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You can download a Briefing Paper on this indicator (Word 107Kb).


Information component Pg 4 Health Summary – Indicator No. 29
Subject category / domain(s) Health and ill-health in our community
Indicator name (* Indicator title in health profile) Mean number of decayed/missing/filled teeth in five-year-olds (*Children’s Tooth Decay)
PHO with lead responsibility Yorkshire and Humber
Date of PHO dataset creation March 2007
Indicator definition Mean number of teeth per child sampled which were either actively decayed or had been filled or extracted.
Geography England, GOR, Local Authority: Counties, County Districts, Metropolitan County Districts, Unitary Authorities, London Boroughs.Children are allocated to these geographies according to the location of their school.
Timeliness BASCD (British Association for the Study of Community Dentistry) conduct a survey of five-year-olds every two years.  The 2007/08 survey results are due for publication in 2009.
Rationale:What this indicator purports to measure The mean number of decayed, missing or filled teeth per child
Rationale:Public Health Importance Dental caries (tooth decay) and periodontal (gum) disease are the most common dental pathologies in the UK.  Tooth decay has become less common over the past two decades, but is still a significant health and social problem. It results in destruction of the crowns of teeth and frequently leads to pain and infection.  Dental disease is more common in deprived, compared with affluent, communities.  The indicator is a good direct measure of dental health and an indirect, proxy measure of child health and diet.
Rationale: Purpose behind the inclusion of the indicator To draw attention to areas of high tooth decay.  To improve oral health in children by reducing the prevalence of dental decay.
Rationale:Policy relevance · Children’s National Service Framework · This indicator supports Choosing Health and LAAs.
Interpretation: What a high / low level of indicator value means A high indicator value (red circle in health summary chart) represents a significantly higher average number of decayed, missing or filled teeth per child than in England overall.A low indicator value (amber circle in health summary chart) represents a significantly lower average number of decayed, missing or filled teeth per child than in England overall.From this statistic alone, it cannot be deduced whether the problem is evenly distributed or confined to a small pocket of children.
Interpretation: Potential for error due to type of measurement method Data was only available at PCT level, and had to be apportioned to Local Authorities.  This process can only be approximate where PCTs are not completely contained within Local Authorities.Data was missing for 22 PCTs listed below and consequently it was not possible to present mean dmft for 29 local authorities and two counties.  Data for 12 PCTs was only available in combination with one or more other PCTs, these are also listed below. 45 PCTs where positive consent operated for all or part of the sampling period are listed below.

Data missing for these PCTs
PCT PCT name
5A7 Bromley PCT
5A8 Greenwich PCT
5AK Southend on Sea PCT
5CE Bournemouth Teaching PCT
5CV South Hams and West Devon PCT
5CW Torbay Care Trust
5FN South and East Dorset PCT
5FQ North Devon PCT
5FR Exeter PCT
5FT East Devon PCT
5FV Mid Devon PCT
5FY Teignbridge PCT
5GF Huntingdonshire PCT
5J8 Durham Dales PCT
5J9 Darlington PCT
5JP Castle Point and Rochford PCT
5KA Derwentside PCT
5KC Durham and Chester-le-Street PCT
5KD Easington PCT
5KE Sedgefield PCT
5KV Poole PCT
TAK Bexley Care Trust
Data available for these PCTs in combination only
South East Hertfordshire PCT (5GJ), Royston & Buntingford and Bishops Stortford PCT (5GK)
Ashford PCT (5LL), Canterbury and Coastal PCT (5LM), East Kent Coastal PCT (5LN), Shepway PCT (5LP)
Watford and Three Rivers PCT (5GV), Dacorum PCT (5GW)
Hertsmere PCT (5CP), St Albans and Harpenden PCT (5GX)
Welwyn and Hatfield (5GG) North Hertfordshire and Stevenage PCT (5GH)
Postive/Mixed consent in operation during sampling period
PCT PCT name Form of Consent
5DF North Hampshire Positive
5DK Newbury Positive
5E1 North Tees Positive
5G6 Blackwater Valley & Hart PCT Positive
5HF Wyre PCT Positive
5KJ Part of Craven Harrogate & Rural (Airedale) Positive
5KL Sunderland Positive
5KM Middlesborough Positive
5L5 Guildford & Waverley PCT Positive
5L7 Surrey Heath and Woking Area PCT Positive
5AC Daventry & South Northants Mixed
5AW Airedale Mixed
5CC Blackburn with Darwen PCT Mixed
5CF Bradford City Mixed
5CG South,West Bradford Mixed
5CH North Bradford Mixed
5CK Doncaster Central Mixed
5CX Trafford South PCT Mixed
5EE North Sheffield Mixed
5EG North Eastern Derbyshire Mixed
5EN Sheffield West Mixed
5EP Sheffield South West Mixed
5EQ South East Sheffield Mixed
5F5 Salford PCT Mixed
5F6 Trafford North PCT Mixed
5G7 Hyndburn & Ribble Valley PCT Mixed
5HA Central Liverpool PCT Mixed
5HE Fylde PCT Mixed
5HG Ashton, Leigh & Wigan PCT Mixed
5HH Leeds West Mixed
5HJ Leeds North East Mixed
5HK East Leeds Mixed
5HL South Leeds Mixed
5HM Leeds North West Mixed
5HN High Peak and Dales Mixed
5HQ Bolton PCT Mixed
5HX Ealing Mixed
5J6 Calderdale Mixed
5J7 North Kirklees Mixed
5LJ Huddersfield Central Mixed
5LK South Huddersfield Mixed
5LV Northamptonshire Heartlands Mixed
5LW Northampton Mixed
5M5 South Sefton PCT Mixed
5M7 Sutton and Merton Mixed

The data source is a series of nationally co-ordinated dental epidemiological surveys commissioned by individual PCTs to standardised national protocols and diagnostic standards and involving the dental examination of children in the specified age-group, in state schools. The data source is part of a cycle of nationally co-ordinated dental epidemiological surveys as outlined in Health Service Guidelines (93)25. Surveys are conducted every second year for 5 year olds and every fourth year for 12 years olds and 14 year olds. The data relate to children attending state schools in an area. It cannot be assumed that all children necessarily live in the same area. National minimum standards are set for the random sampling of children to obtain a sample representative of the age-group in the area. Many Health Authorities commission larger samples in order to obtain data on intra-district variations in dental caries for local planning purposes. Data are collected and analysed locally. Summary data items are reported nationally to the British Association for the Study of Community Dentistry, which produces national tables through the Dental Health Services Research Unit at the University of Dundee. These data are published in the journal of the British Association of the Study of Community Dentistry, Community Dental Health.

Interpretation: Potential for error due to bias and confounding For the first time in the history of the BASCD survey of the dental caries experience of 5-year-old children in England and Wales, some parents were required to give positive consent for their children’s teeth to be inspected. In previous surveys all children in state schools were, by default, eligible for inclusion unless their parents submitted a form stating that they did not wish for their children’s teeth to be inspected. This has led to serious concerns that the results of the 2005/06 survey may be biased and not comparable to earlier surveys.Bias may result for several reasons. Firstly, there may be variation between schools generally in how pro-active they are at encouraging parents to return consent forms. Secondly, parents living in more deprived areas (where mean dmft is higher) may be less likely to return consent forms, than those living in more affluent areas (where mean dmft is lower). The picture is further confused by the fact that positive consent was not universally introduced. In 10 PCTs all schools operated positive consent throughout the sampling period, in 35 PCTs some of the schools operated positive consent for some of the sampling period, and in the remaining PCTs no schools operated positive consent. It will be difficult to disentangle the impact of the introduction of positive consent from genuine reductions in the prevalence of dental caries. Anecdotal evidence so far suggests that positive consent had a large effect in some areas.
Confidence Intervals: Definition and purpose A confidence interval is a range of values that is normally used to describe the uncertainty around a point estimate of a quantity, for example, a mortality rate. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. These occurrences result in random fluctuations in the indicator value between different areas and time periods. In the case of indicators based on a sample of the population, uncertainty also arises from random differences between the sample and the population itself.The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. Confidence intervals quantify the uncertainty in this estimate and, generally speaking, describe how much different the point estimate could have been if the underlying conditions stayed the same, but chance had led to a different set of data. The wider is the confidence interval the greater is the uncertainty in the estimate.Confidence intervals are given with a stated probability level. In Health Profiles 2007 this is 95%, and so we say that there is a 95% probability that the interval covers the true value. The use of 95% is arbitrary but is conventional practice in medicine and public health. The confidence intervals have also been used to make comparisons against the national value. For this purpose the national value has been treated as an exact reference value rather than as an estimate and, under these conditions, the interval can be used to test whether the value is statistically significantly different to the national. If the interval includes the national value, the difference is not statistically significant and the value is shown on the health summary chart with a white symbol. If the interval does not include the national value, the difference is statistically significant and the value is shown on the health summary chart with a red or amber symbol depending on whether it is worse or better than the national value respectively.


Indicator definition: Variable Decayed, filled or missing teeth.
Indicator definition: Statistic Mean number per child
Indicator definition: Gender Persons
Indicator definition: age group Five-year-olds
Indicator definition: period Sampled during winter months of 2005-06.
Indicator definition: scale Per child.
Geography: geographies available for this indicator from other providers PCT and SHA.  Available from
Dimensions of inequality: subgroup analyses of this dataset available from other providers None.
Data extraction: Source 2006/06 BASCD survey of the dental caries experience of 5-year-old children in England and Wales.
Data extraction: source URL Supplied privately by BASCD.
Data extraction: date March 2007
Numerator: definition Number of decayed/missing/filled teeth in the survey sample of children in the respective academic year.This was not available at local authority level, therefore the calculation did not proceed by dividing this number by a local authority population.  See attached paper.
Numerator: source Dental epidemiological survey programme undertaken by Health Authorities and co-ordinated nationally for the UK Health Departments by the British Association for the Study of Community Dentistry (BASCD).
Denominator: definition Number of children in the survey sample.This was not available at local authority level, therefore the calculation did not proceed by dividing the number of decayed, filled or missing teeth by this number.  See attached paper
Denominator: source Provided by BASCD.
Data quality: Accuracy and completeness


Numerator: extraction Provided by BASCD.
Numerator: aggregation /allocation See attached paper.
Numerator data caveats The data for 5 year olds relate to deciduous (milk) teeth.
Denominator data caveats See: Interpretation: potential for error sections
Methods used to calculate indicator value See attached paper
Small Populations: How Isles of Scilly and City of London populations have been dealt with Excluded.
Disclosure Control Not applicable
Confidence Intervals calculation method See attached paper

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