‘Dentistry in a decade’: recent lessons from the adult dental health survey

Abstract

Contemporary dentistry is facing unprecedented challenges in the next decade. Under a new government in an unstable financial climate, dentistry is seeing changes in how healthcare as a whole is managed and delivered. The provision of dentistry is evolving with emphasis on improvements in quality of care from a patient-centred approach. In 2008, the Darzi Report highlighted the importance of care driven by quality.1 The recent introduction of the Care Quality Commission (CQC) seeks to ensure that all providers of adult health and social care operate within a single and consistent set of standards.2 In order to integrate these messages into current practice, it is imperative that one understands the current dental needs of the population going forward. Since 1968, the Adult Dental Health Survey (ADHS) measured prognostic indicators of dental health amongst the adult population, effectively becoming an instrumental tool effecting policy and service provision.3,4 One significant trend since 1968 highlights the decline in numbers of edentulous patients.3 With a greater proportion of the population maintaining their natural teeth, it is important to understand the functional versus nonfunctional dentition and the impact of both on dental services. The World Health Organization (WHO) defines a functional dentition as containing a minimum of 20 teeth.5 This categorization is considered to have good long-term prognosis benefiting from disease prevention and management strategies. Poor oral health and increased tooth loss leading to a non-functional dentition is directly linked to poor general health.6 It is important to assess the impact of the two groups of patients in terms of treatment need and management in the future. Can lessons taken from the past assist in planning for the future of dentistry? Concern must be raised for both groups of adults as those without a functional dentition have a reduced long-term prognosis which may lead to an increased burden on healthcare.4,5 The recent 2009 ADHS identified that the majority of dentate adults less than 45 years of age had, on average, more than 20 natural and unrestored teeth.3 This shows a change in the profile of the middle-aged patient in the years since the 1968 survey. This paper will consider the needs of the adult population over 45 years sampled in the 2009 ADHS, with particular reference to males. Supporting evidence will be used to anticipate their oral healthcare needs and postulate the impact on service provision, research and policy.