Trends in NHS primary dental care for older people in England: implications for the future

Objective: To examine trends over time in the National Health Service (NHS) dental service provision for older people in England and consider the implications for future care. Background: The number and proportion of older people in the population nationally are increasing and their oral health needs are changing as more people retain teeth into older age. Materials and methods: Descriptive analysis of routinely collected activity data for primary dental care in England was undertaken over the 6-year period, 1999/2000-2004/05. Data were cleaned, grouped into age bands for analysis. Activity rates per head of population were calculated for key aspects of care. Population forecasts and national survey data were used to inform future predictions of care required. Results: There was an increase in absolute terms of total items (14.4%) and items per capita (10.7%) between 1999/2000 and 2004/05, with a peak of 15.7 million items claimed in 2003/04. Over the 6-year period, increases per capita were seen for dental examinations (11.3%), periodontal treatments (8.9%), fillings (1.9%), crowns (14.3%) and extractions (4.9%) amongst older people as a group. In contrast, there was a marked decrease in the episodes of care involving domiciliary care (-46.4%) and upper complete dentures (-32.9%) per capita over this period, items that were most commonly provided for the oldest age-band (85 years and over). Apart from complete dentures, the demand for care is predicted to increase. Conclusion: The volume of primary dental care provided for older people has been increasing at a rate which exceeds population growth, but remains low. Planners and commissioners should urgently review the provision of dental care of older people to ensure that their oral health needs are being met particularly in relation to dentures and domiciliary care.