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" Equipping children with the knowledge and skills should help to foster a mutual attitude to oral health throughout their life "


Oral health can have a significant impact on our general health and wellbeing. Our mouths play an essential role in both the verbal and non-verbal communication needed for the social interaction of everyday living.

Most people are born with good oral health and have the potential to maintain it throughout life. Good oral health brings with it enhanced self-esteem, self-confidence and the ability to eat a varied and nutritious diet.

Conversely, diseases that affect the face and mouth - dental caries, periodontal disease, developmental problems or trauma to the oro-facial tissues and oral cancer - can place a heavy burden of morbidity upon the sufferer in terms of pain, discomfort, disfigurement, loss of function and embarrassment.

This is especially important because most dental diseases can be prevented. As shown in Figure 1, many of the direct influences on our oral and general health are outwith the control of individuals. Improvements in oral and general health, therefore, will result from better general socio-economic, cultural and environmental conditions.

[ Figure 1 ] Factors Influencing Oral Health

Factors Influencing Oral Health

Adapted from Dahlgreen & Whitehead1, Sheiham & Watt.2

A mutual approach to improving oral health of children in Lothian

Data on the oral health of Scottish children is collected via the National Dental Inspection Programme (NDIP). NDIP is a collaborative programme which relies on partnership working between health and education services. NDIP data enables us to track the dental health of children in Lothian. Figure 2 shows the trend over time in the proportion of five year old children who are free from obvious dental decay in Scotland, Lothian and in our four Community Health (and Care) Partnerships (CH(C)Ps). All CH(C)P areas show signs of improvement over the last three surveys.

[ Figure 2 ] Percentage of Primary 1 children free of obvious tooth decay - Scotland, Lothian and Community Health Partnership Areas 2004-2008

Percentage of Primary 1 children free of obvious tooth decay - Scotland,
Lothian and Community Health Partnership Areas 2004-2008

Source: National Dental Inspection Programme (NDIP)

Although these improvements are welcome, young people in Scotland still have among the worst oral health in Europe. The data in Figure 2 demonstrates that there is much to do to continue improving the oral health of young children in Lothian. The three elements of the 'Childsmile' Programme - Core Toothbrushing, Childsmile Nursery and Childsmile School - adopt a population and targeted approach to improving the oral health of children through application of fluoride to teeth and by embedding positive oral health behaviours in children from a young age. Equipping children with the knowledge and skills to maintain their oral health should help maintain oral health throughout their lives.

[ Box 1 ] Ways individuals can maintain Oral Health
  • Brush teeth twice daily with fluoride toothpaste plus specific advice from your dentist.
  • Reduce frequency and consumption of sugar-containing foods and drink.
  • Stop smoking and using other forms of tobacco.
  • Reduce alcohol consumption.
  • Visit your dentist regularly for check-ups.

Fostering a mutual attitude to maintaining oral health

As demonstrated by Figure 1, access to dental services is only one of many aspects that influence our oral health. However, the ability to attend a dentist is essential to assist individuals in developing a dentist-patient partnership. A great deal of work to improve access to NHS dental care services has been undertaken in Lothian in recent years. Active promotion of Scottish Dental Access Initiative Grants has helped dentists to expand their premises or open new dental practices, and new dental services in Bonnyrigg and Chalmers Street have opened. This work has been reflected in the decreasing dentist to population ratio seen in Lothian in recent years.

[ Table 1 ] General dental practitioner to population ratio
Year Scotland Lothian
2008 1,986 1,749
2007 2,068 1,761
2006 2,214 1,826
2005 2,359 1,813
2004 2,403 1,852

Dentist Population Ratios

Dentist to population ratios are used to describe the workforce supply. The ratio is based on a headcount of general dental practitioners, not the whole time equivalent and therefore does not allow for part-time working patterns and provision of private dental care.

Table 1 shows the ratio of the population to general dental practitioners in both Scotland and Lothian has markedly reduced over recent years. The Lothian ratio is lower than the average for Scotland (i.e. better access over time and compared to the Scottish average). By ensuring access to NHS dental care NHS Lothian maintains the mutual benefits of regular dental attendance, tailored care for individuals provided by their family dentist.

The benefits of the improved dentist to population ratios has been reflected in NHS Lothian's progress towards the government target on dental registration for children (H2). The target is for 80% of children aged 3 to 5 years of age should be registered with an NHS general dental practitioner.

Table 2 below shows the March figures for the last 10 years. The improvement in 2007/08 reflects increased local efforts to achieve the target and the National 'Childsmile' project being rolled out across Scotland and the mutually beneficial effect this is having on NHS dental registration. Data from September 2008 for Lothian shows 86.9% of all children aged three to five years of age and improvements are also being demonstrated with other age groups of the population.

[ Table 2 ] 3-5 year olds registered with an NHS dentist (Capitation Percentages) - Scotland & Lothian
Year 98/99 99/00 00/01 01/02 02/03 03/04 04/05 05/06 06/07 07/08
Scotland 64.6% 66.9% 65.2% 66.9% 68% 66.1% 66% 68.4% 68.9% 77.3%
Lothian 69.7% 72.5% 70.3% 71.6% 72% 70.9% 71.8% 74% 75.9% 84.4%

Key messages

  • Tooth decay is still a public health problem in Lothian and Scotland. It is still the commonest single reason for children being admitted to hospital.
  • Oral diseases, including tooth decay, are strongly linked to poverty.As there is no water fluoridation in Scotland, fluoride is provided via toothpaste and fluoride varnish.
  • Everyone should attend their dentist for regular screening (dental check-ups).