Leicester Joint Strategic Needs Assessment (JSNA). Health and social care needs associated with oral health, 2016.
Who’s at risk and why?
All age groups and populations are at risk of poor oral health, even though it is largely preventable. The main modifiable risk factors for oral disease include having a diet high in sugar, smoking or chewing of tobacco, excessive consumption of alcohol, poor oral hygiene, trauma and irregular use of dental care services.
The level of need in the population
Local estimates for dental hygiene suggest that 74% of respondents in Leicester clean their teeth at least twice a day. However, significant differences exist: women and respondents from ethnic groups other than White or Asian, were significantly more likely to clean their teeth at least twice a day.
Local estimates for dental attendance in Leicester suggest that, of those respondents with teeth, 40% go to the dentist at least every 6 months, which is lower than the England average of 49%, followed by 67% who visit the dentist at least once a year, which again is lower than the England average of 70%.
Leicester has the highest oral cancer rate (13.7 per 100,000 population) in comparison to its Office of National Statistics (ONS) local authority peer comparators and is statistically significantly higher in comparison to Barking and Dagenham.
Current services in relation to need
There are 62 NHS dental practices in Leicester, with 47% of practices currently accepting new adult patients who pay for their care and 48% accepting new patients who are exempt from paying. The proportion of resident adults in Leicester accessing NHS dental services (in any location of their choice) has constantly been significantly lower than the national average.
There are significantly lower proportions of 18 to 64-year-olds accessing NHS dental services across Leicester, in comparison to the national average (53%) in the last 24 months, as at March 2014. Although access rates are low, there is availability in terms of NHS dental practices accepting new patients in most areas.
Projected services use and outcomes in 3-5 years and 5-10 years
Although Leicester has a young population base, the older population is increasingly retaining a high number of teeth for life. This means that the need for dental services to be accessible to the older population groups and those who are medically compromised, at a time when they may be less able to cope with treatment, will only increase. It also means that any dental treatment required may be more complex, due to a higher need for advanced restorative dental treatment.
Unmet needs and service gaps
Although there are 62 dental practices providing NHS dental care in Leicester, only 47% of practices are accepting new NHS adult dental patients. 38% of Leicester residents who reported difficulty in obtaining an NHS dental appointment, had found it difficult because the dentist they wanted to visit did not have availability. 5% of respondents also reported that they were not able to make an NHS dental appointment.
Although NHS dental care is free for those claiming certain benefits, 33% of those who pay for NHS dental care and reported difficulty in obtaining an NHS dental appointment, had found it difficult because treatment was too expensive, with 23% reporting having to delay NHS dental care/treatment due to cost.
Respondents aged 18-64 years were more likely not to have been to the dentist, because they ‘could not find an NHS dentist’ and because they ‘cannot afford NHS charges’. Respondents aged 65 and over and respondents from more deprived areas were more likely to have found it difficult, because of the ‘difficulties in making the journey to the dentist’ and because their ‘dentist is only treating privately’.
Although 47% of dental practices in Leicester are currently accepting new NHS adult dental patients, 13% of Leicester residents who reported difficulty in obtaining an NHS dental appointment, had found it difficult in making the journey to the practice. There are only 6 NHS dental practices with disabled access that are accepting new patients in Leicester. Local estimates show that 12% of people aged over 65 were limited in their ability to attend a dentist, by a longstanding disability or infirmity.
Although 47% of dental practices in Leicester are currently accepting new NHS dental patients who pay for their NHS dental care and 48% of dental practices are currently accepting new NHS patients who are exempt from paying for their NHS dental care, 15% of Leicester residents who reported difficulty in obtaining an NHS dental appointment, had found it difficult due to inconvenient surgery opening hours.
Recommendations for consideration by commissioners
There are recommendations around the commissioning of NHS dental services for NHS England and oral health promotion for Leicester City Council. Although access is an absolute priority, there should be additional initiatives to help people improve their oral health through education, better diet, awareness of self-care, etc. This is especially relevant in the priority locations, where greater levels of inequalities have been identified.
- Oral Health Joint Specific Needs Assessment
- NICE guidance: Oral health improvement for local authorities and partners
- NICE guidance: Oral health promotion for general dental practices
- Delivering better oral health
- Leicester Dental Survey 2015
- Leicester Health and Wellbeing Survey 2015