​The Department of Health (DH) today (December 6) released the "Report of Oral Health Survey 2021" (OHS 2021), which contains the latest and representative oral health information on Hong Kong citizens.
Report of Oral Health Survey 2021
The OHS 2021 commenced in November of that year, with the objective to continuously monitor the oral health status of the population. It was conducted in accordance with the survey methods recommended by the World Health Organization. Around 7 100 people in five population groups, namely 5-year-old children, 12-year-old youths, adults aged between 35 and 44 (adults), non-institutionalised older persons aged 65 to 74 (NOP), and an additional group of functionally dependent elderly aged 65 or above who were receiving long-term care (LTC) services under the Social Welfare Department were evaluated. Owing to the local COVID-19 epidemic situation, the fieldwork of the OHS 2021 was generally postponed and completed in December 2023.
The OHS 2021 found that the overall level of oral health in Hong Kong has continued to improve over the past 20 years since 2001. There was no obvious change in the proportion of the population with tooth decay experience in the adults and NOP groups, as about one third of adults and almost half of the NOP had untreated tooth decay. There was a significant drop in tooth decay experience among 5-year and 12-year-old groups, from 50.7 per cent and 22.6 per cent in 2011 to 41.6 per cent and 16.3 per cent in 2021 respectively. In terms of the tooth loss situation, the proportion of NOP with no teeth significantly dropped from 5.6 per cent in 2011 to 0.9 per cent in 2021, while their number of "teeth in mouth" increased from 19.3 and 22.8 in parallel.
Effective oral home care is conducive to good oral health. As shown in this survey result, there was an increasing proportion of 5 year olds who brushed their teeth twice or more daily (74.5 per cent in 2011, increased to 77.9 per cent in 2021). The majority of them used toothpaste and had parental assistance when they brushed (90.2 per cent and 90.4 per cent percent in 2011 and 2021 respectively). Over 80 per cent of people who were functionally independent in other population groups brushed their teeth twice or more daily, while only 13.0 per cent to 31.6 per cent of them had daily interdental cleaning habits.
In addition, the periodontal (gum) condition of adults and NOP continued to be a concern. About 40 per cent of adults and NOP presented with gum bleeding at around half or more of their teeth, which was about 50 per cent lower than the percentages a decade ago. However, 57 per cent of adults and 70 per cent of NOP had gum pockets, which was a higher indicator than that of adults (40 per cent) and NOP (60 per cent) in 2011. Gum pockets are more commonly detected in molars (back teeth) for both age groups, which reflected that the technique of dental plaque removal might not be effective in the prevention of periodontal disease.
Regular professional dental care is crucial for prevention and early identification of oral diseases, so dental check-up habits should be promoted as early as the first tooth erupts in order to identify decayed teeth in a timely manner. The OHS 2021 revealed that the habit of dental check-ups was not common in pre-school children. Up to 39.2 per cent of 5 year olds had untreated decay in primary teeth, while a significant proportion of parents had inaccurate assessments of their children's oral health status. On the other hand, when primary school children are eligible to join the School Dental Care Service with annual dental check-ups, there was a significant improvement in their oral health. On average, the 12-year-old youth group only had 0.24 teeth with decay experience, which was extremely low. To encourage adolescents in maintaining the habit of regular dental check-ups after completion of the School Dental Care Service, the Government will launch a new Primary Dental Co-care Pilot Scheme for Adolescents programme in 2025.
The utilisation of professional dental care services among adult and NOP groups was uncommon. Only 57.3 per cent of the adult group and 33.4 per cent of the NOP group had dental check-up habits. They also tended to ignore oral symptoms, even for severe pain that disturbed sleep, and consider self-management of any discomfort. The lack of time and cost concerns were strong barriers for them to seek dental care. Self-perceived good oral health was the most commonly reported reason of both age groups for not having regular dental check-ups, which is unfavourable to early identification and timely management of dental diseases. The delay in dental care, together with an increase in snacking frequency as found in this survey, may result in further deterioration leading to increasing discomfort and more complex and costly treatment, which can result in the extraction of teeth. Professional instructions from dentists and dental care professionals, and individualised risk assessments are helpful for establishing targeted oral self-care and early identification of any hidden risk factors in developing dental disease. In summary, all age groups should develop regular dental check-up habits as soon as possible.
This survey also found more remaining teeth in the 65-year-old or above LTC users, and a smaller proportion of them had complete tooth loss when compared to the same population groups in 2011. However, untreated decayed teeth were found in more than half of the LTC users, and the cleanliness of their teeth and prosthesis was a concern. The importance of daily oral care must also be promoted to their carers. The majority of LTC users required modifications in provision of dental treatment due to their complex medical conditions. As such, enhanced training of the dental profession in management of this high-risk group is important to address their dental needs.
Moreover, the habit of regular dental check-ups was not common in all the target population groups, which supports and reinforces the need to develop primary oral care services appropriately for different age groups in order to facilitate lifestyle changes among people. Regular assessments of oral health risks through dental check-ups by dental professionals should be an integral part of the primary dental services to be developed. Combined with a healthy lifestyle, primary oral care services enable effective prevention, early identification and timely management of oral diseases, with an aim to help maintain good oral health by retaining natural teeth into old age.
Oral Health Goals 2030
The Audit Commission Report No. 68 published in 2017 on provision of dental services recommended that the oral health goals established in 1991 should be reviewed. The DH hence set up an Expert Group in May 2019 comprising members from the Faculty of Dentistry of the University of Hong Kong, representatives from the Hong Kong Dental Association and the College of Dental Surgeons of Hong Kong, and Specialists in Community Dentistry from the DH. After reviewing the 2001 and 2011 OHS reports and the local situation, the Expert Group had proposed appropriate oral health goals for different targeted age groups. Based on the OHS 2021 results, DH conducted a review this year and eventually finalised the oral health goals for Hong Kong to be achieved by 2030.
The Government established the Working Group on Oral Health and Dental Care (Working Group) in December 2022 to review the scope and effectiveness of the existing oral health measures as well as dental care services. These areas are to be examined and suggestions made on the long-term strategic development for oral health and dental care. The Final Report of the Working Group stressed the importance of primary oral health care for all Hong Kong citizens with a focus on prevention, early identification and timely management of dental diseases. The recommendations are substantiated by the findings of OHS 2021.
"The results of the OHS 2021 provides an important basis for the DH in deriving the Oral Health Goals 2030 for Hong Kong. It also supports collaborative planning of oral care services among the Government, dental professionals and relevant stakeholders to meet diverse community needs for better oral health in the Hong Kong population", a spokesman for the DH said.
The full report and highlight versions of the OHS 2021 can be downloaded from the DH website (www.dh.gov.hk/english/index.html).
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