National statistics

Adult oral health survey 2021: self-reported health and oral impacts

Published 25 January 2024

Applies to England

Introduction

Adults’ (16 years and over) perceptions of their general and oral health are important factors to understand, especially as they provide a subjective, non-clinical indication of the potential demand for dental services and treatment.

Self-reported general and oral health

All participants were asked to separately assess their general and oral health from a list of options:

• very good
• good
• fair
• bad
• very bad

General and oral health

Adults were more likely to report very good or good general health than they were to report very good or good oral health:

• 4 in 5 (78%) adults reported they had very good or good general health, 17% reported they had fair general health and 4% reported they had bad or very bad general health
• two thirds (66%) of adults reported they had very good or good oral health, 26% reported they had fair oral health and 7% reported they had bad or very bad oral health

Age

The proportion of adults who reported very good or good general or oral health was lower in older age groups.

The proportion of adults who reported very good or good general health ranged from 89% among those aged 16 to 24 years to 61% of those aged over 75 years.

The proportions of adults who reported very good or good oral health was highest in the youngest age group (82%). It was lower for all other age groups, where the proportion assessing their oral health to be very good or good was between 61% and 68%.

Figure 1: self-assessed general and oral health by age

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 1 in the data tables.

Household income

Adults in the highest income quintile reported better general and oral health. The proportion of adults who reported very good or good general health ranged from between 70% and 73% in the lowest 2 income quintiles to 89% in the highest income quintile.

Similarly, the proportion of adults who reported very good or good oral health ranged from between 57% and 61% in the lowest 2 income quintiles to 75% in the highest income quintile.

Figure 2: self-assessed general and oral health by household income

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 1 in the data tables.

Neighbourhood deprivation

Adults living in less deprived neighbourhoods were more likely to report that their health or oral health was very good or good. The proportion of adults who reported very good or good general health ranged from 71% in the most deprived quintile to 83% in the fourth and 84% in the least deprived quintile.

Similarly, the proportion of adults who reported very good or good oral health ranged from 60% in the most deprived quintile to 73% in the 2 least deprived quintiles.

Usual pattern of dental attendance

Self-assessed general health and oral health were also associated with usual pattern of dental attendance. Adults who reported that they attended the dentist for regular or occasional check-ups were more likely to report very good or good general health (81% and 82%) compared with adults who reported that they only went to the dentist when they had trouble with their mouth, teeth or dentures (70%).

Similarly, adults who reported that they attended the dentist for regular or occasional check-ups were more likely to report very good or good oral health (73% and 70%) compared with adults who reported that they only went to the dentist when they had trouble with their mouth, teeth or dentures (42%).

Figure 3: self-assessed general and oral health by usual pattern of dental attendance

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 2 in the data tables.

Self-assessed general and oral health did not differ by age or NHS region.

Oral Health Impact Profile-14 (OHIP-14)

Introduction

The Oral Health Impact Profile-14 (OHIP-14) is a generic oral health-related quality of life measure rather than a disease or condition specific measure. OHIP-14 is intended to measure the impact of a person’s oral health on their life overall rather than the effects of specific disorders.

All participants were asked 14 questions about how often they experience specific impacts from their teeth, mouth or dentures in the last 12 months. These impacts included:

• trouble pronouncing any words
• worsening sense of taste
• painful aching
• discomfort on eating any foods
• self-consciousness
• feeling tense
• a lack of satisfaction with their diet
• interruption to meals
• difficulty relaxing
• embarrassment
• irritated with other people
• difficulty doing their usual jobs
• a feeling that life in general was less satisfying
• total inability to function

The response options were: never, hardly ever, occasionally, fairly often and very often. If a participant answered occasionally, fairly often or very often to one or more questions, they were coded as having experienced an oral health impact. The total OHIP-14 score was calculated by adding the numerical values for people’s responses on the 14 questions (never: 1, hardly ever: 2, occasionally: 3, fairly often: 4 and very often: 5). The range of values possible was from 14 (never on all 14 questions) to 70 (very often on all 14 questions).

This scoring differed from the usual scoring of OHIP-14, where the range of possible values is from 0 to 56, as the responses are ordinarily coded as never: 0, hardly ever: 1, occasionally: 2, fairly often: 3 and very often: 4. However, the coding scheme starting from 1 was chosen for this survey to maintain continuity with the Adult Dental Health Survey 2009. Regardless, higher scores imply a more impaired oral health-related quality of life.

The highest value recorded among participants was 70 indicating that all 14 questions were reported as problems that were experienced ‘very often’.

Prevalence and summary of reported problems

Nearly half of all adults (47%) experienced one or more oral health impacts in the previous 12 months. The average number of impacts experienced, including those who experienced none, was 1.7 and the average total OHIP-14 score was 19.7. The most commonly reported impacts were being self-conscious (28%), finding it uncomfortable to eat any foods (24%) and having had painful aching in their mouth (20%).

Some of the items included in OHIP-14 are concerned with the overall impact of oral health (rather than specific impacts). For example, 13% of adults felt that problems with their teeth, mouth or dentures made their life less satisfying.

Figure 4: frequency of oral health impacts

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 3 in the data tables.

Sex

Women were more likely than men to report they experienced at least one oral health impact (51% and 42% respectively). Similarly, women reported a higher mean number of oral health impacts (1.9) and a higher average total OHIP-14 score (20.3) compared with men (1.5 for mean number of impacts and 19.2 total OHIP-14 score).

Age

While there was no clear pattern in how experiencing at least one oral health impact varied by age, there were significant differences between some of the age groups. For example, 50% of adults aged 25 to 34 years and 55 to 64 years reported experiencing one or more oral health impact compared with 40% in those aged 75 years or over. The youngest and oldest adults, those aged 16 to 24 years and those over 75 years, reported fewer oral health impacts (mean number 1.3 and 1.2 respectively) compared with those aged 25 to 64 years (mean number 1.8 to 2.0). Similarly, those aged 16 to 24 years and those over 75 years had a smaller average OHIP-14 score (18.6 and 18.5 respectively) compared with those aged 25 to 64 years (20.2 to 20.4).

Figure 5: prevalence of experiencing at least one oral health impact by age

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 4 in the data tables.

NHS region

The mean number of oral health impacts and total OHIP-14 score varied by NHS region. Adults in the North West reported a higher mean number of oral health impacts (2.0) and a higher average total OHIP-14 score (20.5) than adults living in the East of England (1.4 for mean number of oral health impacts and 18.9 for total OHIP-14 score).

Household income

Adults in higher income quintiles were less likely to report experiencing oral health impacts compared with those in lower income quintiles. The proportion who reported experiencing at least one oral health impact was higher in lower income quintiles, ranging from 50% among those in the lowest income quintile and 51% in the second lowest income quintile to 39% among those in the highest income quintile. The mean number of oral health impacts and average OHIP-14 score was also lower for those with higher household incomes ranging from:

• a mean number of oral health impacts of 2.2 in the lowest income quintile to 1.2 in the highest income quintile
• an average total OHIP-14 score of 21.4 in the lowest income quintile to 18.1 in the highest income quintile

Figure 6: prevalence of experiencing at least one oral health impact by household income

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 4 in the data tables.

Neighbourhood deprivation

The proportion who reported experiencing at least one oral health impact was higher among those living in the most deprived quintile (55%) compared with those in the 2 least deprived quintiles (40% and 43%). The mean number of oral health impacts ranged from 2.4 among those living in the most deprived quintile to 1.3 and 1.4 among those living in the 2 least deprived quintiles. Similarly, the total OHIP-14 score ranged from 21.8 among those in the most deprived quintile to 18.5 and 18.8 among those in the 2 least deprived quintile.

Figure 7: prevalence of experiencing at least one oral health impact by neighbourhood deprivation

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 4 in the data tables.

Usual pattern of dental attendance

Adults who said they went to the dentist when having trouble with their mouth, teeth or dentures were the most likely to report experiencing one or more oral health impacts in the previous 12 months (64%). Forty-six per cent of adults who said they never went to the dentist, 42% of those who said they went for regular check-ups and 47% of those who said they went for occasional check-ups reported at least one oral health impact.

Adults who reported only going to the dentist when having trouble with their mouth, teeth or dentures reported approximately twice as many oral health impacts (3.1) compared with those who went to the dentist for a regular or occasional check-up (1.4 and 1.6 respectively). Furthermore, adults who said they went to the dentist when having trouble with their mouth, teeth or dentures reported a higher OHIP-14 score (23.7) compared with those who reported they went to the dentist for a regular or occasional check-up (18.6 and 19.4 respectively).

Figure 8: prevalence of experiencing at least one oral health impact by usual pattern of dental attendance

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 5 in the data tables.

Experiencing at least one OHIP-14 oral health impacts did not vary by region.

Oral impacts on daily performances (OIDP)

Introduction

The previous section looked at the frequency of oral health impacts. This section looks at how severely these impacts affect a person’s ability to carry out their daily life. The oral impacts on daily performances (OIDP) is an indicator of oral health-related quality of life that attempts to measure the severity of the oral impacts. The wording of the question was “Can you tell us what effect the following difficulties and problems caused by your mouth, teeth or dentures have had on your daily life in the past 12 months?” The specific impacts included were:

• difficulty eating
• difficulty speaking
• cleaning your teeth or dentures
• going out (for example to the shops or visiting someone)
• relaxing (including sleeping)
• problems smiling, laughing or showing your teeth without embarrassment
• difficulty carrying out your major work or role
• problems with emotional instability, for example becoming more easily upset than usual
• problems enjoying the contact of other people, such as relatives, friends or neighbours

The specific diseases or conditions referred to were:

• toothache, sensitive tooth, tooth decay (hole in tooth)
• loose tooth, bleeding gums, receding gums, tartar, bad breath, swollen gums (gum abscess)
• bad position of teeth (for example crooked, projecting or gaps), space between teeth, deformity of the mouth or face
• broken or fractured tooth
• missing tooth or teeth
• colour, shape or size of teeth
• loose or ill-fitting denture
• something else

The response formats differed depending on the mode of administration of the survey. Participants who responded online were asked to rate the severity of the effect on a 6-point scale from 0 to 5, where 0 was no effect and 5 was a very severe effect. Participants who responded on paper were asked to use a 5-point scale, where 1 was no effect and 5 was a very severe effect. OIDP measures severe impacts and a standard definition for OIDP includes performances where impact was rated as 3 or higher on a 6-point scale. However, due to the use of a shorter response scale in the paper survey, a higher cut-off was used for participants responding by this method. In this report participants who chose an answer of 3 or higher when completing online or 4 or higher when completing on paper were classified as having experienced a severe impact.  

Prevalence of severe oral impacts

Overall, 1 in 5 (21%) adults reported at least one severe oral impact that affected their daily life. Performances that were most likely to be severely impacted were avoiding smiling, laughing and showing teeth without embarrassment (12% of all adults) and difficulty eating (9%). Severe impacts on working and speaking were least likely to be reported (both 3%).

Figure 9: percentage of adults experiencing severe oral health impacts on their daily life, by performances

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 6 in the data tables.

Sex

Women were more likely to report at least one severe impact on their daily performances than men (24% and 18% respectively). Women were more likely to experience severe oral impacts in relation to all 9 daily performances than men.

Age

Adults in the oldest age group (75 years and over) were least likely to report severe impacts (15%) and adults aged between 25 and 64 years were most likely to report severe impacts on their daily life (22 to 24%). A similar pattern was seen for all daily performances except going out, eating and speaking, where severe oral impacts did not vary by age.

NHS region

The prevalence of severe oral impacts varied by region, ranging from 18% in the South West to 24% in both the North East and Yorkshire and the Midlands. The severe impact varied by region for smiling, laughing and showing teeth without embarrassment, but not for any other daily performances.

Household income

The proportion of adults reporting severe oral impacts was higher among those with a lower household income. Twenty-seven per cent of adults in the lowest income quintile reported at least one severe impact compared with 15% in the highest income quintile. A similar pattern was observed for all 9 daily performances.

Figure 10: prevalence of severe oral impacts on daily performances by household income

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 6 in the data tables.

Neighbourhood deprivation

Adults living in the most deprived neighbourhoods were most likely to report severe oral impacts. Thirty-one per cent of adults living in the most deprived quintile reported at least one severe oral impact, compared with 16 to 17% in the 2 least deprived quintiles. The proportion of those reporting severe oral impacts was highest among those living in the most deprived quintile across all areas of performance.

Figure 11: prevalence of severe oral impacts on daily performances by neighbourhood deprivation

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 6 in the data tables.

Usual pattern of dental attendance

Adults who said they went to a dentist only when they had trouble with their mouth, teeth or dentures were most likely to report at least one severe oral impact on their daily performance (38%). This compared with 16% of those who said they went for regular check-ups and 21% who said they went for occasional check-ups. A similar pattern was observed for all individual daily performances.

Figure 12: prevalence of severe oral impacts on daily performances by usual pattern of dental attendance

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 7 in the data tables.

Number of natural teeth

Adults who had 21 or more natural teeth were less likely to report that their oral health affected their daily performances severely than those who had 1 to 20 natural teeth or no natural teeth (19% compared with 34%). Adults with fewer than 21 natural teeth were more likely to report severe oral impacts on all individual performances. The impacts where the most difference was seen were difficulties with eating and smiling, laughing and showing teeth without embarrassment for which 22% and 21% of adults with 1 to 20 natural teeth reported severe oral impacts, compared with 7% and 11% of those who had 21 or more teeth.

Figure 13: severe oral impact on individual daily performances by number of natural teeth

Base: all adults

Error bars show the 95% confidence interval around the estimates.

Source: Table 8 in the data tables.

Self-reported periodontal diseases

Adults who said they had periodontal disease were more likely to report severe oral impacts on their daily performance. Thirty-one per cent of those who said they had periodontal disease reported at least one severe oral impact compared with 19% of those who said they did not have periodontal disease. Those with self-reported periodontal disease were more likely to report being severely impacted across all individual daily performances with differences being greatest for difficulty eating and for problems smiling, laughing and showing teeth without embarrassment.

Figure 14: severe oral impact on individual daily performances by self-reported periodontal disease

Base: all adults

Error bars show the 95% confidence interval around the estimates.

Source: Table 9 in the data tables.