Tooth decay is putting 30,000 children in hospital every year, a study has found.

That's according to researchers at the Peninsula Dental School, Plymouth, and University College London, who used data from the Hospital Episodes Statistics resource to identify a marked increase in the number of hospital admissions for children with caries and other dental conditions, between 1997 and 2006.

The study shows that while rates of infection are stable, hospitalisation and the use of general anaesthetics have increased and are more prevalent in areas of social deprivation.

The study, published in the British Dental Journal, reveals that there were 517,885 NHS ‘episodes of care' for children with dental conditions in the nine-year period. Of these, over half were for dental caries and 80% involved extractions.

There was a year-on-year increase in the number of episodes during the period covered by the statistics, averaging out at 29,676 admissions a year – most of which would have required a general anaesthetic.

Extractions for caries rose by 66% between April 1997 and March 2006.

The research team emphasises that further investigation into the reasons why more children are presenting at hospital for dental treatment is needed, but suggested reasons include:
• the move post-2000 away from the delivery of general anaesthetic to children in the primary care sector to the secondary care setting
• a possible reduction in restorative care provided for children in the primary care sector, either through lack of training, inadequate recompense or the failure of children and their parents to attend appointments.

Commenting on the research, chief dental officer Barry Cockcroft said: ‘We agree with the conclusion of the paper that further research is required as to why the number of admissions has risen in this way.

‘The data collection period predates the introduction of the new contractual arrangements in 2006, so this rise cannot be attributed to the new arrangements.'

One key finding of the research was the huge difference in instances of dental caries and disease in children from different socioeconomic backgrounds. Twice as many treatments were provided to children in the most deprived sector of society compared with those from the most affluent.

Children in more affluent areas were 33% less likely to present as a dental care emergency than those living in more deprived areas, and they were 75% less likely to develop caries than their less well-off counterparts.

Dr Cockcroft commented: ‘Oral health in our children has greatly improved over the last 30 years and decay rates have fallen very significantly, especially in the permanent dentition, however the research shows a clear link between deprivation and increased likelihood of hospital admission.'

‘In our Choosing Better Oral Health strategy report in 2005, we asked the NHS, where there were significant levels of dental decay, to look at the option of water fluoridation as a means of reducing inequalities. Water fluoridation has the major benefit that it does not require any compliance on behalf of the population and therefore benefits the most vulnerable in society to the greatest extent.'

The research team noted that the increase in the number of general anaesthetics for children and dental treatment goes ‘contra to desired best practice and may put children at risk'.

David Moles, professor of Oral Health Services Research at Peninsula Dental School, said: ‘The findings of our study are very worrying – one poor child was admitted to hospital for extractions on seven separate occasions in the nine-year period of the statistics. If rates of caries and other dental infection are steady, why is there such a marked increase in the number of children being admitted to hospital for dental treatment?

‘And why is it that more and more children are being electively admitted to hospital for extractions? Clearly, these questions need to be answered in order to cut the number of admissions, improve dental care for children and ultimately reduce the financial burden to the NHS.'

Dr Paul Ashley, head of Paediatric Dentistry at the UCL Eastman Dental Institute, added: ‘Two aspects of the study are particularly worrying – the rise in the number of general anaesthetics being given to children, and the widening gulf in dental health between social classes. General anaesthetic can be fatal to children, which is why post-2000 the administration of general anaesthetic to children was moved from the primary care sector to secondary care, where there is back-up should anything go wrong. Priority must be given to research that examines the reasons why the issues highlighted by our study occur, and this is to be our next step.'

In conclusion, Dr Cockcroft added: ‘The authors make the assumption that most of these extractions were carried out under general anaesthetic. There is no data to support or counter that, but interestingly the removal of general anaesthesia from the primary care Statement of Dental Remuneration in 2002 produced no “spike” in referrals. Given that over a quarter of a million general anaesthetics were given through high street practices in 1998, there has been an overall reduction in the provision of general anaesthesia for dental treatment and this has to be good news for patients. But, we do need to do further research in this area.'