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Dental caries – the good and the bad

The rate of hospital admissions for dental caries in children is a staggering 221 times higher in the worst-performing parts of England than the best.

The top 10 and bottom 10

Local Authority Per 1,000 Number
Leicestershire 7.0 6
Staffordshire 12.7 14
Cornwall 13.9 9
Nottingham 17.3 8
East Sussex 23 15
Reading 25.9 7
Bournemouth 26.2 6
Birmingham 27.2 53
Windsor and Maidenhead 27.4 6
Sandwell 29.7 16
     
Westminster 856 245
Southwark 936.4 450
Barnsley 961.1 318
Liverpool 1,005.0 613
Doncaster 1,041.0 470
Blackpool 1,043.8 205
Sheffield 1,045.3 831
Tower Hamlets 1,051.5 459
Blackburn with Darwen 1,074.6 291
Rotherham 1,550.3 584

 

Figures released by the chief medical officer show that 1,550 under-fives per 100,000 are taken into hospital in Rotherham – a total of 584 youngsters, over a three-year period.

But, in Leicestershire, the best-performing area, just six children aged between one and four were admitted – a rate of only seven per 100,000 youngsters of that age.

The next best figures were recorded in Staffordshire (12.7 per 100,000), Cornwall (13.9), Nottingham (17.3) and East Sussex (23), PHE found.

In stark contrast, admissions are far, far higher in Blackburn with Darwen (1,074.6 per 100,000), Tower Hamlets in east London (1,051.5) and Sheffield (1,045.3).

Recently, Public Health England (PHE) urged local authorities to look again at the case for water fluoridation, because of the enormous difference it makes to the health of children’s teeth.

It has calculated that as many as 45% fewer under-fives are admitted to hospital for tooth decay in areas where water is fluoridated, than in those where it is not.

That is backed up in the most recent annual report by the Government’s chief medical officer (CMO), which highlighted the stark variation in dental caries.

The CMO wrote: 'The rate of admission for dental caries is correlated with deprivation.

'However, there is considerable variation, which may be affected by preventive and public health interventions in the population, early recognition of children at risk of developing dental caries, access to dental care, assessment of dental emergencies and criteria for admission and operative intervention.

'Evidence-based preventive interventions (including water fluoridation) and early treatment to at-risk groups, in particular in areas of high deprivation, can be an effective way for commissioners and local authorities to tackle variation.'

Around six million people live in areas with fluoridation schemes, around 10% of the UK total, mainly in the east and West Midlands and parts of the north west.

Some water has been fluoridated for more than 40 years, the level adjusted to 1mg per-litre, or one part per-million, in an effort to reduce tooth decay.

Health experts have dismissed claims that fluoridation causes hip fractures and tooth stains, and that it should not be imposed where people do not want it.

With the abolition of strategic health authorities, decisions rest with elected local authorities, which are thought more likely to block schemes.

A PHE spokesman said: 'There are a number of factors that explain the variation in hospital admissions for dental caries in children.

'But evidence suggests that fluoridating water is the single most effective step we can take to reduce tooth decay generally, both among children and adults, irrespective of personal behaviour.'

The hospital admission figures, for 2009-2012, show that, even excluding the five best and worst authorities, the rate of variation across England is 40-fold.

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