Deprivation associated with increased disease experience in 5-year-old children

Key Points

• Deprivation is associated with increased disease experience and poor dental visiting patterns in 5-year-old children.

• Children attending on a regular basis have more restorative treatment and less overall experience of decay.

• Registration is a poor indicator of dental service use.

Abstract

Objective

To compare the dental caries' experience and treatment received by 5-year-old children registered with a GDP.

Design

Retrospective case note review of all 5-year-old children registered with seven GDPs.

Setting

Wirral and North Cheshire in north west England in 1996/7.

Subjects and materials

Clinical, demographic and attendance data were collected from each practice using a common data abstraction form. Subjects were categorised according to regular/irregular attenders, and into five groups ranging from affluent to deprived using the Super Profiles geodemographic classification. The relationships between disease experience, treatment, attendance and socioeconomic status were compared using cross-tabulations, t-tests and multiple linear regression.

Results

The dental records of 430 5-year-old children were available for analysis. Irregular attenders had significantly higher dmft, dt and mt, and fewer filled teeth. Only 29% of disease experience of regular attenders was treated by restoration. Both socioeconomic status and visiting behaviour exerted significant independent effects on dmft, but dental attendance alone had a significant effect on ft.

Conclusions

Significant inequalities remain in the disease experience and service use of young children. Regularly attending children have less than a third of their diseased teeth restored. Consensus is needed across the profession on the care of the diseased deciduous dentition.

Main

The effects of socioeconomic status and dental attendance on dental caries' experience, and treatment patterns in 5-year-old children M Tickle, M Williams, T Jenner and A Blinkhorn Br Dent J 1999; 186: 135–137

Comment

Regular dental attendance is an important means of helping children to achieve good oral health. Attendance is often recorded in terms of registration and registration rates for different age groups and areas are published regularly by the Dental Practice Board, providing an easily accessible and readily understood indicator. However registration may not necessarily reflect true attendance.

This study relates to 419 5-year-old children registered with seven practitioners in Wirral and North Cheshire. Results show that the children who attend the dentist regularly do indeed have better oral health, having fewer teeth with caries experience and a higher proportion of restored teeth. This is true even when the effects of socioeconomic status are controlled and appears to be encouraging confirmation of benefit by practitioners working to improve oral health.

The findings also contain two less welcome items. The first is confirmation that registration rates alone are not a good reflection of dental attendance. Politicians and planners of health care should therefore not regard these as indicating uptake of care. Similarly, using increased registration rates alone as a target for oral health promotion strategy may be inappropriate and misleading since an increase may give little indication of success in improving regular attendance for check-ups.

The second finding relates to treatment of disease. Although a higher proportion of caries experience in children who attended regularly was made up of restored teeth, even in this apparently better situation, less than one third of the disease had been treated restoratively. Whilst operative treatment may not have been a possibility in some cases, the findings appear to confirm yet again (if confirmation were needed), the depressingly low priority given to restoring primary teeth in young children.

The benefits of restorative care for primary teeth are without question but there may be a number of underlying reasons for the situation and finding a constructive way forward from this point is more difficult. Reducing disease remains the priority but more effective means to provide treatment would also seem to be necessary. Greater use of operating auxiliaries in general dental practice has potential to help towards the goal where services are insufficient to meet the needs of child patients attending for care, as have the greater financial incentives now provided. In the long term, changes in attitude and in behaviour may also be required amongst both public and profession if need is to be met.

Children taking part were 5 years old and a high proportion of the decayed teeth would not have been lost for another 4-5 years. To leave well over 50% of carious teeth apparently without treatment in those with good attendance patterns seems to me indefensible.