The latest Scottish Adult Dental Health Survey is of such poor quality, it’s hard to work out how misleading it actually is, Robert Donald says.

According to the latest ‘so called’ survey on adult oral health published on 30 April, the average middle-aged Scot has more than 10 fillings and only 14 healthy teeth.

The study of 3,114 adults over the age of 45 found that almost two thirds had enough teeth to lead a normal daily life. Fear of the dentist may be part of the problem with 191 people reporting that they were very anxious about appointments. However, it was older patients and those living in deprived areas that suffered from the poorest dental health.

Whilst the government’s priorities have focused on children and the elderly, very little has been known about the dental health of teeth of working-age adults.

Unfortunately, there are serious concerns about the quality and generalisability of the published data. These concerns overshadow all the results and conclusions that have been drawn.

Serious flaws

The last proper Scottish Adult Dental Health Survey was carried out over 20 years ago in 1998. There is therefore a great need for up-to-date figures. Regrettably the Scottish government (SG) has failed to collect them properly and this report does not meet that need.

The survey is seriously flawed for a variety of reasons. Primarily, the results report an age group of over 45-year-olds (not over 18 years, which is the usual adult coming of age), so there has been no attempt to collect recent dental epidemiology data on Scottish citizens aged between 18 to 44 years.

The patients and dentists chosen were not a random sample but a ‘convenience sample’. Therefore, we cannot extrapolate from these figures to the whole Scottish population. The report itself admits that there is also over-representation of females and older patients when compared to the Scottish population.

According to the reported survey figures for dental attendance, 94% say they attended within the previous two years. This is in sharp contrast to participation rates reported by ISD in January 2019 (all adults, not just over 45s) was only 66.6%. This again shows the considerable mismatch between the convenience sample and the Scottish population.

The smoking and alcohol consumption data is ‘reported’ data, so we all know that it will be inaccurate and unrepresentative of the true picture. As the dentists were self-selected for the study, neither the dentists nor their patients are likely to be representative of the wider population.

Data from two time periods 2015/16 and 2017/18 has been combined to give the appearance of a large sample. Combining data from different time periods is very poor survey and statistical practice.

According to the report: ‘A notable limitation of the data reported here is therefore that it represents only those people who sought a dental examination either as a new or emergency patient, or as a regular patient of the GDS or PDS.’

The dentists and patients were only GDS and PDS, so we can safely assume that private dental care, hospital care; industrial and military providers and patients are excluded. This further reduces the generalisability of any of the data.

The results are therefore likely to give an optimistic view of adult dental health in Scotland and the publication may therefore be misleading. However, it is of such poor quality it is hard to judge how misleading. It’s a prime example of trying to do epidemiology on the cheap.

How much?

One thing I think we can all agree on from properly run surveys is that older patients living in deprived areas suffer from the poorest oral health. They are more likely to develop and subsequently die from oral cancer and more likely to lose their teeth due to dental caries and periodontal disease. My Scottish colleagues who work in these areas attest to it.

Addressing and reducing health inequalities is stated as a priority of the Scottish government and has been a major policy plank since they came into power 12 years ago. In fact, Nicola Sturgeon specified it as her top priority when she was Health Minister in 2008.

You would therefore think that SG would know how much it has spent on this policy initiative? Well, think again.

Unbelievably, SG’s Public Health Minister has confirmed that it is not possible to even estimate how much cash has been spent trying to reduce health inequalities. He said that work to tackle the problem takes place ‘across a significant number of strategies and policies’, and ‘it is not, therefore, possible to estimate spend on reducing health inequalities.’

After more than a decade in power, the SNP government can’t even tell us how much money has been invested in this so-called top priority area. People in poorer areas are still developing more oral cancer; they’re still far more likely to suffer from a preventable dental disease. When oral cancer occurs they’re less likely to survive it. The SNP Government might talk a good game on inequality and poverty, but the reality is that it’s failing to deliver on its promises.

New chief dental officer?

Meanwhile it is now 10 months since the chief dental officer (CDO) announced her retirement and almost six months since she retired. Her post as permanent CDO for Scotland remains unfilled and at the time of writing, there is still no word about when the job will be advertised.

There are also many unanswered questions about where Scottish dentistry is heading. Where is the funding coming from for the Oral Health Improvement Plan? The standard government response is ‘appropriate funding will be made available’ but no mention of where it will be coming from. Will it be ‘new money’ or, judging from past actions will it be snatched from the ‘existing’ dental budget – robbing Peter to pay Paul?

What is your view? The British Dental Association will shortly issue a survey to assess the views of dentists in Scotland (both BDA members and non-members).

The survey includes a range of questions on various themes, including national and local leadership for dentistry, funding for NHS dentistry, oral health issues, dental practice management systems, pensions, and how the BDA could better represent members’ interests. I would encourage you to complete the survey to ensure the BDA can effectively represent dentists’ views to the Scottish government, NHS boards and other stakeholders.

It’s your chance to have your say and it’s essential that as many Scottish dentists respond to the BDA survey as possible, so that the results are more representative than the Scottish government’s Adult Dental Health Survey!

The opinions and views expressed here are personal to the author and do not reflect the policy of any organisation with which he is associated.