Over the last forty years, the oral health in England has improved continuously and the oral health in Northumberland has also followed this pattern. Levels of dental disease in Northumberland are similar to those in England as a whole. Despite this positive trend, there are still many people suffering from preventable, poor dental health.  Further focus is required to ensure further improvement in the oral health of Northumberland’s residents, especially those with the greatest need.

Following the implementation of the Health and Social Care Act 2012 in April 2013, responsibilities for oral health improvement and oral health promotion lie with the Local Authority, with the commissioning responsibilities of dental services being mandated to NHS England. As part of their statutory duties, local authorities have commissioning responsibilities to provide oral health promotion programmes, to commission the dental epidemiology programme and to fund the running costs of water fluoridation schemes where they exist. In areas, where there currently are no schemes of water fluoridation, the local authority needs to consider if implementing water fluoridation would be of benefit to its population (PHE 2014(e)).

This oral health needs assessment is the first assessment of Northumberland residents’ oral health needs since the transfer in responsibilities. In describing the current oral health needs of the population, it sets a basis for a cyclic process of oral health needs assessments and helps strategic planning, to ensure the improving trend of oral health continues as well as contributes to reducing health inequalities

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Please click here to view Oral Health Profile for Northumberland

  • The population size of Northumberland is 315,806.
  • Northumberland’s population profile shows a shift to higher age bands, with a significant increase in the population of the over 55 year olds, at the cost if the under 25 year olds, compared to the demographic profile of England as a whole.
  • Projected growth in coming years suggests a further increase in the older age bands.
  • The population of Northumberland is predominantly classed as “White British” (97.2% of the population), with little ethnic diversity.
  • Deprivation levels in Northumberland overall are similar to those of England as a whole. However this overall level hides significant pockets of deprivation in some areas of the county, with 14 LSOAs in Northumberland being among the 10% most deprived according to the Index of multiple deprivation. Some wards in Northumberland have up to 45.6% of children living in child poverty and others having 28.1% of their populations living with income deprivation (more than double the English average).
  • Healthy life expectancy averages at 63 years across Northumberland, however the impact of health inequalities is clearly visible with healthy life expectancy ranging from 51 years to 74 years in different areas across the county.
  • The overall smoking prevalence in Northumberland in 2015 was similar to the England average with a prevalence of current smokers being 16.6%.Smoking rates at time of delivery, with 15%, was significantly worse than for England as a whole.  Smoking rates are not distributed evenly across the county with increased rates in areas of higher socioeconomic deprivation.
  • Problematic alcohol consumption follows a similar distribution as smoking prevalence, and Hospital admission for alcohol-related conditions (822 per 100,000 population) as well as Alcohol-specific mortality (14.9 per 100,000 population) were significantly worse for Northumberland overall compared to the English average. 
  • A number of determinants have been identified to be linked to an increased risk of poor oral health in individuals and societies. Among these established risk factors  are; living in an area of deprivation; being from a lower socioeconomic group, or living with a family in receipt of income support; suffering from substance abuse; having a chronic medical condition; belonging to a family of Asian origin or living with a Muslim family were the mother speaks little English.
  • Poor oral health impacts significantly on individuals and societies. Poor oral health negatively impacts the individual overall health and wellbeing. In children, poor oral health can negatively affect their ability to thrive, develop and learn. Good oral health has been linked to higher levels of school readiness.
  •  The economic impact from work absences as a result of poor dental health has been estimated to be £36.6 million in the UK in 2012 (British Dental Health Foundation), with an additional cost relating to the annual direct spend of £3.4 billion per year by NHS England on dental care (with an additional estimated £2.3 billion being spent on private dental care annually). 
  • The overall prevalence of dental decay among three-year olds in Northumberland is comparable to that of England overall. However, the rate of Early Childhood Caries (ECC)[1] was the fourth highest in Northumberland, compared to the rest of the North East.
  • The prevalence of dental decay among 5-year olds in Northumberland is comparable to the England average, however  the overall rates mask significantly higher rates of dental decay[2] (measured as % d₃mft>0)in areas higher levels of socioeconomic derivation  across Northumberland.
  • The difference of the percentage of 5 year olds having experienced dental decay (measured as % d₃mft>0) in Northumberland varies from 13% (among the least deprived) to over 40% in the most deprived quintiles (according to 2010 Index of multiple deprivation).
  • The prevalence of 12 year olds having experienced dental decay (measured by % D₃MFT >0) in 12 year olds to be significantly higher (45.3%) among 12 year olds in Northumberland, compared to England as a whole (33.4%). Regionally this level is the third highest in the North East (after Middlesbrough and Darlington).
  • The care index (is the percentage of teeth with decay experience which have been filled (FT/ D₃MFT) for 12 year olds in Northumberland (32%) is significantly below the England average (47%).  This indicates that the dental care needs of 12 year olds are currently not met.
  • The oral health of 12 year olds is potentially an area of unmet need that has the risk of impacting lifelong dental health and dental health associated quality of life.
  • Findings from the Health Related Behaviour Questionnaire (HRBQ) among secondary school children in Northumberland suggest a good engagement with good health related practices, which are in contrast with the potentially high unmet oral health need.
  • The oral health of young people is identified as an area of importance to address as a result of this oral health needs assessment.
  • Nationally, adults are retaining their teeth longer, which lead to an increase in the number of restored teeth among the older age groups.
  • To ensure that services meet the needs of Northumberland’s aging population, the findings of the 2015/16 National Oral Health Survey of Older People will be an important source of further information.
  • The majority of adult population retain their natural teeth, with only 8% of adults across the North East being categorized as edentate. 82% of adults in the North East had more than 21 natural teeth. However only 10% of adults met the criteria to be considered of being “with excellent oral health”[3]. About a third (34%) of dentate adults in the North East have any carious teeth.

Oral Healthcare services

  • Northumberland is characterised through a significant percentage of the population living in rurality with some larger cities and urban areas, especially on the coast. Thus a particular issue for those living in the rural areas of the county is access to dental care.
  • Access to NHS dental care varies by age bands with a peak attendance of just over 75% in children aged 5-9 years and a drop in NHS dental care attendants in young adults (15-19 years and 25-29 years)  to under half of all residents accessing NHS dental care.
  • Access to NHS care also varies significantly between different wards in Northumberland, with under 40% of residents attending NHS dental care in some wards and the highest attendance being 68% of residents in other wards.
  • Distance travelled to NHS dental care by patients is a significant issue in the rural setting of Northumberland, with just over 40% of all patients having travelled 5 miles or more to their NHS dentist.
  • Access to fluoride varnishes are provided by dentists across Northumberland following individual risk assessment of patients. There is no programme of fluoride varnish application for children not attending their dentist.
  • Community dental services are provided through Northumbria Healthcare NHS Foundation Trust.
[1] Early Childhood Caries (ECC) is the presence of one or more decayed (non-cavitated or cavitated lesions), missing teeth (due to caries), or filled tooth surfaces in any primary tooth in a child 72 of months age or younger, and linked to the use feeding bottles, especially with sugar sweetened-beverages.
[2]  Dental decay measured as % d₃mft>0, that is evidence of decayed, missing or filled primary teeth.
[3] Office for National Statistics. Social Survey Division, Information Centre for Health and Social Care. (2012). Adult Dental Health Survey, 2009. [data collection]. 2nd Edition. UK Data Service. SN: 6884, http://dx.doi.org/10.5255/UKDA-SN-6884-2
  • Local authorities are responsible for improving the oral health of their population. They have responsibility for commissioning oral health improvement programmes and oral health surveys. They also have powers relating to making proposals regarding water fluoridation for their local population
  • Northumberland County Council currently commissions oral health promotion programmes targeted in particular at children and older people, as well as children and adults with special needs delivered through Northumbria Healthcare NHS Foundation Trust.
  • Northumberland has a water fluoridation programme which originated in 1968. The area covered by the current water fluoridation arrangement is patchy, and a large number of areas with populations at high risk of dental decay are currently not receiving fluoridated mains water supplies.
  • The rates of hospital admission for dental extraction for dental decay in children and young people aged 0-19 years under general anaesthetic were twice as high in areas not benefitting from community water fluoridation, compared to those receiving fluoridated water, when adjusting for levels of deprivation in Northumberland.
  • A local survey was conducted to obtain an understanding of oral health of Northumberland’s residents. The majority of participants in the oral health questionnaire described having adopted good dental hygiene practices.
  • It is important to consider that the public engagement is not representative for all residents in Northumberland and those with the highest needs are often the ones less likely to participate in the form of public engagement that was conducted.
  • Future oral health improvement services need to contribute to reducing health inequalities in Northumberland.
  • A future strategy for oral health in Northumberland should ensure it addresses issues related to the expected increase in the older age population, as well as continuing to address oral health needs in the early years (0- 5years) as well as for young people.
  • For Northumberland County Council to ensure that oral health is an integrated part of all relevant service specification in children and adult Health and Social care.
  • To work together with its partners, of promoting the importance of oral health on individual’s health, and to ensure that oral health related aspects are addressed in line with a common risk factor approach.
  • For Northumberland County Council to work on improving meeting the NICE guidance(PH 55) further.
  • For Northumberland County Council to explore the feasibility of extending the current water fluoridation scheme, to provide a more equitable scheme , ensuring  those at greatest needs are also receiving fluoridated mains water supply to aid reducing health inequalities.
  • To work together with NHS England to ensure NHS dental care is accessible to all of Northumberland’s residents.

Next Steps

This oral health needs assessment represents the first step in the ongoing assessment of the oral health needs of the population of Northumberland since the 2012 Health and Social care act, and with it the transfer of responsibilities of oral health improvement and promotion to the local authority. Further exploration of the areas identified in this assessment as well as a strategy to address the needs will have to be developed and the ongoing assessment of changing needs planned into this strategy moving forward.
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