Dental Informatics
Programme Newsletter

February 2009

Introduction

Welcome to the first Dental Informatics Programme newsletter - we hope it makes for interesting reading. Keep a look-out for our dedicated website, which will be accessible shortly. In the meantime, please let us know what you think via the contact details below.

Why a Dental Informatics Programme?

The Dental Informatics Programme now operating within the Information Services Division (ISD) seeks to develop and enhance dental information and support eHealth developments for dentistry in Scotland, so that better-informed decisions can be made for the delivery of better dental services and better oral health (and, indeed, better general health).

Building an ISD-hosted dental data warehouse governed by a dedicated project board is at the heart of the Programme’s plans for SHIS-Dental - a data warehouse and access portal for stakeholders across the NHS, using the Scottish Health Information Service.

Why is oral health so important?

Oral health means more than “good teeth” - it is integral to general health, is essential for wellbeing, and is a determinant of quality of life (World Health Organisation, 2003). It allows us to speak, smile, kiss, touch, taste, chew, swallow and cry. Conversely, oral disease can lead to significant time lost from school, work and other activities. This wider definition of oral health should not detract from the importance of the two most important oral diseases - dental caries and periodontal (gum) disease. Both can be effectively prevented and treated, but have to be considered in the context of their strong relationship with socio-economic factors.

The incidence of oral disease is higher in people from deprived areas. The relationship between oral health and general health is well documented, with oral disease and non-communicable chronic disease having many common risk factors. Moreover, many general conditions have oral manifestations or can affect dental treatment.

How good is oral health in Scotland?

Children's dental health in Scotland has improved over the last 30 years, but this improvement slowed down during the 1990s. Many Scottish children still suffer from tooth decay and have begun “a journey of deteriorating oral health” to adulthood.

National target for primary 1 by 2010

In 2006, 54% of children in Scotland at the age of five had some dental decay. Those from deprived communities had the greatest disease burden and are unlikely to meet the Scottish target of 60% with no obvious decay by 2010. This chart shows the improvements in the proportion of P1 children with no obvious decay experience, 1988 to 2006.

Scotland's children still have some of the highest levels of decay compared to their contemporaries in the United Kingdom and western Europe.

The oral health of adults in Scotland has improved markedly over the last 30 years. The trend is likely to continue into the future, with fewer adults having no natural teeth and more adults retaining more teeth into their older years.

In the future, staff working in the Dental Informatics Programme based in ISD will be analysing both the Detailed and the Basic National Dental Inspection Programme data. Basic NDIP data are used in Community Health Partnership (CHP) Community Health and Wellbeing Profiles produced by the Scottish Public Health Observatory (ScotPHO); Detailed NDIP data, published by the Scottish Dental Epidemiological Coordinating Committee, are used to provide robust epidemiological information for all NHS boards across Scotland.

What’s the National Dental Inspection Programme (NDIP)?

This programme of surveys is managed by the Scottish Dental Epidemiology Coordinating Committee (SDECC); it aims to gather appropriate information in order to inform children (and parents) of their dental/oral health status and, through appropriately anonymised, combined data, advise the Scottish Government, NHS boards and other organisations concerned with children's health of the oral disease prevalence in their area.

Every P1 and P7 child attending a local authority school receives a Basic Inspection (asimple assessment of the child's mouth), while in alternate years a sample of P1 or P7 children receive a Detailed Inspection (a more rigorous and comprehensive assessment in accordance with international epidemiological conventions).

After the Basic Inspection a letter is sent to parents advising them of the level of the child’s dental health. The specific goals of the Detailed Inspection are to determine current levels of established tooth decay, to obtain a simple measure of the level of oral cleanliness and to analyse the impact of deprivation on dental health.

Around 10,000 children in Scotland have a Detailed Inspection each year, while the aim is for all children in the target population to have a Basic Inspection.

ISD will be leading the collection and analysis of this key dataset, with a view to hosting the entire dataset in collaboration with partners in Glasgow University’s Dental Public Health Unit and further enhancing the software used to collect the data at source.

What’s the policy context?

Overarching Scottish Government and NHSScotland health policy is governed by Better Health, Better Care, which is centred on:

early years and child health
improving health and tackling health inequalities
improving health service quality – defined by the domains patient-centred, effective, efficient, safe, timely, equitable

There is a specific HEAT target for oral health that 80% of all 3-5-year-old children should be registered with an NHS dentist by 2010/11.

What are the vision and aims of the Dental Informatics Programme?

The vision is, quite simply, provision of high-quality information to improve oral health and reduce inequalities. To do this we will:

develop fit-for-purpose information so that better-informed decisions can be made for the delivery of better dental services and better oral health (and, indeed, better general health)
work with NSS partners to effectively support NHS “eDental” through the delivery and development of patient-centred, IT-enabled, “joined-up” dental services with modern systems for information, communication, payment and governance
raise the profile and improve the integration of dentistry and dental health issues across the NHS and within NHS National Services Scotland (NSS) and ISD.

What’s Childsmile?

childsmile logo Childsmile is a programme to improve the dental health of children in Scotland. It’s split into three main elements:

Childsmile Core programme, which involves nursery and school toothbrushing schemes, and distributes free toothbrushes and fluoride toothpaste in their first five years of life
Childsmile Practice programme, involving clinical prevention activities
Childsmile Nursery and School programmes, involving the application of fluoride varnish to nursery school children's teeth

ISD will be closely involved in the analysis of this fast-growing dataset through data linkage for evaluation and service development, as well as monitoring of Childsmile Core activity; we’ll be working closely with Practitioner Services on Childsmile payments analysis and with National Information Systems Group on future IT solutions.

What are the facts and figures?

These selected facts and figures will help set the establishment of the Dental Informatics Programme in context:

in 2006, 54% (target 60%) of 5-year-olds across Scotland had no obvious decay in their teeth
in 2007, 59% (target 60%) of 11-year-olds across Scotland had no obvious decay in their permanent teeth
in 1998, 18% of adults in Scotland were found to be without natural teeth, compared with 44% in 1972 (new data will be collected this year)
77% of children and 57% of adults are currently registered with an NHS dentist
The NHS Community Dental Service (soon to become the Scottish Public Dental Service) treats about 90,000 patients a year
Nearly 27% of all elective hospital procedures in children during 2006/07 were related to “operations on the tooth including simple extraction”

Who’s driving the Programme?

photograph of Dr David Conway, Consultant in Dental Public Health and Clinical Lead of the Programme

Clinical Lead is Dr. David Conway, Consultant in Dental Public Health

The steering group of the Dental Informatics Programme is the Dental Informatics Group (DIG), which is supported by the Chief Dental Officer and representatives from all areas of NHS dentistry and dental public health. Key partners in the delivery of the Programme are:

other NSS divisions, such as Practitioner Services and National Information Systems Group
clinicians, practitioners and dental care professionals in the NHS general, community and hospital services
the dental public health community and NHS boards
NHS Education, NHS Quality Improvement
Scottish Dental Practice Board
Scottish Government Health Directorates
patients, members of the public and their representatives
the academic community - Glasgow University’s Dental Public Health Unit and Dundee University’s Dental Health Services Research Unit / Health Informatics Centre