| Information component |
Pg 4 Health Summary – Indicator No. 29 |
| Subject category / domain(s) |
Health and ill-health in our community |
| Indicator name (* Indicator title in health profile) |
Mean number of decayed/missing/filled teeth in five-year-olds (*Children’s Tooth Decay) |
| PHO with lead responsibility |
Yorkshire and Humber |
| Date of PHO dataset creation |
March 2007 |
| Indicator definition |
Mean number of teeth per child sampled which were either actively decayed or had been filled or extracted. |
| Geography |
England, GOR, Local Authority: Counties, County Districts, Metropolitan County Districts, Unitary Authorities, London Boroughs.Children are allocated to these geographies according to the location of their school. |
| Timeliness |
BASCD (British Association for the Study of Community Dentistry) conduct a survey of five-year-olds every two years. The 2007/08 survey results are due for publication in 2009. |
|
Rationale:What this indicator purports to measure
|
The mean number of decayed, missing or filled teeth per child |
|
Rationale:Public Health Importance
|
Dental caries (tooth decay) and periodontal (gum) disease are the most common dental pathologies in the UK. Tooth decay has become less common over the past two decades, but is still a significant health and social problem. It results in destruction of the crowns of teeth and frequently leads to pain and infection. Dental disease is more common in deprived, compared with affluent, communities. The indicator is a good direct measure of dental health and an indirect, proxy measure of child health and diet. |
| Rationale: Purpose behind the inclusion of the indicator |
To draw attention to areas of high tooth decay. To improve oral health in children by reducing the prevalence of dental decay. |
|
Rationale:Policy relevance
|
· Children’s National Service Framework · This indicator supports Choosing Health and LAAs. |
| Interpretation: What a high / low level of indicator value means |
A high indicator value (red circle in health summary chart) represents a significantly higher average number of decayed, missing or filled teeth per child than in England overall.A low indicator value (amber circle in health summary chart) represents a significantly lower average number of decayed, missing or filled teeth per child than in England overall.From this statistic alone, it cannot be deduced whether the problem is evenly distributed or confined to a small pocket of children. |
| Interpretation: Potential for error due to type of measurement method |
Data was only available at PCT level, and had to be apportioned to Local Authorities. This process can only be approximate where PCTs are not completely contained within Local Authorities.Data was missing for 22 PCTs listed below and consequently it was not possible to present mean dmft for 29 local authorities and two counties. Data for 12 PCTs was only available in combination with one or more other PCTs, these are also listed below. 45 PCTs where positive consent operated for all or part of the sampling period are listed below.
| Data missing for these PCTs |
| PCT |
PCT name |
| 5A7 |
Bromley PCT |
| 5A8 |
Greenwich PCT |
| 5AK |
Southend on Sea PCT |
| 5CE |
Bournemouth Teaching PCT |
| 5CV |
South Hams and West Devon PCT |
| 5CW |
Torbay Care Trust |
| 5FN |
South and East Dorset PCT |
| 5FQ |
North Devon PCT |
| 5FR |
Exeter PCT |
| 5FT |
East Devon PCT |
| 5FV |
Mid Devon PCT |
| 5FY |
Teignbridge PCT |
| 5GF |
Huntingdonshire PCT |
| 5J8 |
Durham Dales PCT |
| 5J9 |
Darlington PCT |
| 5JP |
Castle Point and Rochford PCT |
| 5KA |
Derwentside PCT |
| 5KC |
Durham and Chester-le-Street PCT |
| 5KD |
Easington PCT |
| 5KE |
Sedgefield PCT |
| 5KV |
Poole PCT |
| TAK |
Bexley Care Trust |
| Data available for these PCTs in combination only |
| South East Hertfordshire PCT (5GJ), Royston & Buntingford and Bishops Stortford PCT (5GK) |
| Ashford PCT (5LL), Canterbury and Coastal PCT (5LM), East Kent Coastal PCT (5LN), Shepway PCT (5LP) |
| Watford and Three Rivers PCT (5GV), Dacorum PCT (5GW) |
| Hertsmere PCT (5CP), St Albans and Harpenden PCT (5GX) |
| Welwyn and Hatfield (5GG) North Hertfordshire and Stevenage PCT (5GH) |
| Postive/Mixed consent in operation during sampling period |
| PCT |
PCT name |
Form of Consent |
| 5DF |
North Hampshire |
Positive |
| 5DK |
Newbury |
Positive |
| 5E1 |
North Tees |
Positive |
| 5G6 |
Blackwater Valley & Hart PCT |
Positive |
| 5HF |
Wyre PCT |
Positive |
| 5KJ |
Part of Craven Harrogate & Rural (Airedale) |
Positive |
| 5KL |
Sunderland |
Positive |
| 5KM |
Middlesborough |
Positive |
| 5L5 |
Guildford & Waverley PCT |
Positive |
| 5L7 |
Surrey Heath and Woking Area PCT |
Positive |
| 5AC |
Daventry & South Northants |
Mixed |
| 5AW |
Airedale |
Mixed |
| 5CC |
Blackburn with Darwen PCT |
Mixed |
| 5CF |
Bradford City |
Mixed |
| 5CG |
South,West Bradford |
Mixed |
| 5CH |
North Bradford |
Mixed |
| 5CK |
Doncaster Central |
Mixed |
| 5CX |
Trafford South PCT |
Mixed |
| 5EE |
North Sheffield |
Mixed |
| 5EG |
North Eastern Derbyshire |
Mixed |
| 5EN |
Sheffield West |
Mixed |
| 5EP |
Sheffield South West |
Mixed |
| 5EQ |
South East Sheffield |
Mixed |
| 5F5 |
Salford PCT |
Mixed |
| 5F6 |
Trafford North PCT |
Mixed |
| 5G7 |
Hyndburn & Ribble Valley PCT |
Mixed |
| 5HA |
Central Liverpool PCT |
Mixed |
| 5HE |
Fylde PCT |
Mixed |
| 5HG |
Ashton, Leigh & Wigan PCT |
Mixed |
| 5HH |
Leeds West |
Mixed |
| 5HJ |
Leeds North East |
Mixed |
| 5HK |
East Leeds |
Mixed |
| 5HL |
South Leeds |
Mixed |
| 5HM |
Leeds North West |
Mixed |
| 5HN |
High Peak and Dales |
Mixed |
| 5HQ |
Bolton PCT |
Mixed |
| 5HX |
Ealing |
Mixed |
| 5J6 |
Calderdale |
Mixed |
| 5J7 |
North Kirklees |
Mixed |
| 5LJ |
Huddersfield Central |
Mixed |
| 5LK |
South Huddersfield |
Mixed |
| 5LV |
Northamptonshire Heartlands |
Mixed |
| 5LW |
Northampton |
Mixed |
| 5M5 |
South Sefton PCT |
Mixed |
| 5M7 |
Sutton and Merton |
Mixed |
The data source is a series of nationally co-ordinated dental epidemiological surveys commissioned by individual PCTs to standardised national protocols and diagnostic standards and involving the dental examination of children in the specified age-group, in state schools. The data source is part of a cycle of nationally co-ordinated dental epidemiological surveys as outlined in Health Service Guidelines (93)25. Surveys are conducted every second year for 5 year olds and every fourth year for 12 years olds and 14 year olds. The data relate to children attending state schools in an area. It cannot be assumed that all children necessarily live in the same area. National minimum standards are set for the random sampling of children to obtain a sample representative of the age-group in the area. Many Health Authorities commission larger samples in order to obtain data on intra-district variations in dental caries for local planning purposes. Data are collected and analysed locally. Summary data items are reported nationally to the British Association for the Study of Community Dentistry, which produces national tables through the Dental Health Services Research Unit at the University of Dundee. These data are published in the journal of the British Association of the Study of Community Dentistry, Community Dental Health.
|
| Interpretation: Potential for error due to bias and confounding |
For the first time in the history of the BASCD survey of the dental caries experience of 5-year-old children in England and Wales, some parents were required to give positive consent for their children’s teeth to be inspected. In previous surveys all children in state schools were, by default, eligible for inclusion unless their parents submitted a form stating that they did not wish for their children’s teeth to be inspected. This has led to serious concerns that the results of the 2005/06 survey may be biased and not comparable to earlier surveys.Bias may result for several reasons. Firstly, there may be variation between schools generally in how pro-active they are at encouraging parents to return consent forms. Secondly, parents living in more deprived areas (where mean dmft is higher) may be less likely to return consent forms, than those living in more affluent areas (where mean dmft is lower). The picture is further confused by the fact that positive consent was not universally introduced. In 10 PCTs all schools operated positive consent throughout the sampling period, in 35 PCTs some of the schools operated positive consent for some of the sampling period, and in the remaining PCTs no schools operated positive consent. It will be difficult to disentangle the impact of the introduction of positive consent from genuine reductions in the prevalence of dental caries. Anecdotal evidence so far suggests that positive consent had a large effect in some areas. |
| Confidence Intervals: Definition and purpose |
A confidence interval is a range of values that is normally used to describe the uncertainty around a point estimate of a quantity, for example, a mortality rate. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. These occurrences result in random fluctuations in the indicator value between different areas and time periods. In the case of indicators based on a sample of the population, uncertainty also arises from random differences between the sample and the population itself.The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. Confidence intervals quantify the uncertainty in this estimate and, generally speaking, describe how much different the point estimate could have been if the underlying conditions stayed the same, but chance had led to a different set of data. The wider is the confidence interval the greater is the uncertainty in the estimate.Confidence intervals are given with a stated probability level. In Health Profiles 2007 this is 95%, and so we say that there is a 95% probability that the interval covers the true value. The use of 95% is arbitrary but is conventional practice in medicine and public health. The confidence intervals have also been used to make comparisons against the national value. For this purpose the national value has been treated as an exact reference value rather than as an estimate and, under these conditions, the interval can be used to test whether the value is statistically significantly different to the national. If the interval includes the national value, the difference is not statistically significant and the value is shown on the health summary chart with a white symbol. If the interval does not include the national value, the difference is statistically significant and the value is shown on the health summary chart with a red or amber symbol depending on whether it is worse or better than the national value respectively. |
