There have been exciting developments in dental technology in recent years, which should inform all employers’ dental healthcare policies. For example, dental implants now integrate into jaws to provide a firm base to replace missing teeth, tooth-coloured materials now replace old amalgam fillings, and veneers enhance the appearance of stained or damaged teeth. There is much demand for all of these.
Employers should also consider their staff at an actuarial level because there are big changes they should also factor into their policies.
The Adult dental health survey for England, Wales and Northern Ireland 2009, published by the Office for National Statistics in March 2011, shows how seismic these changes are. They arise from the introduction of the National Health Service (NHS) in the 1950s and the use of fluoride toothpastes since the 1970s.
Before the NHS
Before the NHS, dentistry was unaffordable for many people. Instead, people chose to have troublesome teeth removed. But public opinion changed as dentistry became more affordable. People preferred to have their teeth filled, and the number of teeth extracted fell. The first generation to receive the full benefit of NHS dentistry and to grow up with this attitude of saving teeth were the baby boomers.
Children whose adult teeth erupted after the 1970s have had a lifetime of exposure to fluoride toothpaste, which has proved an extremely effective way of preventing tooth decay.
With these factors in mind, adults can be crudely classified in three groups: adults with no natural teeth, older adults with a lifetime experience of tooth decay and reparative dentistry, and younger adults.
No natural teeth
When I was a student in the 1970s, one-third of all adults had no natural teeth of their own. This figure has now fallen to 6%.
Very few people lose all their teeth nowadays. It is getting to the point where it is hard to find enough patients to teach our students how to make full dentures. This means the demand for full dentures will continue to fall.
To some extent, this effect is offset because the population is ageing and so the fall will continue, but may not be quite so dramatic. From a healthcare benefits perspective, the needs of these people are likely to fall, too.
Lot of tooth decay
Older adults, above the age of about 45, grew up with a lot of tooth decay, but had NHS dentists to repair their teeth. Unfortunately, those fillings had a finite lifespan. Over the years, they have broken, been replaced, got bigger and then been replaced by crowns and bridges.
The baby boomers’ dentistry needs are complex. All those years of decay and broken fillings mean they are more likely to need specialist care in the form of advanced crown and bridges, implants and periodontal (gum) therapy. Such treatment is not widely available in the NHS and is very expensive. It is this generation that will consume most of employers’ budgets for dental benefits.
Most adults under the age of 45 have grown up with fluoride toothpaste. Today, only about half of 12-year-olds have had tooth decay in their adult teeth, and many will never need a filling.
The treatment needs of this group will remain relatively modest. In fact, any fillings they do need are likely to be more straightforward and performed satisfactorily by dental therapists. These patterns will emerge as employers look at their employees, and they must plan for them.
KEY POINTS
- Employers should consider their staff at an actuarial level to understand the changes to factor into their dental healthcare policies.
- Staff aged 45 and above will place the greatest demands on dental benefits.
- A young workforce is unlikely to have great dental needs because they have grown up with fluoride toothpaste
Peter G Robinson is director of research at the School of Clinical Dentistry, University of Sheffield
