figure 11: Average number of dentinally decayed, missing (due to decay) and filled
permanent teeth (D3MFT) among 12-year-old children attending special support schools
in England by government region, 2014.
Error bars represent 95% confidence limits
Figure 12: Average number of dentinally decayed, missing (due to decay) and filled
primary teeth (D3MFT), with components, among 12-year-old children attending special
support schools in England by government region, 2014.
Error bars represent 95% confidence limits
0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40
North West
North East
South West
East Midlands
Yorkshire and The Humber
England
East of England
South East
West Midlands
London
Average D3MFT
Government region
0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40
North West
North East
South West
East Midlands
Yorkshire and The Humber
England
East of England
South East
West Midlands
London
Average D3MFT
Government region
England
Avg D3T
Avg MT
Avg FT
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
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There was variation in mean D3MFT across PHE centres, ranging from 1.23 in Greater
Manchester to 0.47 in London (Figure 13).
Figure 13: Average number of dentinally decayed, missing (due to decay) and filled
permanent teeth (D3MFT) among 12-year-old children attending special support schools
in England by Public Health England centre, 2014.
Extent of dental decay at age 12
In England, the average number of permanent surfaces affected by decay (decayed, missing or
filled surfaces (D3MFS) per child attending special support schools was 1.52. At the
government regional level this ranged from 2.45 in the North East to 0.93 in London (Figure
14). Those affected by decay experience had an average 5.20 D3MFS.
0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60
Greater Manchester
Cheshire and Merseyside
North East
East Midlands
Avon, Gloucestershire and Wiltshire
Devon, Cornwall and Somerset
Cumbria and Lancashire
Yorkshire and the Humber
England
Wessex
Anglia and Essex
Thames Valley
West Midlands
Kent, Surrey and Sussex
South Midlands and Hertfordshire
London
Average D3MFT
PHE centre
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
21
Figure 14: Average number of dentinally decayed, missing (due to decay) and filled
permanent surfaces (D3MFS) among 12-year-old children attending special support
schools in England by government region, 2014.
Severity of decay among children with caries experience at age five and 12
It is helpful to look more closely at those children who had experience of decay, separately from
those with none. In the current survey the decay identified occurred in 22% of five-year-olds
and 29% of 12-year-olds who were surveyed. Calculation of the average number of decayed,
missing or filled teeth in the groups affected with decay (referred to as d3mft>0 or D3MFT>0)
allows us to understand more about the extent of disease in the mouths of children who were
affected.
Among the children with decay experience, the average number of decayed, missing (due to
decay) or filled teeth was 3.90 among five-year-olds and 2.37 among 12-year-olds, this
compares with 3.38 in mainstream five-year-old children and 2.21 in mainstream 12-year-old
children (Tables 3 and 4). This ranged in special support school children from 4.43 in the North
West to 3.19 in the East Midlands among five-year-olds, and ranged from 2.88 in the South
West to 1.87 in the West Midlands among 12-year-olds.
At PHE centre level the variation of severity among affected children was greater, with a range
of 4.90 in Greater Manchester to 2.70 d3mft in Kent, Surrey and Sussexii for five-year-olds.
Among 12-year-olds the highest score for affected children was 3.08 in Avon, Gloucestershire
and Wiltshire and the lowest in West Midlands (1.87).
0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50
North East
North West
South West
East Midlands
England
Yorkshire and The Humber
South East
West Midlands
East of England
London
Average D3MFS
Government region
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
22
This shows that children attending special support schools who get any decay have more teeth
affected by this decay.
Comparison with children attending mainstream schools
Among five-year olds attending special support schools the prevalence of decay experience of
22% compares with 28% in the 2012 DPHEP survey of mainstream educated children. The
mean severity measure of 0.88 d3mft compares with 0.94 found in the 2012 DPHEP survey
(Table 3). This comparison uses BASCD standards for calculating the prevalence of caries
experience and the mean d3mft.
Comparison with the 2013 Child Dental Health survey (CDHS) data requires the removal of the
‘mt’ component of the index for calculation of both prevalence and severity for the primary
dentition. This is because the CDHS excludes missing teeth from their calculations for severity
and prevalence and reports the d3ft only. Thus, the revised prevalence for special support fiveyear-olds becomes 18% and compares with 31% in the CDHS (Table 3a). The mean d3ft for
special support children is 0.56 and compares with 0.89 in the CDHS. This shows the impact
that the ‘missing’ component has upon the prevalence and severity calculations, especially for
children attending special support schools.
Similar comparison can be made for 12-year-olds with the prevalence of 29% being lower than
33% in the 2009 DPHEP survey and 32% found in the CDHS. The mean D3MFT of 0.69 in this
survey is lower than that found in the 2009 DPHEP survey of 12-year-olds (0.74) and the
CDHS (0.78). The criteria for calculation in the permanent dentition remain the same in all three
surveys (Table 4).
Tables 3 and 3a: Mean prevalence and severity of dental caries among five- year-old
children attending special support schools compared with DPHEP 2012 (applying BASCD
criteria which include mt in the calculation of d3mft) and CDHS 2013 (applying CDHS criteria
which exclude mt in the calculation of severity and prevalence).
Survey group N
examined
% affected by
caries (dm3ft>0)
(95% CI)
Mean d3mft
(95% CI)
Mean d3mft
among those
affected
(95% CI)
Special support school
5-yr-olds (mt included) 1,415 22.5
(20.3, 24.6)
0.88
(0.76, 0.99)
3.90
(3.58, 4.22)
Mainstream school
5-yr-olds 2012 DPHEP 133,516 27.9*
(27.7, 28.1)
0.94
(0.93, 0.96)
3.38*
(3.36, 3.41)
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
23
Table 3a:
Survey group N
examined
% affected by
caries (d3ft>0 )
(95% CI)
Mean d3ft
(95% CI)
Mean d3ft among
those affected
(95% CI)
Special support school
5-yr-olds (mt excluded) 1,415 18.2
(16.2, 20.2)
0.56
(0.48, 0.64)
3.10
(2.81, 3.39)
Mainstream school
5-yr-olds 2012 DPHEP 133,516 26.8*
(26.5, 27.0)
0.83*
(0.82, 0.84)
3.12
(3.09, 3.14)
Mainstream school
5-yr-olds 2013 CDHS 1,526 30.7*
(26.6, 34.8)
0.89*
(0.74, 1.05)
2.90
(2.66, 3.17)
*significantly different from measure for special support children
Figure 15: Percentage of five-year-old children with decay experience (d3mft > 0) in
special support (2014) and mainstream schools (2012) in England by government region.
Difference (%) 15
(50%)
5
(20%)
5
(15%)
3
(10%)
1
(4%)
-1
(-5%)
16
(62%)
10
(37%)
6
(17%)
5
(19%)
Error bars represent 95% confidence limits
East
Midlands
East of
England London North
East
North
West
South
East
South
West
West
Midlands
Yorkshire
and The
Humber
England
Special support 15 18 28 27 33 22 10 16 28 22
Mainstream 30 23 33 30 35 21 26 26 34 28
0
5
10
15
20
25
30
35
40
% d mft > 0 3
England
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
24
Figure 16: Average number of dentinally decayed, missing (due to decay) and filled
primary teeth (d3mft) among five-year-old children in special support (2014) and
mainstream schools (2012) in England by government region.
Difference (%) 0.44
(48%)
0.09
(12%)
0.07
(6%)
0.04
(4%)
-0.20
(-16%)
-0.06
(-9%)
0.46
(58%)
0.20
(24%)
0.04
(3%)
0.06
(6%)
Figure 17: Percentage of five-year-old children with decay experience (d3mft > 0) in
special support (2014) and mainstream schools (2012) in England by Public Health
England centre.
Error bars represent 95% confidence limits
East
Midlands
East of
England London North
East
North
West
South
East
South
West
West
Midlands
Yorkshire
and The
Humber
England
Special support 0.48 0.66 1.16 0.98 1.49 0.73 0.33 0.62 1.19 0.88
Mainstream 0.92 0.75 1.23 1.02 1.29 0.67 0.79 0.82 1.23 0.94
0.00
0.25
0.50
0.75
1.00
1.25
1.50
1.75
2.00
Average d mft 3
England
0 5 10 15 20 25 30 35 40 45 50 55 60
Cumbria and Lancashire
Greater Manchester
Thames Valley
Cheshire and Merseyside
Yorkshire and the Humber
London
North East
South Midlands and Hertfordshire
England
Kent, Surrey and Sussex
Wessex
West Midlands
Anglia and Essex
East Midlands
Avon, Gloucestershire and Wiltshire
Devon, Cornwall and Somerset
% d3mft > 0
PHE centre
Special support
Mainstream
England
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
25
Figure 18: Average number of dentinally decayed, missing (due to decay) and filled
primary teeth (d3mft) among five-year-old children in special support (2014) and
mainstream schools (2012) in England by Public Health England centre.
Table 4: Mean prevalence and severity of dental caries among 12-year-old children
attending special support schools compared with DPHEP 2009 survey and CDHS 2013.
Survey group N
examined
% affected by
caries
(95% CI)
Mean D3MFT
(95% CI)
Mean D3MFT
among those
affected
(95% CI)
Special support school
12-yr-olds 3,055 29.2
(27.6, 30.8)
0.69
(0.64, 0.74)
2.37
(2.26, 2.49)
Mainstream school
12-yr-olds 2009 DPHEP 89,442 33.4*
(33.1, 33.7)
0.74
(0.73, 0.75)
2.21*
(2.19, 2.23)
Mainstream school
12-yr-olds 2013 CDHS 1,434 31.6
(26.9, 36.3)
0.78
(0.65, 0.91)
2.50
(2.17, 2.76)
*significantly different from measure for special support children
0.00 0.25 0.50 0.75 1.00 1.25 1.50 1.75 2.00 2.25 2.50
Greater Manchester
Cumbria and Lancashire
Cheshire and Merseyside
Thames Valley
Yorkshire and the Humber
London
North East
England
South Midlands and Hertfordshire
West Midlands
Wessex
Anglia and Essex
Kent, Surrey and Sussex
East Midlands
Avon, Gloucestershire and Wiltshire
Devon, Cornwall and Somerset
Average d3mft
PHE centre
Special support
Mainstream
England
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
26
Figure 19: Percentage of 12-year-old children with decay experience (D3MFT > 0) in
special support (2014) and mainstream schools (2009) in England by government region.
Difference (%) -1
(-3%)
4
(14%)
5
(18%)
-1
(-2%)
-1
(-2%)
6
(21%)
1
(2%)
5
(16%)
14
(30%)
4
(13%)
Figure 20: Average number of dentinally decayed, missing (due to decay) and filled
permanent teeth (D3MFT) among 12-year-old children in special support (2014) and
mainstream schools (2009) in England by government region.
Difference (%) -0.16
(-22%)
0.02
(3%)
0.11
(19%)
-0.09
(-10%)
-0.09
(-10%)
0.05
(9%)
-0.21
(-28%)
0.18
(26%)
0.36
(34%)
0.05
(6%)
East
Midlands
East of
England London North
East
North
West
South
East
South
West
West
Midlands
Yorkshire
and The
Humber
England
Special support 34 24 23 39 41 22 33 27 31 29
Mainstream 33 28 28 38 40 27 33 32 45 33
0
5
10
15
20
25
30
35
40
45
50
% D MFT > 0 3
England
East
Midlands
East of
England London North
East
North
West
South
East
South
West
West
Midlands
Yorkshire
and The
Humber
England
Special support 0.90 0.55 0.47 0.97 1.04 0.50 0.94 0.50 0.71 0.69
Mainstream 0.74 0.57 0.58 0.88 0.95 0.55 0.73 0.68 1.07 0.74
0.00
0.25
0.50
0.75
1.00
1.25
Average D MFT 3
England
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
27
Figure 21: Percentage of 12-year-old children with decay experience (D3MFT > 0) in
special support (2014) and mainstream schools (2009) in England by Public Health
England centre.
Figure 22: Average number of dentinally decayed, missing (due to decay) and filled
permanent teeth (D3MFT) among 12-year-old children in special support (2014) and
mainstream schools (2009) in England by Public Health England centre.
0 5 10 15 20 25 30 35 40 45 50 55
Greater Manchester
Cheshire and Merseyside
North East
Cumbria and Lancashire
Devon, Cornwall and Somerset
East Midlands
Yorkshire and the Humber
Avon, Gloucestershire and Wiltshire
England
West Midlands
Anglia and Essex
Wessex
Thames Valley
South Midlands and Hertfordshire
London
Kent, Surrey and Sussex
% D3MFT > 0
PHE centre
Special support
Mainstream
England
0.00 0.25 0.50 0.75 1.00 1.25 1.50 1.75
Greater Manchester
Cheshire and Merseyside
North East
East Midlands
Avon, Gloucestershire and Wiltshire
Devon, Cornwall and Somerset
Cumbria and Lancashire
Yorkshire and the Humber
England
Wessex
Anglia and Essex
Thames Valley
West Midlands
Kent, Surrey and Sussex
South Midlands and Hertfordshire
London
Average D3MFT
PHE centre
Special support
Mainstream
England
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
28
In summary, comparison with survey information involving mainstream educated children
shows that in most instances the levels of decay in both age groups are similar within each of
the geographical areas presented. There are very few significant differences and these are in
the same direction with some geographies where the prevalence or severity of decay among
children attending special support schools is lower than among mainstream educated children.
Correlation of decay prevalence and severity with deprivation
The association of high levels of decay with high levels of deprivation have been widely
described. For example, in the most recent survey of five-year-olds in England, the correlation
was shown to be strong, with 45% of the variation in decay levels in local authorities being
explained by differences in deprivation.
11 Deprivation is measured using the index of multiple
deprivation.
9
The association would appear to be weaker among five-year-old children in special support
schools than those attending mainstream schools (see Figures 23 and 24). Children attending
special support schools who are in the more deprived groups have significantly lower
prevalence of caries but only in the most deprived group is there a significant difference in
severity.
Figure 23: Prevalence of caries among five-year-old children attending special support
schools and DPHEP survey 2012 results by index of multiple deprivation (IMD 2010).
Difference (%) 16
(39%)
6
(20%)
5
(20%)
-2
(-10%)
0
(2%)
Most deprived Second most
deprived
Third most
deprived
Fourth most
deprived Least deprived
Special support 24 25 20 23 17
Mainstream 40 32 25 21 18
0
5
10
15
20
25
30
35
40
45
% d mft > 0 3
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
29
Figure 24: Severity of caries among five-year-old children attending special support
schools and DPHEP survey 2012 results by index of multiple deprivation (IMD 2010).
Difference (%) 0.54
(35%)
0.09
(8%)
0.02
(3%)
-0.28
(-47%)
-0.07
(-16%)
Figures 25 and 26 suggest that there is a stronger relationship between socio-economic
deprivation and caries levels for 12-year-olds attending special support schools than for fiveyear-olds. This mirrors the association found among mainstream educated children where the
most deprived children have higher prevalence and severity of decay.
Figure 25: Prevalence of caries among 12-year-old children attending special support
schools and DPHEP survey 2009 results by index of multiple deprivation (IMD 2010).
Difference (%) 5
(15%)
8
(20%)
2
(7%)
7
(23%)
7
(26%)
Most deprived Second most
deprived
Third most
deprived
Fourth most
deprived Least deprived
Special support 1.01 1.03 0.75 0.87 0.52
Mainstream 1.55 1.12 0.77 0.59 0.45
0.00
0.25
0.50
0.75
1.00
1.25
1.50
1.75
Average d mft 3
Most deprived Second most
deprived
Third most
deprived
Fourth most
deprived Least deprived
Special support 37 30 30 23 19
Mainstream 42 38 32 29 25
0
5
10
15
20
25
30
35
40
45
% D MFT > 0 3
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
30
Figure 26. Severity of caries among 12-year-old children attending special support
schools and DPHEP survey 2009 results by index of multiple deprivation (IMD 2010).
Difference (%) 0.16
(15%)
0.10
(11%)
-0.01
(-1%)
0.12
(20%)
0.05
(10%)
Prevalence of extraction experience (children with teeth extracted due to dental
decay) at age five
The proportion of five-year-old children attending special support schools who have had one or
more teeth extracted on one or more occasions, across England, was 6% (95% CI 4.9–7.4%)
(Table 5). At government regional level this ranged from 11% in London to 3% in the East and
West Midlands and at PHE centre level ranged from 12% in Cumbria and Lancashireii to zero in
the Thames Valley. This overall figure is significantly higher than that found among mainstream
educated children where the proportion with extraction experience was 3% (95% CI 3.0–3.2%).
It should be noted that the vast majority of these extractions would have required admission to
hospital for such young children.
Measures of decay for different types of disability
There doesn’t appear to be a strong or consistent pattern of disease levels affecting particular
types of disability among five or 12-year-olds (Tables 5 and 6). The only exception is for older
children with behavioural or social disabilities where the prevalence of decay and untreated
decay are higher than other groups and the proportion with substantial plaque present is also
high.
Most deprived Second most
deprived
Third most
deprived
Fourth most
deprived Least deprived
Special support 0.88 0.77 0.70 0.49 0.43
Mainstream 1.04 0.87 0.69 0.61 0.48
0.00
0.25
0.50
0.75
1.00
1.25
Average D MFT 3
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
31
Table 5: Various measures of decay for all five-year-old children attending special support schools and by disability group. Children classified
according to the prime specialisation of the school they attended. It is recognised that many children have multiple disabilities so the code of the school
acted as a proxy measure for broad disability types.
Group
N (%)
dental chart
completed
N (%) plaque
assessment
completed
N (%)
sepsis
assessment
completed
*Mean
d3mft
* % with
decay
experience
(d3mft>0)
* Mean
d3mft of
those
affected
* % with
untreated
decay
(d3t>0)
* % with
extraction
experience
(mt>0)
^ % with
substantial
amount of
plaque visible
^ %
with
sepsis
present
* %
with
incisor
caries
All 1,415
(73%)
1,834
(95%)
1,813
(94%) 0.88 22.5 3.90 17.2 6.1 4.3 1.0 4.7
Autistic spectrum
disorder
241
(76%)
303
(96%)
299
(94%) 1.07 25.3 4.23 17.8 9.1 1.3 1.0 4.6
Behavioural
emotional and
social difficulty
29
(91%)
31
(97%)
31
(97%) 0.69 27.6 2.50 24.1 6.9 3.2 3.2 0.0
Hearing or visual
impairment
26
(96%)
27
(100%)
27
(100%) 0.92 19.2 4.80 15.4 3.8 11.1 0.0 3.8
Moderate learning
disability
227
(79%)
281
(97%)
278
(96%) 0.82 25.1 3.26 22.9 2.6 3.2 1.4 5.3
Profound and
multiple learning
disability
322
(73%)
417
(94%)
410
(92%) 0.81 20.5 3.95 14.6 7.1 5.8 1.2 2.8
Severe learning
disability
365
(68%)
503
(94%)
497
(93%) 0.88 20.5 4.27 15.6 6.0 5.4 0.8 6.8
Specific learning
disability
19
(73%)
23
(88%)
23
(88%) 0.95 26.3 3.60 15.8 10.5 0.0 0.0 0.0
Physical disability 59
(81%)
68
(93%)
68
(93%) 0.68 18.6 3.64 15.3 1.7 7.4 1.5 6.8
Speech language
and communication
impairment
56
(77%)
70
(96%)
70
(96%) 0.73 21.4 3.42 12.5 8.9 1.4 0.0 1.8
Other Including
Asperger’s syndrome,
ADHD, multi-sensory
impairment
71
(60%)
111
(93%)
110
(92%) 1.00 25.4 3.94 21.1 4.2 4.5 0.0 5.6
*Reported for those who had a completed dental chart. ^Reported for those who had a completed plaque or sepsis assessment
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
32
Table 6: Various measures of decay for all 12-year-old children attending special support schools and by disability group
Group
N (%)
dental chart
completed
N (%) plaque
assessment
completed
N (%)
sepsis
assessment
completed
*Mean
D3MFT
* % with
decay
experience
(D3MFT>0)
* Mean
D3MFT
of those
affected
* % with
untreated
decay
(D3T>0)
* % with
extraction
experience
(MT>0)
^ % with
substantial
amount of
plaque visible
^ %
with
sepsis
present
All 3,055
(88%)
3,385
(98%)
3,362
(97%) 0.69 29.2 2.37 15.4 6.1 19.5 0.6
Autistic spectrum
disorder
378
(88%)
421
(98%)
420
(98%) 0.58 25.7 2.26 14.3 5.3 17.1 1.2
Behavioural
emotional and social
disability
277
(95%)
280
(96%)
280
(96%) 1.07 41.5 2.58 25.6 8.7 23.9 0.7
Hearing or visual
impairment
55
(90%)
60
(98%)
60
(98%) 0.62 29.1 2.13 10.9 7.3 16.7 0.0
Moderate learning
disability
1,014
(96%)
1,050
(100%)
1,046
(99%) 0.71 30.1 2.35 16.2 4.6 20.0 0.5
Profound and
multiple learning
disability
381
(74%)
495
(96%)
485
(94%) 0.56 23.1 2.42 8.7 9.4 19.6 0.6
Severe learning
disability
558
(83%)
652
(96%)
646
(96%) 0.63 27.8 2.26 15.9 5.2 17.3 0.3
Specific learning
disability
33
(92%)
36
(100%)
36
(100%) 0.48 27.3 1.78 6.1 0.0 25.0 0.0
Physical disability 60
(90%)
64
(96%)
64
(96%) 0.33 20.0 1.67 11.7 5.0 23.4 1.6
Speech language
and communication
impairment
58
(94%)
61
(98%)
61
(98%) 0.72 24.1 3.00 13.8 5.2 13.1 1.6
Other Including
Asperger’s syndrome,
ADHD, multi-sensory
impairment
241
(90%)
266
(99%)
264
(99%) 0.85 33.6 2.53 15.4 8.3 22.6 0.4
*Reported for those who had a completed dental chart. ^Reported for those who had a completed plaque or sepsis assessment.
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
33
Prevalence of caries affecting incisors (early childhood caries)
The raw data for five-year-olds was manipulated to allow for reporting of a specific type of
caries sometimes called early childhood caries (ECC). This is an aggressive form of decay that
affects upper incisors and can be rapid and extensive in attack. It is associated with long term
bottle use with sugar-sweetened drinks, especially when these are given overnight or for long
periods of the day. The definition of ECC used here is:
Caries affecting any surface of one or more upper primary incisors, regardless of the
caries status of any other teeth.
13
Overall the prevalence of ECC was 4.7% (95% CI 3.6–5.8%) (Table 5) and varied by
government region, but at PHE centre level there was a far wider range from 12% in Cumbria
and Lancashireii to 0% in Devon, Cornwall and Somerset.
ii
In comparison the prevalence of ECC among five-year-old children attending mainstream
schools in 2012 was higher at 6.3% (95% CI 6.2–6.4%).
Figure 27. Percentage of five-year-old children attending special support schools with
early childhood caries in England by government region, 2014.
Error bars represent 95% confidence limits
0 2 4 6 8 10 12 14
North West
Yorkshire and The Humber
London
West Midlands
England
South East
North East
East Midlands
East of England
South West
% with early childhood caries
Government region
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
34
Children with sepsis at the time of the examination
Sepsis was defined in the protocol as the presence of a dental abscess or sinus recorded by
visual examination of the soft tissues. Across England, 1% of five-year-old children attending
special support schools showed signs of sepsis (Table 5). As might be expected, the level was
generally higher in those areas where there were higher levels of decay. For example, the
highest levels occurred in Greater Manchester (4%). This prevalence compares with 2% found
in the 2012 mainstream survey.
The prevalence of sepsis among 12-year-olds attending special support schools was very low
at 0.6% (Table 6), sepsis information was not collected in the 2009 mainstream school survey.
Children with substantial amount of plaque at the time of the examination
Across England, 4% of five-year-old children attending special support schools had substantial
amount of plaque visible (Table 5), compared with 2% found in 2012 mainstream children. At
PHE centre level this ranged from 11% in Thames Valley to 0.8% in Kent, Surrey and Sussex.
ii
Among 12-year-old children attending special support schools, 20% had substantial amount of
plaque visible across England (Table 6), compared with 10% found in 2009 mainstream
children. At PHE centre level this ranged from 34% in Avon, Gloucestershire and Wiltshire to
9% in Wessex. In this age group over 20% of children were found to have substantial amounts
of plaque present in specific disability groups; behavioural and social disability, those with
specific learning disability, physical disability and other non-specified disabilities.
It is likely that parents undertake toothbrushing for younger children but older ones are left to
brush by themselves. Physical limitations could mean that plaque removal is difficult for some
12-year-olds and it would appear that some behavioural disabilities mean that toothbrushing
isn’t done effectively.
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
35
Assessing factors and associations with disease
Table 7: Summary table for five-year-old children to assess where similarities lie.
5-year-old children
Proportion
with caries
experience %
Mean
d3mft
Mainstream schools 27.9 0.94
Special support schools 22.5 0.88
Disability type
Autistic spectrum disorder
Behavioural, emotional, social difficulty
Hearing or visual impairment
Moderate learning difficulty
Profound, multiple learning difficulty
Severe learning difficulty
Specific learning difficulty
Physical disability
Speech language and communication
Other, including Asperger’s syndrome,
ADHD, multi-sensory impairment
25.3
27.6
19.2
25.1
20.5
20.5
26.3
18.6
21.4
25.4
1.07
0.69
0.92
0.82
0.81
0.88
0.95
0.68
0.73
1.00
Table 8: Summary table for 12-year-old children to assess where similarities lie.
12-year-old children
Proportion
with caries
experience
%
Mean
D3MFT
Mainstream schools 33.4 0.74
Special support schools 29.2 0.69
Disability type
Autistic spectrum disorder
Behavioural, emotional, social difficulty
Hearing or visual impairment
Moderate learning difficulty
Profound, multiple learning difficulty
Severe learning difficulty
Specific learning difficulty
Physical disability
Speech language and communication
Other, including Asperger’s syndrome,
ADHD, multi-sensory impairment
25.7
41.5
29.1
30.1
23.1
27.8
27.3
20.0
24.1
33.6
0.58
1.07
0.62
0.71
0.56
0.63
0.48
0.33
0.72
0.85
The information derived from this survey shows that there is no single factor to explain variation
in disease between children attending special support schools compared with those in
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
36
mainstream education, or within the group of children with disabilities. The strongest trend is
seen when groups are compared by geographic location, where disease levels among children
attending special support schools mirror those in mainstream education in the same locality.
Deprivation shows a weaker association with caries among special support children than for
mainstream educated children. No clear pattern has been found whereby children attending
specific types of special support schools have notably higher or lower levels of disease (Table 8
and table 9).
Section 3. Implications of results
This report only reports measures of oral health for children attending special support schools.
It is acknowledged that the majority of children with disabilities and special needs are educated
in mainstream schools and that local policies vary regarding educational provision for this
group. It therefore cannot be known how disease levels among all children with special needs
vary and compare with children who have no disabilities. This report simply reports the levels
of disease among those children who are educated in special support schools.
The levels of dental decay and other measure reported here are likely to be an underestimate
of the true picture. This is explained in two ways; firstly the standard epidemiological
examination used does not report decay into enamel and, as radiographs are not used, caries
on approximal surfaces of teeth may not be seen. Secondly, the bias created by the
requirement for positive parental consent tends to cause lower levels of disease to be recorded
than in surveys where passive consent is used. The hypotheses explaining these findings are
that families that live less organised lives are less likely to return a signed form and less likely
to have good oral care habits and that parents who know that their child has decay would be
less willing for this to be seen by an epidemiological examiner.
Variation and inequality
For the first time, this report is able to show the wide variation in the levels of dental decay
experienced by children attending special support schools in different parts of the country. The
cause of dental decay is well understood and is related to the frequency and amount of sugar
consumed in foods and drinks and to low fluoride exposure. In the younger age group the
impact of infant and young child feeding is of particular note. High levels of consumption of
sugar-containing food and drink is also a contributory factor to other issues of public health
concern in children for example, childhood obesity.
Results show that there was greater polarisation of dental decay among children attending
special support schools than is typically seen among mainstream educated children. Put
simply, fewer children have experience of decay, but those who have tend to have decay more
severely, with more teeth affected than mainstream educated children.
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
37
Variation in disease levels was found according to geographic location, socio-economic status
and to some degree, type of disability. The strongest association was with location in England;
in areas where decay levels are high among mainstream educated children they are also high
for children attending special support schools. This finding may be explained by the multifactorial influences on oral health related behaviour, with higher levels and more frequent
consumption of sugar and less regular use of fluoride toothpaste being the social norm in some
parts of the country than others.
The larger proportion of five-year-olds with experience of extraction may reflect treatment
approaches where a general anaesthetic is required either due to the high number of teeth
affected or because the patient is unable to tolerate dental care under local anaesthesia. In
these circumstances the avoidance of repeat anaesthetics is the dominant principle for
planning treatment and therefore any teeth with a questionable prognosis are likely to be
removed. Consultants and specialists in paediatric dentistry are in the best position to make
these decisions and be able to provide the full range of clinical services in and out of theatre.
Putting this information to use
Data from this survey can be used to give background information when considering the PHOF
dental indicator (4.2 tooth decay in children aged five).
5 Children attending special support
schools should be regarded as vulnerable because of the consequences of decay in terms of
impact on the general health of the child and the specialist services required to manage it.
Since the Health and Social Care Act (2012) amended the National Health Service Act (2006)
responsibilities for health improvement, including oral health improvement, rest locally with local
authorities who now provide or commission oral health promotion programmes to improve the
health of the local population, to the extent that they consider appropriate in their areas. PHE
recently published an evidence based toolkit to support this work, ‘Local authorities improving
oral health: commissioning better oral health for children and young people’2
(CBOH) and
subsequently jointly published a further guidance document with the local government
association ‘Tackling poor oral health in children and young people’. NICE have also produced
recent oral health guidance which makes recommendations on undertaking oral health needs
assessments, developing a local strategy on oral health and delivering community-based
interventions and activities for all age groups including children.
3
Locally this data can also be used in oral health needs assessments, and in contributions to
local authority joint strategic needs assessments (JSNAs). Commissioning or providing dental
public health programmes should follow strategic planning. Advice is available from consultants
in dental public health at PHE centres regarding planning and commissioning tailored oral
health improvement programmes. There is good evidence that, in addition to place based
generic health improvement activities, which will address some of the common risk factors for
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
38
dental decay, strategies to increase the exposure to fluoride are effective.
In order to improve oral health for this vulnerable group action is required at all levels to contribute
to oral health improvement and the reduction of oral health inequalities. This requires a partnership
approach; with upstream healthy public policy, creating supportive environments and downstream
reorientation of services, for example focussing dental activities on prevention.
Preventive actions that clinical teams can encourage should be based on ‘Delivering better oral
health: an evidence based toolkit for prevention’14 and include:
 Breast feeding provides the best nutrition for babies
 From 6 months of age infants should be introduced to a free flow cup and from the age of 1
use of a feeding bottle discouraged
 Sugar should not be added to weaning foods or drinks
 The frequency and amount of sugary food and drinks should be reduced
 Avoid sugar containing foods and drinks at bedtime when saliva flow is reduced and
buffering capacity lost
 As soon as teeth erupt, to maximise caries prevention, brush them twice daily with a family
fluoride toothpaste (1350 -1500 ppm fluoride), 0 – 3 year olds using a smear and 3 – 6 year
olds a pea-sized amount
 Brush last thing at night and at least one other occasion
 Spit out toothpaste and do not rinse
 Brushing should be supervised by a parent or carer
 Sugar free medicines should be recommended
Commissioning clinical care for children with extra needs
Those commissioning treatment services for this group, and for other children with disabilities who
attend mainstream school, will note the increased severity and aim to prevent decay wherever
possible. Contracts with clinical teams should support, encourage and reward a proactive
preventive approach. Commissioning of specialist services will be required within primary and
hospital care for those children with additional needs who cannot be examined, or receive simple
or advanced clinical treatment without sedation or general anaesthesia. Commissioners will want
to be assured that such services have the expertise and facilities available to ensure equality of
outcome for children with disabilities.
Clinical teams will be aware of the implications of caries and its consequences for a child with
additional needs. Results of this survey show that action to prevent decay is required for all
children but particularly for those at higher risk, such as those with some evidence of decay.
‘Delivering better oral health: an evidence based toolkit for prevention’14
gives clear indications of
the advice to be given and actions that the clinical team should take.
i
Survey data were collected during the academic year 2013 to 2014 but are referred to here as 2014.
ii
Some lower-tier local authorities did not participate.
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
39
Section 4. References
1. The Stationery Office (2006). Health & Social Care Act 2012. Available at
www.legislation.gov.uk/ukpga/2012/7/enacted
2. Public Health England (2014). Local authorities improving oral health: commissioning better
oral health for children and young people. An evidence-informed toolkit for local authorities
available at www.gov.uk/government/publications/improving-oral-health-an-evidenceinformed-toolkit-for-local-authorities
3. NICE (2014). Oral health: approaches for local authorities and their partners to improve the
oral health of their communities. NICE guidelines [PH55]. Available at
www.nice.org.uk/guidance/ph55
4. Statutory Instrument 2012 No 3094. National Health Service, England Social Care Fund,
England Public Health, England. The NHS Bodies and Local Authorities (Partnership
Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations 2012.
Available at www.legislation.gov.uk/uksi/2012/3094/part/4/made
5. Department of Health. Public Health Outcomes Framework 2013 to 2016. From: Department
of Health. First published: www.gov.uk/government/publications/healthy-lives-healthypeople-improving-outcomes-and-supporting-transparency
6. Pine, C. M., Pitts, N. B. and Nugent, Z. J. (1997a). British Association for the Study of
Community Dentistry (BASCD) guidance on the statistical aspects of training and calibration
of examiners for surveys of child dental health. A BASCD co-ordinated dental epidemiology
programme quality standard. Community Dental Health 14 (Supplement 1):18-29
7. Pitts, N. B., Evans, D. J. and Pine, C. M. (1997). British Association for the Study of
Community Dentistry (BASCD) diagnostic criteria for caries prevalence surveys – 1996/97.
Community Dental Health 14 (Supplement 1): 6-9
8. Pine, C. M., Pitts, N. B. and Nugent, Z. J. (1997b). British Association for the Study of
Community Dentistry (BASCD) guidance on sampling for surveys of child dental health. A
BASCD coordinated dental epidemiology programme quality standard. Community Dental
Health 14 (Supplement 1):10-17
9. Office for National Statistics (2013). Ward population estimates, mid – 2011(Census based).
Statistical bulletin. Available at www.ons.gov.uk/ons/dcp171778_311891.pdf
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
40
10. Emerson, E. (2012). Deprivation, ethnicity and the prevalence of intellectual and
developmental disabilities. J Epidemiol Community Health 66:218-224
doi:10.1136/jech.2010.111773
11. Public Health England (2013). National dental epidemiology programme: oral health survey
of five-year-old children 2012. A report on the prevalence and severity of dental decay.
Available at www.nwph.net/dentalhealth
12. NHS Dental epidemiology programme for England. Oral Health Survey of 12 year old
Children 2008 / 2009. Available at www.nwph.net/dentalhealth
13. Davies, G. M., Blinkhorn, F. A., and Duxbury, J. T. (2001). Caries among 3-year-olds in
Greater Manchester. British Dental Journal 190: 381-384
14. Public Health England (2014). Delivering better oral health: an evidence based toolkit for
prevention. Third edition. Available at www.gov.uk/government/publications/deliveringbetter-oral-health-an-evidence-based-toolkit-for-prevention
15. Health and Social Care Information Centre (2015). Child Dental Health Survey 2013,
England, Wales and Northern Ireland. Available at
http://www.hscic.gov.uk/catalogue/PUB17137
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
41
Section 5. Supplementary tables
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
42
Appendix A: Dental Public Health Epidemiology Programme for England, Oral Health Survey of five-year-old children attending special support schools 2014, upper tier local authority (LA), Public Health England (PHE) Centre, region
Region Upper Tier
LA Code Upper Tier LA Name
5-year-olds
attending
special support
schools
Dental
chart
completed
Mean
d3mft % d3mft > 0
Mean d3mft
(% d3mft > 0)
% with
incisor
caries
Lower
d3mft
Upper
d3mft
Lower %
d3mft > 0
Upper %
d3mft > 0
Lower
d3mft > 0
(mean)
Upper
d3mft > 0
(mean)
Lower %
with incisor
caries
Upper %
with incisor
caries
Eng Eng England 2,941 1,415 0.88 22.5 3.90 4.7 0.76 0.99 20.3 24.6 3.58 4.22 3.6 5.8
31 Leicestershire 37 32 0.78 25.0 3.13 6.3 0.08 1.48 10.0 40.0 0.98 5.27 0.0 14.6
32 Lincolnshire 28 26 0.77 15.4 5.00 3.8 0.00 1.84 1.5 29.3 0.00 10.93 0.0 11.2
22 Essex 43 34 0.56 20.6 2.71 0.0 0.08 1.04 7.0 34.2 1.19 4.24 0.0 0.0
26 Hertfordshire 60 44 0.45 13.6 3.33 0.0 0.00 1.00 3.5 23.8 0.00 6.75 0.0 0.0
00AJ Ealing 38 26 1.35 38.5 3.50 7.7 0.54 2.15 19.8 57.2 2.29 4.71 0.0 17.9
30
Lancashire (survey undertaken in
Burnley, Fylde, Hyndburn,
Lancaster, Pendle, Preston, Ribble
Valley, Rossendale, Wyre ONLY)
65 30 1.67 43.3 3.85 10.0 0.74 2.59 25.6 61.1 2.39 5.30 0.0 20.7
00CB Wirral 35 25 1.64 36.0 4.56 4.0 0.53 2.75 17.2 54.8 2.59 6.52 0.0 11.7
24 Hampshire 70 40 0.43 10.0 4.25 2.5 0.00 0.87 0.7 19.3 2.08 6.42 0.0 7.3
29
Kent (survey undertaken in Ashford,
Canterbury, Dover, Gravesham,
Sevenoaks, Thanet, Tonbridge &
Malling, Tunbridge Wells ONLY)
108 51 0.47 17.6 2.67 5.9 0.05 0.89 7.2 28.1 0.85 4.49 0.0 12.3
45 West Sussex 51 21 1.05 33.3 3.14 0.0 0.19 1.91 13.2 53.5 1.36 4.93 0.0 0.0
23 Gloucestershire 58 39 0.36 15.4 2.33 2.6 0.01 0.71 4.1 26.7 0.76 3.91 0.0 7.5
00CN Birmingham 124 46 0.22 6.5 3.33 4.3 0.00 0.48 0.0 13.7 1.60 5.06 0.0 10.2
41 Staffordshire 62 52 0.63 15.4 4.13 3.8 0.13 1.14 5.6 25.2 2.05 6.20 0.0 9.1
44 Warwickshire 45 34 0.44 17.6 2.50 5.9 0.09 0.79 4.8 30.5 1.66 3.34 0.0 13.8
X25001AA London 500 215 1.16 27.9 4.17 5.1 0.84 1.49 21.9 33.9 3.41 4.92 2.2 8.1
X25002AA South Midlands and Hertfordshire 165 100 0.78 25.0 3.12 2.0 0.39 1.17 16.5 33.5 1.94 4.30 0.0 4.7
X25002AC East Midlands 135 90 0.50 13.3 3.75 3.3 0.10 0.90 6.3 20.4 1.42 6.08 0.0 7.0
X25002AD Anglia and Essex 136 88 0.53 13.6 3.92 2.3 0.18 0.89 6.5 20.8 2.29 5.54 0.0 5.4
X25002AE West Midlands 466 221 0.62 16.3 3.83 5.0 0.39 0.86 11.4 21.2 2.98 4.69 2.1 7.8
X25003AA Cheshire and Merseyside 125 73 1.27 28.8 4.43 4.1 0.70 1.85 18.4 39.2 3.22 5.64 0.0 8.7
X25003AC Cumbria and Lancashire 79 43 1.53 41.9 3.67 11.6 0.82 2.25 27.1 56.6 2.55 4.79 2.0 21.2
X25003AD Greater Manchester 194 90 1.63 33.3 4.90 10.0 1.03 2.24 23.6 43.1 3.77 6.03 3.8 16.2
X25003AE North East 187 90 0.98 26.7 3.67 4.4 0.50 1.46 17.5 35.8 2.35 4.98 0.2 8.7
X25003AF Yorkshire and the Humber 249 86 1.19 27.9 4.25 7.0 0.69 1.68 18.4 37.4 3.21 5.29 1.6 12.4
X25004AA Avon, Gloucestershire and Wiltshire 118 80 0.43 12.5 3.40 1.3 0.10 0.75 5.3 19.7 1.64 5.16 0.0 3.7
X25004AC Devon, Cornwall and Somerset 59 20 0.15 5.0 3.00 0.0 0.00 0.44 0.0 14.6 3.00 3.00 0.0 0.0
X25004AD Wessex 129 76 0.62 17.1 3.62 5.3 0.26 0.97 8.6 25.6 2.56 4.67 0.2 10.3
X25004AE Kent, Surrey and Sussex 299 105 0.51 19.0 2.70 2.9 0.24 0.79 11.5 26.6 1.68 3.72 0.0 6.0
X25004AF Thames Valley 100 38 1.24 31.6 3.92 7.9 0.32 2.15 16.8 46.4 1.63 6.20 0.0 16.5
E East Midlands 155 107 0.48 15.0 3.19 2.8 0.14 0.82 8.2 21.7 1.39 4.99 0.0 5.9
G East of England 266 164 0.66 18.3 3.63 2.4 0.37 0.96 12.4 24.2 2.50 4.76 0.1 4.8
H London 500 215 1.16 27.9 4.17 5.1 0.84 1.49 21.9 33.9 3.41 4.92 2.2 8.1
A North East 187 90 0.98 26.7 3.67 4.4 0.50 1.46 17.5 35.8 2.35 4.98 0.2 8.7
B North West 398 206 1.49 33.5 4.43 8.3 1.12 1.85 27.0 39.9 3.75 5.11 4.5 12.0
J South East 507 215 0.73 22.3 3.29 4.7 0.48 0.99 16.8 27.9 2.52 4.06 1.8 7.5
K South West 213 111 0.33 9.9 3.36 0.9 0.09 0.57 4.4 15.5 1.77 4.96 0.0 2.7
F West Midlands 466 221 0.62 16.3 3.83 5.0 0.39 0.86 11.4 21.2 2.98 4.69 2.1 7.8
D Yorkshire and The Humber 249 86 1.19 27.9 4.25 7.0 0.69 1.68 18.4 37.4 3.21 5.29 1.6 12.4
95 % Confidence Limits
Some lower-tier LAs did not partake in survey
Based on fewer than 20 volunteers Regions Upper tier local authorities PHE Centres
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
43
Appendix B: Dental Public Health Epidemiology Programme for England, Oral Health Survey of twelve-year-old children attending special support schools 2014, upper tier local authority (LA), Public Health England (PHE) centre, region
Region Upper Tier
LA Code Upper Tier LA Name
12-year-olds
attending
special support
schools
Dental
chart
completed
Plaque
assessment
completed
Mean
D3MFT % D3MFT > 0
Mean D3MFT
(% D3MFT >
0)
% with
substantial
plaque
Lower
D3MFT
Upper
D3MFT
Lower %
D3MFT > 0
Upper %
D3MFT > 0
Lower
D3MFT > 0
(Mean)
Upper D3MFT
> 0 (Mean)
Lower %
with
substantial
plaque
Upper %
with
substantial
plaque
Eng Eng England 6,873 3,055 3,385 0.69 29.2 2.37 19.5 0.64 0.74 27.6 30.8 2.26 2.49 18.2 20.9
17 Derbyshire 33 25 27 0.60 16.0 3.75 14.8 0.00 1.40 1.6 30.4 0.00 7.86 1.4 28.2
31 Leicestershire 79 35 35 0.69 31.4 2.18 22.9 0.27 1.10 16.0 46.8 1.40 2.97 8.9 36.8
32 Lincolnshire 93 37 38 1.05 43.2 2.44 31.6 0.47 1.64 27.3 59.2 1.43 3.45 16.8 46.4
34 Northamptonshire 118 46 50 0.72 30.4 2.36 22.0 0.13 1.30 17.1 43.7 0.71 4.01 10.5 33.5
37 Nottinghamshire 50 21 22 0.76 19.0 4.00 4.5 0.03 1.49 2.3 35.8 2.61 5.39 0.0 13.2
12 Cambridgeshire 55 44 50 0.86 29.5 2.92 0.0 0.36 1.36 16.1 43.0 1.87 3.97 0.0 0.0
00KC Central Bedfordshire 36 24 26 0.25 16.7 1.50 3.8 0.01 0.49 1.8 31.6 0.93 2.07 0.0 11.2
22 Essex 161 75 79 0.53 22.7 2.35 17.7 0.25 0.82 13.2 32.1 1.57 3.14 9.3 26.1
26 Hertfordshire 132 80 87 0.45 22.5 2.00 18.4 0.20 0.70 13.3 31.7 1.26 2.74 10.3 26.5
33 Norfolk 78 42 42 0.50 19.0 2.63 14.3 0.15 0.85 7.2 30.9 1.80 3.45 3.7 24.9
00JA Peterborough 47 22 22 0.50 31.8 1.57 0.0 0.10 0.90 12.4 51.3 0.73 2.41 0.0 0.0
00KF Southend-on-Sea 41 22 23 0.95 36.4 2.63 8.7 0.22 1.69 16.3 56.5 1.19 4.06 0.0 20.2
42 Suffolk 10 27 32 0.44 18.5 2.40 18.8 0.02 0.87 3.9 33.2 1.07 3.73 5.2 32.3
00AF Bromley 57 24 24 0.29 12.5 2.33 29.2 0.00 0.61 0.0 25.7 1.68 3.0 11.0 47.4
00AJ Ealing 36 24 26 0.54 20.8 2.60 46.2 0.00 1.11 4.6 37.1 0.68 4.52 27.0 65.3
00AK Enfield 39 25 30 0.60 24.0 2.50 10.0 0.00 1.22 7.3 40.7 0.49 4.51 0.0 20.7
00AL Greenwich 8 18 21 9.5 0.0 22.1
00AM Hackney 13 19 20 5.0 0.0 14.6
00AP Haringey 33 17 20 20.0 2.5 37.5
00AT Hounslow 32 31 32 0.90 48.4 1.87 25.0 0.46 1.34 30.8 66.0 1.27 2.47 10.0 40.0
00AU Islington 23 19 20 20.0 2.5 37.5
00AX Kingston upon Thames 32 22 23 1.36 36.4 3.75 30.4 0.21 2.52 16.3 56.5 1.27 6.23 11.6 49.2
00EJ County Durham 99 49 56 1.18 46.9 2.52 42.9 0.74 1.63 33.0 60.9 1.96 3.08 29.9 55.8
00EM Northumberland 62 20 23 0.55 30.0 1.83 17.4 0.03 1.07 9.9 50.1 0.55 3.12 1.9 32.9
00CM Sunderland 43 24 25 1.33 50.0 2.67 28.0 0.55 2.11 30.0 70.0 1.53 3.81 10.4 45.6
00BL Bolton 44 19 20 5.0 0.0 14.6
00BX Knowsley 31 20 21 1.60 65.0 2.46 23.8 0.97 2.23 44.1 85.9 1.94 2.99 5.6 42.0
30
Lancashire (survey undertaken in
Burnley, Fylde, Hyndburn,
Lancaster, Pendle, Preston, Ribble
Valley, Rossendale, Wyre ONLY)
240 69 80 0.75 36.2 2.08 28.8 0.46 1.04 24.9 47.6 1.61 2.55 18.8 38.7
00BY Liverpool 120 40 42 1.28 42.5 3.00 21.4 0.73 1.82 27.2 57.8 2.33 3.67 9.0 33.8
00BN Manchester 61 39 46 1.13 48.7 2.32 32.6 0.63 1.63 33.0 64.4 1.61 3.02 19.1 46.2
00CA Sefton 72 31 34 0.71 29.0 2.44 26.5 0.23 1.19 13.1 45.0 1.46 3.43 11.6 41.3
00BS Stockport 68 23 23 1.04 34.8 3.00 13.0 0.31 1.78 15.3 54.2 1.72 4.28 0.0 26.8
00BT Tameside 27 26 26 1.04 30.8 3.38 7.7 0.13 1.95 13.0 48.5 1.06 5.69 0.0 17.9
00CB Wirral 43 21 24 1.10 47.6 2.30 33.3 0.46 1.73 26.3 69.0 1.47 3.13 14.5 52.2 London LAs North East LAs North West LAs
Some lower-tier LAs did not partake in survey
Based on fewer than 20 volunteers 95 % Confidence Limits East Midlands LAs
Number examined too small (<20) for
robust estimate East of England LAs
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
44
Appendix B: Dental Public Health Epidemiology Programme for England, Oral Health Survey of twelve-year-old children attending special support schools 2014, upper tier local authority (LA), Public Health England (PHE) centre, region
Region Upper Tier
LA Code Upper Tier LA Name
12-year-olds
attending
special support
schools
Dental
chart
completed
Plaque
assessment
completed
Mean
D3MFT % D3MFT > 0
Mean D3MFT
(% D3MFT >
0)
% with
substantial
plaque
Lower
D3MFT
Upper
D3MFT
Lower %
D3MFT > 0
Upper %
D3MFT > 0
Lower
D3MFT > 0
(Mean)
Upper D3MFT
> 0 (Mean)
Lower %
with
substantial
plaque
Upper %
with
substantial
plaque
11 Buckinghamshire 30 47 55 0.66 25.5 2.58 20.0 0.27 1.05 13.1 38.0 1.70 3.47 9.4 30.6
21 East Sussex 55 23 27 0.22 17.4 1.25 0.0 0.01 0.43 1.9 32.9 0.76 1.7 0.0 0.0
24 Hampshire 159 107 110 0.48 22.4 2.13 2.7 0.28 0.68 14.5 30.3 1.65 2.60 0.0 5.8
29
Kent (survey undertaken in Ashford,
Canterbury, Dover, Gravesham,
Sevenoaks, Thanet, Tonbridge &
Malling, Tunbridge Wells ONLY)
248 79 89 0.51 13.9 3.64 10.1 0.20 0.81 6.3 21.6 2.71 4.56 3.8 16.4
00MG Milton Keynes 29 22 23 0.45 27.3 1.67 8.7 0.05 0.86 8.7 45.9 0.70 2.64 0.0 20.2
38 Oxfordshire 71 25 45 0.68 32.0 2.13 15.6 0.19 1.17 13.7 50.3 1.19 3.06 5.0 26.1
00MS Southampton 35 19 20 0.0 0.0 0.0
43 Surrey 152 59 62 0.53 20.3 2.58 22.6 0.21 0.84 10.1 30.6 1.77 3.40 12.2 33.0
45 West Sussex 107 44 46 0.48 20.5 2.33 15.2 0.12 0.83 8.5 32.4 1.20 3.46 4.8 25.6
00HA Bath and North East Somerset 15 18 20 50.0 28.1 71.9
18 Devon 83 44 45 0.66 31.8 2.07 31.1 0.33 0.99 18.1 45.6 1.55 2.59 17.6 44.6
19 Dorset 51 18 33 24.2 9.6 38.9
23 Gloucestershire 80 46 48 1.04 32.6 3.20 37.5 0.46 1.63 19.1 46.2 1.99 4.41 23.8 51.2
40 Somerset 16 21 28 1.43 47.6 3.00 14.3 0.63 2.22 26.3 69.0 2.03 3.97 1.3 27.2
00HY Wiltshire 13 25 30 0.96 28.0 3.43 16.7 0.06 1.86 10.4 45.6 0.94 5.92 3.3 30.0
00CN Birmingham 204 40 45 0.63 27.5 2.27 35.6 0.19 1.06 13.7 41.3 1.15 3.40 21.6 49.5
00CQ Coventry 40 26 26 0.58 34.6 1.67 19.2 0.23 0.92 16.3 52.9 1.20 2.13 4.1 34.4
00CR Dudley 76 21 21 0.43 33.3 1.29 19.0 0.14 0.72 13.2 53.5 0.92 1.65 2.3 35.8
41 Staffordshire 148 80 81 0.31 20.0 1.56 23.5 0.16 0.47 11.2 28.8 1.21 1.92 14.2 32.7
00GL Stoke-on-Trent 38 28 31 0.79 39.3 2.00 6.5 0.33 1.24 21.2 57.4 1.30 2.70 0.0 15.1
00CU Walsall 72 22 26 0.32 18.2 1.75 0.0 0.02 0.62 2.1 34.3 1.26 2.24 0.0 0.0
44 Warwickshire 109 57 61 0.68 38.6 1.77 18.0 0.40 0.97 26.0 51.2 1.33 2.22 8.4 27.7
00CW Wolverhampton 65 19 21 0.0 0.0 0.0
47 Worcestershire 45 34 40 0.65 17.6 3.67 20.0 0.13 1.16 4.8 30.5 2.46 4.87 7.6 32.4
00CC Barnsley 0 24 25 0.79 37.5 2.11 28.0 0.26 1.32 18.1 56.9 1.22 3.00 10.4 45.6
00CX Bradford 52 23 25 0.74 39.1 1.89 0.0 0.27 1.20 19.2 59.1 1.20 2.58 0.0 0.0
00FA Kingston upon Hull, City of 32 20 23 0.65 35.0 1.86 21.7 0.15 1.15 14.1 55.9 0.96 2.76 4.9 38.6
00CZ Kirklees 74 23 29 0.26 17.4 1.50 24.1 0.01 0.51 1.9 32.9 0.93 2.07 8.6 39.7
00FD North Lincolnshire 37 18 21 0.0 0.0 0.0
36 North Yorkshire 26 25 27 0.60 20.0 3.00 3.7 0.00 1.33 4.3 35.7 0.00 6.04 0.0 10.8
00CG Sheffield 73 40 48 1.25 50.0 2.50 52.1 0.75 1.75 34.5 65.5 1.86 3.14 38.0 66.2
Some lower-tier LAs did not partake in survey
Number examined too small (<20) for
robust estimate
Based on fewer than 20 volunteers 95 % Confidence Limits West Midlands LAs Yorkshire and the Humber LAs South East LAs South West LAs
Oral health survey of five-year-old and 12-year-old children attending special support schools 2014
45
Appendix B: Dental Public Health Epidemiology Programme for England, Oral Health Survey of twelve-year-old children attending special support schools 2014, upper tier local authority (LA), Public Health England (PHE) centre, region
Region Upper Tier
LA Code Upper Tier LA Name
12-year-olds
attending
special support
schools
Dental
chart
completed
Plaque
assessment
completed
Mean
D3MFT % D3MFT > 0
Mean D3MFT
(% D3MFT >
0)
% with
substantial
plaque
Lower
D3MFT
Upper
D3MFT
Lower %
D3MFT > 0
Upper %
D3MFT > 0
Lower
D3MFT > 0
(Mean)
Upper D3MFT
> 0 (Mean)
Lower %
with
substantial
plaque
Upper %
with
substantial
plaque
X25001AA London 986 419 467 0.47 23.2 2.02 23.1 0.36 0.58 19.11 27.2 1.7 2.35 19.3 27.0
X25002AA South Midlands and Hertfordshire 363 201 218 0.48 23.9 2.02 14.2 0.30 0.66 17.99 29.8 1.4 2.59 9.6 18.9
X25002AC East Midlands 392 165 171 0.95 35.2 2.69 18.1 0.69 1.20 27.87 42.4 2.2 3.17 12.4 23.9
X25002AD Anglia and Essex 420 249 266 0.63 25.7 2.45 11.7 0.46 0.80 20.27 31.1 2.1 2.85 7.8 15.5
X25002AE West Midlands 935 383 416 0.50 26.9 1.87 18.0 0.40 0.61 22.45 31.3 1.6 2.10 14.3 21.7
X25003AA Cheshire and Merseyside 331 179 192 0.99 39.1 2.54 20.3 0.71 1.28 31.96 46.3 2.0 3.10 14.6 26.0
X25003AC Cumbria and Lancashire 336 103 121 0.81 36.9 2.18 28.9 0.55 1.06 27.57 46.2 1.8 2.58 20.8 37.0
X25003AD Greater Manchester 442 172 185 1.23 44.2 2.78 16.2 0.95 1.50 36.76 51.6 2.4 3.20 10.9 21.5
X25003AE North East 458 175 199 0.97 38.9 2.49 33.2 0.73 1.20 31.64 46.1 2.1 2.86 26.6 39.7
X25003AF Yorkshire and the Humber 573 263 298 0.71 31.2 2.28 23.5 0.55 0.88 25.58 36.8 1.9 2.62 18.7 28.3
X25004AA Avon, Gloucestershire and Wiltshire 248 122 148 0.91 29.5 3.08 33.8 0.57 1.25 21.42 37.6 2.3 3.87 26.2 41.4
X25004AC Devon, Cornwall and Somerset 210 95 92 0.84 35.8 2.35 27.2 0.56 1.13 26.15 45.4 1.9 2.83 18.1 36.3
X25004AD Wessex 334 186 219 0.65 25.3 2.55 8.7 0.44 0.85 19.02 31.5 2.0 3.09 4.9 12.4
X25004AE Kent, Surrey and Sussex 634 219 240 0.48 18.3 2.65 12.5 0.32 0.65 13.15 23.4 2.2 3.14 8.3 16.7
X25004AF Thames Valley 211 124 153 0.57 25.0 2.29 13.7 0.36 0.78 17.38 32.6 1.8 2.77 8.3 19.2
E East Midlands 510 211 221 0.90 34.1 2.63 19.0 0.66 1.13 27.7 40.5 2.13 3.12 13.8 24.2
G East of England 636 382 411 0.55 24.1 2.29 11.9 0.43 0.68 19.8 28.4 1.97 2.61 8.8 15.1
H London 974 419 467 0.47 23.2 2.02 23.1 0.36 0.58 19.1 27.2 1.69 2.35 19.3 27.0
A North East 458 175 199 0.97 38.9 2.49 33.2 0.73 1.20 31.6 46.1 2.11 2.86 26.6 39.7
B North West 1,109 454 498 1.04 40.5 2.57 20.9 0.88 1.20 36.0 45.0 2.28 2.85 17.3 24.5
J South East 1,103 513 568 0.50 21.6 2.33 10.2 0.40 0.61 18.1 25.2 2.07 2.60 7.7 12.7
K South West 563 255 307 0.94 32.5 2.88 29.0 0.71 1.16 26.8 38.3 2.42 3.34 23.9 34.1
F West Midlands 947 383 416 0.50 26.9 1.87 18.0 0.40 0.61 22.5 31.3 1.64 2.10 14.3 21.7
D Yorkshire and The Humber 573 263 298 0.71 31.2 2.28 23.5 0.55 0.88 25.6 36.8 1.94 2.62 18.7 28.3
Eng Eng England 6,873 3,055 3,385 0.69 29.2 2.37 19.5 0.64 0.74 27.6 30.8 2.26 2.49 18.2 20.9

Dental public health epidemiology programme

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