Nottinghamshire Insight

Joint strategic needs assessment

Oral Health (2020)

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Topic title Oral Health (2020)
Topic owner Oral Health Strategy Group
Topic author(s) Kay Massingham, Public Health and Commissioning Manager
Topic quality reviewed October 2019
Topic endorsed by Oral Health Strategy Group
Topic approved by Health and Wellbeing Board January 2020
Current version January 2020
Replaces version 2014

Executive summary


The previous JSNA chapter for oral health in Nottinghamshire focused on children and young people’s oral health. It has been nearly five years since that chapter was last amended. The refreshed chapter seeks to understand current and future demands, trends and pressures, looking at oral health across the whole life course. The JSNA chapter will be used to inform local oral health strategy via the Nottinghamshire Oral Health Strategy Group.

Definitions and overall approach

The World Health Organisation (WHO) defines oral health as “a state of being free from chronic mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing.”

National surveys of both adults’ and children’s oral health indicate improvements in dental health over time, shown by reductions in decayed, missing and filled teeth in children, and by adults keeping teeth longer as they age. However, inequalities persist associated with socio-economic background. For example, more people from managerial and professional occupation households had good oral health (91%) compared with people from routine and manual occupation households (79%) (Adult Dental Health Survey (ADHS), 2009). In children, those eligible for free school meals were less likely to be in good overall oral health (29%) compared to those not eligible (40%) (Children’s Dental Health Survey (CDHS), 2013).

Overall Nottinghamshire County is generally similar or better than the rest of the country when considering oral health outcomes; however, there are variations at a sub-county level. For example, five-year-old children in Broxtowe and Rushcliffe had better oral health than the England average. Five-year-old children in Mansfield and Ashfield showed greater prevalence of tooth decay compared with other districts in Nottinghamshire (National Dental Epidemiology Programme, 2017). There were larger numbers of child admissions for hospital dental extractions for districts in the north of the County than for the districts in the south (PHE, 2018).

Oral health diseases continue to be widespread despite being highly preventable. Simple measures such as improved oral hygiene practices, improved diet, use of and access to fluoride, along with attending the dentist for regular check-ups to identify problems early, can all help to prevent, or at least reduce, the burden of oral diseases. A common risk factor approach also supports oral health improvement, because the most common oral diseases – tooth decay and gum disease – as well as oral cancers, share many of the same common risk factors (e.g. smoking, alcohol misuse, obesity and poor diet) as other common diseases, such as cardiovascular disease and other cancers – so addressing these risk factors can benefit more than one aspect of health. 

Unmet need and gaps

The following unmet needs and service gaps have been identified:

  • Certain groups have been identified as having particularly poor oral health, being at increased risk of oral health problems, experiencing difficulties in accessing services, or being less likely to visit the dentist. Groups identified as having poor oral health include children from deprived backgrounds, who are less likely to visit the dentist than children from less deprived backgrounds, and older people. Groups at increased risk of oral health problems include people with learning disabilities and with serious mental illness, people who are homeless or who frequently relocate, such as gypsy, Roma and traveller (GRT) communities, people who misuse drugs or who drink alcohol at levels posing a risk to health, prisoners, and frail older people who may have difficulties maintaining good oral hygiene. Some of these groups also experience difficulties accessing dental services, such as GRT communities, homeless people, and frail older people.
  • Anticipated changes in demography and in the way in which older people’s care is delivered are likely to lead to increased need for older people’s dental services and potential changes to the way in which services are delivered.
  • There is a need to integrate oral health promotion within wider social policies (e.g. housing, planning) and other care pathways, to maximise the opportunities for delivering oral health messages.
  • There is a need to systematically follow up children who are admitted to hospital for oral health problems, to reduce the risk of problems occurring in the future.

These are explored further in section 8 of this JSNA chapter

Recommendations for consideration by commissioners

The recommendations below are reproduced from section 10 and identify key changes needed to address the oral health needs of people in Nottinghamshire.

  Recommendation Lead(s)

Oral health impact assessments relating to any intended relevant policy decisions should be systematically considered as part of a Health In All Policies approach.

All public sector agencies


Integrate oral diseases into policies addressing non-communicable diseases and general health more broadly to secure health and wellbeing throughout life.

All public sector agencies

Public Health Intelligence and Data Improvement

Include examination of effectiveness of oral health questions in evaluation of Learning Disability Health Checks.

NHS commissioner of LD health checks (NHS England)


The approach to delivery of future oral health promotion interventions must consider reducing inequalities in our most vulnerable groups by taking a proportionate universalism approach.

All commissioners


Explore how to mitigate the risks associated with the proposed reduction of the oral health commissioned service due to budget constraints, especially in relation to vulnerable adults and older people.

Nottinghamshire County Council


Improve the oral health care of older people living in care homes through working with care homes to promote the use of NICE and CQC guidance.

Local authority: Adult Social Care and Public Health commissioners, Public Health England (PHE), Health Education England, care home providers / associations and carers’ organisations


Integrate oral health within adults’ and children’s services, for example embedding oral health within the frailty pathway for older people, ensuring oral health is integrated within the early years’ service, ensuring dental trauma is considered in the context of avoidable injuries.

Statutory bodies and providers with responsibility, Integrated Care System (ICS) leads


Scope how systematic processes for following up children who experience hospital admission because of tooth decay could be established. These should comprise follow up for regular dental treatment and appropriate information sharing with other professionals including social care, to ensure that children are safeguarded, as dental neglect may be a feature of wider neglect.

Local authority with support from NHS England and PHE

Service Quality and Accessibility

Plan for anticipated changes to demography and operating context e.g. need for complex treatments in older people, as more people retain their natural teeth for longer, consideration of how best to make oral health services accessible to vulnerable people who have difficulty accessing routine care. 

NHS England


Improve access for older people to oral health care through further provision of training for care home staff on how to recognise urgent dental problems and how to access urgent dental care for residents, and for dental professionals on treatment of people in care homes.

Local authority with support from care providers, PHE, Health Education England and carer/care home associations


Seek to improve access to dental services for other vulnerable groups e.g. continuity of oral health care for people coming out of places of detention; integrate oral health promotion into substance misuse pathway; promote NHS low income scheme and equity of access for those without a fixed address, integrate oral health into Learning Disability care pathways.

Local authority, PHE and NHS


Key contacts

This is an online synopsis of the topic which shows the executive summary and key contacts sections. To view the full document, please download it.

Full report »