This paper reports baseline data collected for dental caries prevalence, self-reported oral health behaviours, OHRQoL and HRQoL in a sample of 4680 pupils aged 11–13 years, attending UK secondary schools, participating in the BRIGHT trial.
CDHS are conducted every 10 years, with the last CDHS sampling 2532 participants aged 12 years, compared to this study of nearly twice as many participants with a mean age of 12.7 years. This paper adds to the sparse literature on the oral health of secondary school children, at an age where oral health behaviours are established that remain throughout the life course (5). This is particularly important as few oral health promotion programmes are delivered in secondary schools in contrast to primary schools.
Overall, 34.7% had dental caries experience at DICDAS4−6MFT level. In the most recent CDHS, the equivalent findings for 12-year-olds were 43.0% in 2003 and 34.0% in 2013. This CDHS also oversampled schools and pupils in deprived areas and, as expected, the deprivation level of the area in which a pupil lived was a factor associated with caries experience. However, we found high levels of missing data where schools were unable to provide valid postcodes. Schools for BRIGHT were chosen where FSM eligibility was above the national average. As FSM eligibility was found to be associated with caries experience, this may be a useful approach to targeting schools for future oral health promotion activities.
Both OHRQoL and HRQoL were factors associated with caries experience. The results suggest caries has a significant impact on pupils' lives with 44.5% of participants responding that their oral health was “a bit” or “a lot” of a problem. The mean CARIES-QC score was 3.7 which was lower than reported by Gilchrist and colleagues in 201821 but their study involved a clinical sample.26 The mean CHU9D score of 0.93 was similar to that found in a study of children with caries in New Zealand (mean 0.88). The use of child self-reported outcome measures was a strength of this study, avoiding parent/carers as proxy reporters.
Frequency of toothbrushing was also associated with caries experience even at the relatively high toothbrushing frequencies reported; three-quarters reported brushing at least twice a day. The association between frequency of brushing and plaque and bleeding scores continues to support their use as clinical objective indicators of oral hygiene efficacy. In comparison to CDHS the proportion of participants using a powered toothbrush (54.3%) was higher than previously found (37.0%) which may reflect further adoption of powered toothbrushes by young people, a group comfortable with technology. While it was not possible to compare the cariogenic score found here with the CDHS, it was clear that some pupils reported high frequency of consumption of sugary foods and drinks, which was also a significant factor associated with caries experience. The BRIGHT trial evaluated a behaviour change intervention to increase the frequency of toothbrushing with a fluoride toothpaste and not to reduce sugar consumption, further research is needed to address this oral health behaviour in this age group.
Interestingly, although school attendance was high at a mean of 95.9%, school attendance was still associated with caries experience. A previous systematic review concluded children with caries experience had a higher probability of poor school attendance than children with no obvious caries experience based on studies of school aged children. The authors discussed whether this may be related to dental pain, attendance at dental appointments or may be confounded by factors such as socio-economic status.27
One of the limitations in generalising the results of this study to the wider UK population is that pupils had to own a mobile telephone to be eligible for the BRIGHT trial and a very small proportion (1.9%, 270/14083) had to be excluded on this basis. In addition, the method of consent was different to the CDHS. In the BRIGHT trial, parents were first given the opportunity to opt their child out of the trial before pupils themselves provided consent. This approach to consent was approved by the ethics committee but is not typically used in the CDHS.