Oral health

Oral Health is an integral part of healthy living and a key marker of the health of a community. Poor oral health can cause discomfort, pain and disability and affects appearance and self-confidence with a major impact on quality of life. Oral diseases are largely preventable; however dental disease remains a major public health problem.

The oral health of the UK has improved significantly over the last few decades and the types of disease present now have also changed. However the oral health of the Tees region is significantly worse than that of the national level in children and oral health for adults in the North East is worse than the English average.

Health inequality is a common feature in dental disease; high levels of dental disease tend to affect those in low income families and those living in socially deprived conditions (National Children’s Bureau, 2015).

More people are keeping their teeth as they age, whereas in the past older populations had fewer teeth. As people get older the combination of frailty, ill health and social and economic constraints make looking after their oral health and accessing services more difficult. This leads to an increase in the burden and complexity of dental care needed for this group.

Oral cancer is a disease for which the outcome and prognosis can be significantly improved if it is caught early. Risk factors for oral cancer are smoking, excessive alcohol consumption and the Human Papilloma Virus (HPV) infection.

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Last updated: 2015-12-10 16:28:39
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1. What are the key issues?

  • Stockton has one of the worst oral disease rates in the North East and has 14% more children with decay experience than the national average.
  • Dental disease is highest in most deprived populations. There are stark variations in young children’s oral health outcomes across the country, region and within Stockton. A school in Billingham has over 70% of its 5 year old children having had some decay compared to a school in Ingleby Barwick with only 13%.
  • Thirty-two per cent of 5 year old children in 2012 had experienced some dental decay with an average of 3.5 teeth per child. Twenty-five per cent of these children have untreated decay.
  • Rates of general anaesthesia (GA) to treat tooth decay are high. In Stockton in 2012/13, 193 children had a GA to have teeth extracted.
  • Dental access rates for children aged 0-4 years are low at about 51%. This rises to over 90% for ages of 5-9 years. To start prevention programmes early, before decay starts, we need to increase dental attendance in our youngest children.
  • About one-third (34%) of members of the public found it difficult to access urgent or emergency care in a survey undertaken by NHS England North East (2014).
  • Poor oral health and obesity share common risk factors. Strategies and messages to reduce obesity should optimise the opportunity to integrate oral health messages.
  • Oral cancer incidence has been increasing in the last 10 years in Stockton following the national upward trend for both males and females. Mortality rates are also above the national average due to late presentation at initial diagnosis.
  • An increasing older population who are retaining more of their teeth, may have difficulty accessing services and maintaining their oral health. In a Tees needs assessment of older people resident in care homes 22% of residents reported brushing less than once per day. This low exposure to fluoride toothpaste will increase the risk of dental decay in this vulnerable group.
  • The Department of Health have proposed a reformed dental contract. The reformed contract will place greater emphasis on a preventive service. However until this is in place, practices will need to be supported to re-orientate their services to be more prevention focused.


Last updated: 10/12/15

2. What commissioning priorities are recommended?

Tackle the determinants of poor oral health
by working with key stakeholders to consult on the implementation of water fluoridation throughout the region

Commission prevention services to improve oral health and reduce inequalities

  • Implementing NICE and Public Health England guidance on commissioning oral health improvement services, published in 2014.
    • Increasing the number of schools on the tooth brushing programme to be a universal offer to all primary schools.
    • Increasing the number of targeted pre-schools on the toothbrushing programme.
    • Commissioning a fluoride varnish programme in targeted schools.
    • Identifying more opportunities to integrate good oral health practices into service specifications and policies of local authority commissioned services: making oral health everyone's business in local authorities.
  • Offering all special educational needs schools (primary and secondary) resources to implement a tooth brushing programme.
  • Supporting NHS dental practices to promote prevention-focused services.
  • Providing an offer of oral health training to appropriate education and health and social care partners relating to the key messages in “Delivering Better Oral Health: an evidence based toolkit for prevention” (PHE, 2014). 

Improve access for young children to preventive health care

  • implementing a facilitated dental access pathway for 0-3 year olds through partnership working with Health Visitors.
  • offering dental care to children participating in the fluoride varnish programme that report not having a family dentist.
  • follow up of access information contained in the school entry questionnaire to facilitate access to services at an early stage.
  • including oral health milestones in the “Delivering Differently” programme.

Improve access to urgent care

  • implementing a new urgent care pathway to improve access for patients not currently accessing dental services.
  • considering commissioning urgent access slots for patients not currently seeking dental treatment.
  • reducing waiting times for young children needing urgent general anaesthetic treatment (ideally 4 weeks).

Promote oral health in Care Home settings

  • including oral health assessment and support for residents included in a care plan as a contractual requirement
  • including oral health training for care home staff as a contractual requirement
  • implementing the recommendations of Oral health in nursing and residential care (NICE, anticipated July 2016).

Implement recommendations from the national survey of older people
2015-16, when published.

Integrate messages on risk factors for oral cancer
as part of public health cancer awareness programmes.

Previously published commissioning recommendations

Tackle the determinants of poor oral health by working with key stakeholders to consult on the implementation of water fluoridation throughout the region. Remains a priority – now 2015/01.

Commission prevention services to improve oral health and reduce inequalities by:

  • Implementing a fluoride varnish programme in targeted schools.  Remains a priority – now 2015/02.  Procurement in progress 2015
  • Implementing a fissure sealant programme in targeted schools.  Partially achieved: non recurrent programmes were commissioned in 2013.
  • Extending the school tooth brushing programmes.  Remains a priority – now 2015/02.
  • Supporting practices to reorient their services to follow evidence-based care pathways.  Remains a priority- now 2015/02.
    • “Delivering Better Oral Health” conference was held September 2014, to update dental practices on key prevention messages.
    • The Oral Health Promotion Team provide evidence based training for all dental teams on prevention.
    • NHS England non recurrently commissioned dental practices to provide an enhanced prevention pathway in 2014/15.

Improve access for children to preventive health care by:

  • Implementing 2nd birthday card scheme. Achieved in 2013 but now delivered by Health Visitors 2015/03.
  • Extending “Adopt a school” scheme by practices. Partially achieved but needs to be revitalised with public health support.

Improve waiting times for specialist services in:

  • Orthodontics (hospital services).  Achieved 2012-15.
  • Community Dental Service - general anaesthetic services.  Achieved 2012-15. Additional waiting list initiatives commissioned. Further work is needed to reduce waiting times for urgent cases (ideally 4 weeks).
  • Paediatric anxiety management services.  Achieved 2012-15. Additional sedation capacity commissioned via a procurement process.

Implement a targeted systematic oral cancer screening programme as part of the early cancer diagnosis initiative.  Abandoned: Pilot programme highlighted operational difficulties with participant recruitment.

Improve oral health for vulnerable groups.

  • Implementing recommendations from the needs assessment undertaken for older people in nursing homes.  Achieved 2014: Learning from the needs assessment published in a peer reviewed journal and used to inform the national Public Health England protocol for the survey of dependent older people.
  • Undertaking a needs assessment/health equity audit for people with learning disabilities, drug misusers and young offenders.  Partially achieved 2013: Qualitative report of the experiences of people with learning difficulties in Hartlepool completed by Teesside University.


Last updated: 10/12/15

3. Who is at risk and why?

Older people retaining teeth have differing oral health needs

  • Older people may have difficulty brushing their own teeth and may be reliant on others to maintain their oral health regime. A recent survey by the British Dental Association (2012) reports variations in the delivery of oral health care by care home providers, high levels of unmet needs, the reluctance of staff to support oral hygiene maintenance and lack of staff training. 
  • A recent local Tees survey of older people living in nursing and care home settings (2013) found high levels of active decay that is not being treated and also 69% of residents that needed support to improve cleaning of their teeth. Dental decay is associated with levels of dental plaque, reducing plaque levels by better cleaning of teeth will reduce the levels of active decay in this group of vulnerable adults
  • Older people may find travelling to a dental practice more difficult e.g. transport issues, or the need for somebody to accompany them.
  • Comorbidities e.g. Parkinson’s, dementia, drugs that lead to dry mouth, make the effects of oral diseases worse. Adults living with dementia may experience difficulties in maintaining good oral health (Preston, 2006).

No gender-specific risks identified.

Socioeconomic status
Children from low socioeconomic groups or living in a deprived area tend to have worse oral health (Gregory et al., 2000).

  • Poorer families tend to have diets containing high levels of sugar.
  • Children from poorer families tend to brush their teeth less regularly.

No specific risks identified.

Other risks

People with learning disabilities

  • Surveys of the dental health of adults with learning disabilities show that poor oral hygiene and a high prevalence of gum disease are common, and although decay levels are similar to or lower than the general population, they tend to have had more teeth extracted rather than restored. (Kendal, 1992). The Steele review (Department of Health, 2009) highlights that people with disabilities also have difficulty accessing services.
  • The Marmot review has identified people with learning disabilities as a high risk group, as has the Department of Health (Department of Health, 2007, 2001).

People with high risk factors for oral cancer


People with diabetes are more prone to periodontal (gum) disease and premature loss of teeth (Botero et al, 2012).

Drug Misuse
Drug misusers taking methadone (with sugar) are at a higher risk of dental decay because of the increased frequency of sugar intake associated with methadone rehabilitation therapy.

Drug misusers generally have a neglected dentition (Nathwani and Gallager, 2008).

Smoking or chewing tobacco is a risk factor for oral cancer, and the combination of smoking and consuming excessive amounts of alcohol increases the risk of oral cancer even further. Smokers are 6 times more likely to develop oral cancer than non-smokers and drinkers are 6 times more likely to develop cancer than non-drinkers. People who smoke and drink are 15 times more likely to develop oral cancer than those who do not drink or smoke. (Mouth Cancer Foundation, 2012).

Communicable disease
Sexually transmitted Human Papilloma Virus is the fastest growing risk factor for oral cancer (Cancer Research UK, 2012).


Last updated: 10/12/15

4. What is the level of need in the population?

Dental Decay - Children

There are stark inequalities in young children’s oral health outcomes across the country, region and wards in Stockton-on-Tees. Stockton-on-Tees has the fourth worst oral disease rates in the North East. On average one-third of five year old children (32%) have experienced some decay compared with the England average of 27.9%. This equates to 14% more children with decay than the national average.

dmft prevalence in 5-year-olds, North East local authorities, 2012

Dental disease is highest in most deprived populations. Three schools in deprived wards in Stockton-on-Tees have more than two-thirds of their 5-year-old children with some decay, ten times the rate seen in a school in a less deprived area with only one-in-fifteen of children have decay.

dmft prevalence in 5-year-olds, Stockton wards, 2012


High levels of dental disease tend to affect those in low income families and those living in socially deprived conditions. There is a very strong linear relationship between the index of multiple deprivation (IMD) and dental decay levels. As the IMD score increases dental decay experience rates rise. Water fluoridation however mitigates against this risk factor.

Mean dmft in 5-year-olds, Tees wards, ranked by deprivation, highlighting fluoridation, 2012

Dental Decay - Adults
Tooth decay still affects a large proportion of the adult population. The distribution of dental disease has changed considerably. Adult dental health surveys demonstrate that older adults have more filled teeth compared to similar age groups in the past whilst the reverse is true for the younger population i.e. that younger age cohorts have less disease than similar age cohorts in the past.

Changes in adults with no teeth, England, 1978-2009

Care home residents in Teesside have been identified as having a higher proportion than elsewhere in the North East who don’t brush their teeth on a daily basis.  Clinicians identified more need for hygiene instruction in Tees.


Oral Hygiene status of residents in care homes, Tees and the North East, 2013


[N=number of residents ]

Oral Hygiene

[Number and (%)]

Reported frequency of brushing

[Number and (%)]

Residents cleaning own teeth

[Number and (%)]

Clinician identified oral hygiene instruction needed

[Number and (%)]




Less than once a day

Once a day

Twice or more a day





50 (48%)

55 (52%)

23 (22%)

28 (25%)

47 (48%)

91 (80%)

73 (69%)

North East

N= 312

99 (32%)

191 (61%)

51 (16%)

84 (27%)

135 (43%)

245 (79%)

176 (56%)









*Adult dental Health Survey (2009)

Source: Local epidemiology data 2013 (unpublished)


Oral Cancer

Between 2001 and 2012, incidence of mouth cancers amongst the population of Stockton-on-Tees appears to be increasing for both males and females, similar to the national upward trend.

Oral cancer incidence, Redcar & Cleveland, 2001-03 to 2010-12

Mortality rates are above the national average in recent years, primarily due to advanced presentation at initial diagnosis which accounts for just under half the diagnosed cases.

Oral cancer mortality, Hartlepool and Stockton, 2001-03 to 2010-12


General anaesthetics
Rates of general anaesthesia (GA) to treat tooth decay are lower in Stockton compared with Middlesbrough and Redcar & Cleveland.  However in 2012/13, 193 children in Stockton had a GA to have teeth extracted.  This is unsurprising as every 5 year old with dental decay will have on average 3.5 teeth affected by decay with 26% having active disease. Treatment for young children can be challenging and often GA is the treatment of last resort to manage children with dental infections that cannot be treated with local anaesthetic.

Decay rates in 3 and 5 year old children and general anaesthetic rates, Tees Valley, 2012/13



Dental decay

3 yr olds,

2013 (%)

Dental decay

5 yr olds,

2012 (%)

General anaesthetics


number, (%)




74 (0.3%)




193 (0.4%)




231 (0.6%)

Redcar and Cleveland



218 (0.7%)




53 (0.2%)





Source: Public Health England



Last updated: 10/12/15

5. What services are currently provided?

Primary dental care
Primary dental care is provided by General Dental Services (GDS), Personal Dental Services (PDS) and Personal Dental Services Plus (PDS+).  There are 23 general dental practices evenly distributed throughout Stockton. Some of these practices also provide additional services such as orthodontics or sedation.

Community dental services
These salaried dental services provide a complementary dental service to that provided by the General Dental Services, Personal Dental Services and Hospital Dental Service to meet the oral health needs of the population.  In Teesside these services are provided by the Tees Community Dental Service (hosted by North Tees and Hartlepool Foundation Trust) from six clinic locations. In Stockton this is provided from Lawson Street Health Centre with the following objectives:

  • Provide dental care for patients who, because of disability, need specialised dental care regarding facilities, equipment or expertise.
  • Provide a specialist referral service for general dental practitioners, the hospital dental service, general medical practitioners for special needs  services.
  • Providing additional services: general anaesthesia, sedation and domiciliary services.
  • Delivering oral health promotion programmes.
  • Undertaking targeted dental inspections of school children and targeted adult special needs screening.
Specialist Services

Specialist orthodontic provision
Orthodontics is the dental speciality concerned with the development and management of irregularities of the teeth, jaw and face.  There are 10 practices commissioned for orthodontic services as part of their GDS contract and 1 specialist orthodontic referral practice.

Orthodontic clinics are also provided at James Cook University Hospital for more complex treatment needs.

Minor oral surgery
Includes the diagnosis and surgical treatment of diseases involving the hard and soft tissues of the mouth, teeth, gums and jaws. It involves procedures such as complex extractions, removal of cysts and apicetomies.

There is 1 commissioned specialist minor oral surgery (MOS) services in primary care in Billingham and MOS services are provided at James Cook University Hospital.

Domiciliary care
Domiciliary oral healthcare has been defined as “a service that reaches out to care for those who cannot reach a service themselves”.  There are 3 practices in Stockton commissioned to provide domiciliary care.

Sedation services
Sedation is a technique in which the use of drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. Clinical indications for conscious sedation including:

  • patients that are anxious or phobic
  • those patients with movement disorder, physical and/or mental disability who are otherwise unlikely to allow safe completion of treatment
  • to enable a particularly unpleasant and complicated procedure to be carried out without distress to the patient.
  • to avoid the need for general anaesthesia, for example in patients with long-standing dental phobia.

There are 3 practices that provide sedation services in Stockton, one specialist advanced sedation service, and the Community Dental Service (CDS) also provide sedation services for vulnerable groups.

Secondary care provision
Consultant led specialist services are provided at the James Cook University Hospital for Orthodontics and Maxillofacial and Oral Surgery.

Public Health Initiatives

Tooth brushing programmes
The initially targeted tooth brushing programme has now been extended as a universal offer to all primary schools. Currently nursery, reception and Year 1 children are offered free tooth brushing resources. Forty-eight out of fifty-nine schools are now participating in the programme. There are also five schools that are whole school brushing.

Fluoride varnish programme
There are 11 schools in Stockton that will be offered the opportunity to participate in a targeted fluoride varnish programme. All pupils in these schools are offered the opportunity to participate in this programme. Schools in this programme have been targeted based on high dental decay rates.

Smile Sack
The Smile Sack is an educational resource aimed at nursery and reception children and their parents to increase knowledge of oral health and healthy eating messages through the medium of play. Schools participating in the tooth brushing programme have been provided with smile sacks.

Health visitor facilitated care pathway
As part of a wider strategy to improve dental attendance in children aged 0 to 2 years Dental Public Health is working with South Tees Health Visitors to support parents to make an appointment with a dental practice for their child. A member of the Health Visiting team will contact the dental practice and make an appointment for those children/families not currently receiving dental care. It is hoped uptake of dental services at an early stage will enable a prevention programme to be started early before the child experiences any decay. Following the evaluation of the South of Tees scheme, extension may be considered in Stockton.


Last updated: 10/12/15

6. What is the projected level of need?

Older and elderly people
The number of people over the age of 65 has been increasing in Stockton-on-Tees over the last few years, from 30,200 in 2011 to 33,200 in 2014. This population group is expected to increase over the following years more than any other age group, increasing to 37,800 in 2020 and 42,300 in 2025. Older people are retaining more of their teeth and, due to ill health and frailty, may have problems with oral care and accessing dental services. The needs of this population group are increasing and becoming more complex (British Dental Association 2003, Department of Health 2009).

Population projection, aged 65+, Stockton, 2012 to 2037

Projected level of need for access
Access to NHS dentistry is not a problem in the Stockton area. Uptake of dental services is above the national average for adults. However uptake of services for the youngest children could be improved and is also variable by ward. On average the uptake rate for children aged 0-4 years is about 51%.  However this ranges from 65% in Hartburn ward to only 37% in the Northern Parishes. Unfortunately in some of the wards that have the highest dental needs such as Billingham Central (44%) and Stockton Town Centre (46%) uptake rates are sub optimal. Initiatives are underway to improve uptake of services in this age group.

Dental registration by age and sex, Stockton, 2014

Oral cancer
Oral cancer incidence rates have increased in Great Britain since the mid-1970s. For males, directly age standardised (DAS) incidence rates increased by 82% between 1975-1977 and 2009-2011. The rise is similar for females, with rates increasing by 88%. There are likely to be several reasons for the increase, including changes in the prevalence of oral cancer risk factors such as alcohol consumption, tobacco use (smoking and smokeless) and human papilloma virus (HPV) infection (Cancer Research UK, 2015). Over the next 20 years, cancers of the lip, mouth and pharynx (ICD-10 C00-C14) are projected to increase by more than 1% per year (Mistry, 2011) thus early intervention is important to decreasing morbidity and increasing survival rates.


Last updated: 10/12/15

7. What needs might be unmet?

Although dental decay rates are falling, they are still amongst the worst in the country. Further extension of public health programmes are needed to improve oral health.

At the age of three, 7% of children have some dental decay. However this rate increases four fold by the age of five (32%). This steep increase in dental decay suggests that in this 2 year period opportunities for prevention are sub-optimal. Given that dental attendance in this cohort is also sub-optimal, opportunities for prevention are clearly being missed. More needs to be done to optimise prevention interventions in our youngest children.

A recent Tees survey of older people living in nursing and care home settings (2013) found high levels of active decay and identified 69% of residents needed support to improve cleaning of their teeth. Dental decay is associated with levels of dental plaque, reducing plaque levels by better cleaning of teeth will reduce the levels of active decay in this group of vulnerable adults.


Last updated: 10/12/15

8. What evidence is there for effective intervention?

Evidence for water fluoridation
The drinking water in Hartlepool is naturally fluoridated. There is a stark difference between the decay rates in Hartlepool and the other 3 localities in Tees see table below. Hartlepool has an average decay rate less than half of any of the other 3 local authority areas.

Dental decay rates in 5-year-olds, Tees local authorities, 2012

Local Authority

Average number of decayed, missing and filled teeth

Hartlepool (Fluoridated water)




Redcar & Cleveland




Source: Public Health England


Evidence of effectiveness of Tees tooth brushing programme
The following is the data from a local evaluation of the Tees Tooth brushing programme.

  • Data for 166 Teesside schools were analysed: with 4,241 children. 58 of these schools were tooth brushing schools
  • Tooth brushing schools: the mean reduction in dental decay rates was 1.45 (95% CI: 1.23, 1.66)
  • Control group schools: the mean reduction was 0.72 (95%: 0.58, 0.86)
  • The above results show:
    • Significant reductions in disease rates across all schools in Teesside
    • The tooth brushing schools show even greater significant reductions in disease rates when compared with the control schools


difference in dmft reduction between tooth brushing programme schools and other schools, Teesside, 2005/6 to 2011/12

Evidence of good oral hygiene practice in Tees school children
The 2012 dental survey also recorded dental plaque levels, the following results show lower plaque levels in all Teesside 5 year old children compared with their counterparts in the North East and England. The coverage of the toothbrushing programme may account for these differences.


Dental plaque levels among five-year olds in Teesside, North East and England, 2012


High levels of plaque present on front teeth (%)



Redcar and Cleveland






North East




Source: Public Health England 2012


Fluoride varnish application
A Cochrane review by Marinho et al (2007) found a 46% reduction in decayed, missing and filled surfaces through the use of topical fluoride varnish.

Early detection of oral cancer and survival rates
It is well documented that the stage that oral cancer (or any cancer) is diagnosed will have a significant impact on the survival rate, with 5-year survival rates approaching 80% for stage I (early) disease reducing significantly for stage IV (later) disease (Rusthoven et. al, 2010). Most patients (over 60%) present with stage III and IV disease (Lingen et. al, 2008) and diagnostic delay is considered the most significant contributor to the high level of mortality in oral cancer (McLeod et. al, 2005).


Last updated: 10/12/15

9. What do people say?

GP survey
From the GP Survey carried out from January to March 2015, the majority (98%) of respondents succeeded in getting an NHS dental appointment in the last 24 months with a dentist they had been to before. In the same period 82% of respondents were successful in getting an NHS dental appointment with a new dentist.

Urgent care review
The NHS England (North East and Cumbria) urgent care review 2014 found:

  • Better information is needed for patients on how to access urgent care
  • 34% of members of the public found it difficult to access urgent or emergency care
  • Need improved access for unregistered patients
  • More walk in options to be available
  • Single contact number
  • Extended opening hours
  • Quicker access to treatment
  • Provide responsive treatment
  • 47% of patients reported that when they had been contacted or been put in touch with services their problem was not resolved!

Friends and Family Test
The NHS ‘Friends and Family Test’ shows that 99.2% of respondents in Hartlepool and Stockton-on-Tees CCG were ‘extremely likely’ or ‘likely’ to recommend their dentist.  This is similar to Cumbria and the North East (98.1%) and England (97.2%).  These data need to be treated with caution as there were 527 responses in Hartlepool and Stockton-on-Tees (0.4%), similar to the 0.5% rate for England.

Evaluation of Fluoride Varnish programme
The school fluoride varnish programme was evaluated by the Centre for Health and Social Care Evaluation (CHASE) at Teesside University. The report explored the views of Head Teachers regarding the implementation of the fluoride varnish programme in South Tees.  Following discussions with Head Teachers, the report concluded:"There is clear evidence that schools realised the benefits of fluoride varnishing for their pupils.  Schools were also largely supportive of the programme being carried out in their school and the benefits such a programme could have on their children’s oral health and wellbeing."(CHASE, 2015)

At a recent School Fluoride Varnish Event (November 2015), Head Teachers also stated they had experienced wider benefits of the programme namely: increased school attendance; fewer children suffering from toothache; fewer children needing urgent dental care; and better community links between their school and the dental practice providing the service.


Last updated: 10/12/15

10. What additional needs assessment is required?

Tees Valley Oral Health Needs Assessment 2015-2020.

Collation of waiting times for specialist services.

Qualitative evaluation of the fluoride varnish programme.

Review of specialist service pathways.


Last updated: 10/12/15

Key contact

Name: Dr. Kamini Shah
Job title: Consultant in Dental and Public Health
e-mail: kamini.shah@phe.gov.uk
Phone: 0113 825 1665


Local strategies and plans

Tees Oral Health and Commissioning Strategy - Primary Care Dental Services 2009-2014

Strategic Dental Commissioning Plan 2015

Compendium of Dental Data for County Durham and Tees Valley 2015

Evaluation of the Facilitators and Barriers to maximising consent rates in Schools for the Fluoride Varnish Scheme.  Chase 2015

Urgent and emergency dental care pathway review. NHS England CNTW 2015


National strategies and plans

Review of NHS dental services in England, Professor Jimmy Steele, Newcastle University, for Department of Health, 22 June 2009

British Dental Association (2003) Oral Healthcare for Older People 2020 Vision

Department of Health (2014). Delivering better Oral health – An evidence based toolkit for prevention (3rd edition).

NICE (2014) Oral health: approaches for local authorities and their partners to improve the oral health of their communities.

Public Health England (2014) Local Authorities improving oral health: commissioning better oral health for children and young people.


Cited references

McDonagh M, Whiting P, Bradley M, Cooper J, Sutton A, Chestnut I et al., (2000): A systematic review of public water fluoridation. York: The University of York NHS Centre for Reviews and Dissemination. Report 18.

Marinho, V., Higgins, J., Logan, S. & Sheiham, A. (2013). Fluoride varnishes for preventing dental cavities in children and adolescents. Cochrane Database of Systematic Reviews.

Marinho VC, Higgins JP, Sheiham A, Logan S. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003;(1):CD002278. Review.

Mistry M, Parkin DM, Ahmad, AS and Sasieni P (2011). Cancer Incidence in the United Kingdom: projections to the year 2030, British Journal of Cancer (2011) 105, 1795–1803.

National Children’s Bureau (2015). Poor Beginnings: Health inequalities among young children across England

NHS England (2015), GP Patient Survey Dental Results Summary; January to March 2015

Department of Health (2007). Valuing People’s Oral Health.  A good practice guide for improving the oral health of disabled children and adults.

Department of Health (2001). Valuing people. A new strategy for learning disabilities for the 21st century.

PN Kendall.  Differences in the dental health observed within a group of non-institutionalised mentally handicapped adults attending day centres.  Community Dental Health, 1992; 9: 31-8.

Preston A (2006) The Oral health of individuals with dementia in nursing homes. Gerodontology 23 (2): 99–105

Botero JE, Yepes FL, Roldán N, Castrillón CA, Hincapie JP, Ochoa SP, Ospina CA, Alejandra Becerra M, Jaramillo A, Jakeline Gutierrez S, Contreras A.  Tooth and Periodontal Clinical Attachment Loss are Associated With Hyperglycemia in Diabetic Patients. J Periodontol. 2012 Jan 16. [Epub ahead of print]

Nathwani NS, Gallagher JE. Methadone: dental risks and preventive action. Dent Update. 2008 Oct;35(8):542-4, 547-8.

Rusthoven KE, Raben D, Song JI, Kane M, Altoos TA, Chen C. Survival and patterns of relapse in patients with oral tongue cancer. Journal of Oral and Maxillofacial Surgery 2010;68(3):584-9.

McLeod NM, Saeed NR, Ali EA. Oral cancer: delays in referral and diagnosis persist. British Dental Journal 2005; Vol. 198, issue 11:681-4.

Lingen MW, Kalmar JR, Karrison T, Speight PM. Critical evaluation of diagnostic aids for the detection of oral cancer. Oral Oncology 2008;44(1):10-22.

Mouth Cancer Foundation (2012). Risk factors for developing oral cancer.

Cancer Research UK (2015). Oral cancer incidence statistics.

Gregory JR, Lowe S, Bates CJ, Prentice A, Jackson LV, Smithers G, Wenlock R, Farron H (2000). National Diet and Nutrition Survey: young people aged 4 to 18 years. Volume 1: Report of the diet and nutrition survey. London: TSO


Data Sources

Health and Social Care Information Centre (2009). Adult dental health survey 2009.

Northern and Yorkshire Cancer registry and Information Service – UKCIS (NCIN, Oct 2015), Lip, oral cavity and pharynx – ASR Directly Age-Standardised Rate (European) per 100,000 population at risk.

Public Health England (2014). Dental Public Health Intelligence Programme.


Non-cited references

The British Fluoride Society (2004). One in a Million,The facts about water fluoridation, 2nd edition.

Owens J, Dyer TA and Mistry K (2010). People with learning disabilities and specialist services. Br Dent Jr 2010; 208: 203-205

Scully C, Bagan J (2009). Oral squamous cell carcinoma overview. Oral Oncology 2009;45(4-5):301-8.