The Scottish Health Survey 2024 - volume 1: main report

5. Dental Health

Rory McClelland

5.1     Introduction

Oral diseases, including tooth decay, affect almost half of the world’s population[i]. The WHO report that tooth decay is the most common non-communicable disease globally yet is largely preventable[ii]. It is widely recognised that an unhealthy mouth has a significant impact on physical health as well as on other aspects of day-to-day life including eating, sleeping, missing school or work and engaging with others socially and as a result, may have wider socio-economic consequences[iii],[iv].

Oral health can both affect and be affected by mental health. For example, mental health issues can lead to neglect of oral hygiene, avoidance of dental visits, overbrushing and/or issues caused by medication[v]. Oral health issues can also result in physical pain, social isolation/withdrawal and/or an overall reduction in quality of life that have the potential to impact on an individual’s mental wellbeing[iii].

Oral cancer is the oral condition of greatest concern due to its seriousness and increasing incidence[vi], particularly in Scotland when compared with the rest of the UK[vii]. Major risk factors for oral cancer include tobacco use, excessive alcohol consumption and physical inactivity, with incidence higher among men, older age groups and those who are socioeconomically disadvantaged[viii].

5.1.1     Policy background

The First Minister’s Policy Prospectus (2023)[ix] set out the Scottish Government’s primary objective to sustain and improve equitable patient access to NHS dentistry. As part of this commitment, Scottish Government introduced significant reform to the NHS dental payment system on 1 November 2023.

The new fee structure was designed to incentivise dentists to provide more NHS care and remain within the NHS. The reform also provides NHS dentists with a comprehensive range of NHS treatment options that enables improved clinical discretion[x].

The foundation of the reform builds on and incorporates many of the commitments from the Oral Health Improvement Plan (2018), which was developed following one of the biggest consultations with the dental sector in recent times[iv].

The new system is the first step towards a modern NHS dental service which appropriately assesses and supports the oral health needs of all NHS patients in Scotland. Through the new fee structure there are increased incentives to ensure dentists focus on prevention, putting this at the centre of the care provided. Patients will also benefit from treatment items being brought in line with current best practice guidance, particularly around periodontal (gum) treatment, helping maintain and improve oral health.

Alongside this, Scottish Government continues to fund 5 Oral Health Improvement Programmes and several other initiatives to support more vulnerable groups. The Programmes are targeted at older people living in care homes, homeless people, people within the justice system and people with special care needs, as well as children through the flagship Childsmile programme[xi]. Childsmile supports a range of measures both in dental practices and in schools, nurseries and the community.

5.1.2     Reporting on dental health in the Scottish Health Survey

In this chapter, the following data are presented for adults:

• Number of natural teeth
• Issues with mouth, teeth or dentures
• Issues with mouth, teeth or dentures by mental wellbeing

Figures are reported by sex.

An interactive data dashboard is also available presenting key indicators for Scotland, NHS Boards and local authority areas.

For detailed definitions of terminology used in this chapter and for further details on the data collection methods for dental health, please refer to the Scottish Health Survey 2024 - volume 2: technical report.

5.1.3     Comparability with other UK statistics

The Health Survey for England [xii], Health Survey Northern Ireland[xiii] and the National Survey for Wales[xiv] provide estimates of dental health prevalence in the other UK countries. The surveys are conducted separately and have different sampling methodologies, so dental health prevalence estimates across the surveys are only partially comparable.

5.2     Results

Summary points

In 2024:

• Over nine in ten adults (93%) had at least some natural teeth, towards the top end of the range recorded since 2008 (88%-96%).
• The majority (90%) of adults reported having no issues with their mouth, teeth, or dentures. This proportion has remained broadly consistent since 2018 (89%-91%).
• Mental wellbeing scores for adults who reported having issues with their mouth, teeth, or dentures were much lower than for those who reported having no issues (mean WEMWBS scores of 43.3 and 49.1 respectively).

5.2.1     The proportion of adults that reported having any natural teeth remained  towards the top end of the range recorded since 2008

Over nine in ten adults reported having any natural teeth in 2024 (93%), similar to the levels recorded in 2022 and 2023 (both 94%) and remaining in the upper end of the range recorded since 2008 (88% - 96%).

There was no significant difference between males and females in the proportion who reported having any natural teeth in 2024.

Figure 5A Table 5.1

5.2.2     The proportion of adults that reported having issues with their mouth, teeth, or dentures has remained broadly consistent across the timeseries

In 2024, nine in ten adults (90%) reported that they had no issues with their mouth, teeth or dentures, a proportion that has remained in the range of 89%-91% since 2018. Males were significantly more likely than females to report having no issues with their mouth, teeth or dentures (91% compared to 89%).

The two most commonly experienced issues in 2024 among adults with their mouth, teeth and dentures were difficulty eating food (6%), and/or difficulty smiling, laughing and showing teeth without embarrassment (5%). These issues have consistently been most commonly reported across the timeseries.

Table 5.2

5.2.3     Adults with dental issues had much lower mental wellbeing than those without issues

In 2024, adults who reported having any issues with their mouth, teeth, or dentures had significantly lower mental wellbeing scores than those who did not have issues (mean WEBWBS scores of 43.3 and 49.1 respectively).

Among all adults, the lowest mean WEMWBS scores were recorded among those who experienced issues speaking clearly (41.8) and/or smiling, laughing and showing teeth without embarrassment (42.4).

Differences by sex with regards to the mental wellbeing scores for those who had/ had not experienced any issues with their mouth, teeth or dentures or for the individual issues covered in the survey in 2024 were not significant.

Figure 5B Table 5.3

Table List

Table 5.1  Number of natural teeth/no natural teeth, 2008 to 2024, by sex

Table 5.2  Issues with mouth, teeth or dentures, 2018 to 2024, by sex

Table 5.3  Issues with mouth, teeth or dentures, 2024, by mental wellbeing (WEMWBS mean score) and sex

References and notes