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Fact sheet

Dental Health in Norway - fact sheet

Over the last 30 years there has been a significant improvement in dental health. More children and young people have no or little tooth decay. Among adults and the elderly, many still have their own teeth and do not need dental prostheses. However, dental health still varies with age, economy, location and belonging to vulnerable groups.

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Clinics in the public dental service send annual reports to the county about the dental health of 5, 12 and 18-year-olds (KOSTRA). There is no ongoing reporting of dental health in children under 5 years, adults and the elderly. Details must be obtained from individual studies.

Dental health in children under 5 years

Children are examined in clinics at 2 years of age for possible referral to a dentist. We do not have statistics on how many 2-year-olds are referred.

Information about dental health for 3-year-olds comes from a 2003 study. Emphasis was placed on measuring cavity incidence. The results show that 87 per cent of the investigated 3 year-olds had completely cavity-free teeth, with regional variation from 78 to 91 per cent of those surveyed. Children with caries had an average of 3.4 affected teeth. The statistics covered 67 per cent of 3-year-olds (Ministry of Health and Care Services, 2006).

Dental health in children over 5 years

In 2014, 73-86 per cent of 5-year-olds and 45-71 per cent of 12-year-olds had completely cavity-free teeth (DMFT = 0). For Norway as a whole, the proportion has risen steadily over the past 25 years, see figure 1.

Interactive figure
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Figure 1 Percentage of 5 and 12-year-olds with healthy, completely cavity-free teeth. Until 1993, about 90 per cent of the classes were studied, while the proportion has been approximately 75 per cent since 2001. Children with good oral health have less frequent dental check-ups. Dental health cannot therefore be better than that shown in the figure. Interactive figure. Source: Statistics Norway.

The improvement in dental health is also shown by the fact that those who have caries have fewer affected teeth. Since 1995, 12-year-olds on average have fewer than 2 teeth with caries. In 1985 the figure was approximately 3.5 teeth (Statistics Norway).

Since 2000, dental health seems to have remained stable, but the statistics include fewer children. This is probably because children with good dental health have fewer check-ups and are not as well represented as children with poor dental status.

Children can also have other types of dental problems than caries such as tooth loss or damage during play. We have no current data on these dental injuries.

Children born with cleft lip and palate often need extensive dental health care. This affects about 14 out of 10 000 newborns.

Dental health among children of immigrants

Children with immigrant backgrounds seem to have more dental caries than children with a Norwegian background. This is shown in two studies from Oslo in 1999 and 2001. 50-60 per cent of 3-year-olds with an immigrant background had no caries compared to 84 per cent of 3 year-olds with a Norwegian background. Similar differences were found among 12 and 18-year-olds (Skeie 2005).

We know little about the variations in dental health between different immigrant groups.

Dental health among 18-20 year olds

The dental health of 18-20 year olds has improved sharply in recent decades and is now generally good. This is shown from surveys of 18 year-olds by the public dental service and of recruits in the Armed Forces.

In 1985 about 1 percent of the surveyed 18 year-olds had never had caries. Today, approximately 17 per cent are in this fortunate situation, although the figure is probably somewhat higher.

A small group has a lot of decay, with 11-19 affected tooth surfaces at examination. Military figures from 2008 indicate that this applies to about 3 per cent.

Among the 18 year-olds with caries in 2008, the number of teeth with so-called caries experience was under 5 on average, compared with just over 10 in 1985. A tooth with caries experience means that the tooth has caries, fillings or has been extracted because of caries. In 1968, recruits had an average of nearly 20 teeth with caries experience. (Statistics Norway, NIPH Health, 2009, p. 21).

Today it is rare that a 20 year-old will have lost teeth because of caries. In 1968, recruits had an average of 2 teeth extracted.

The problem of acid erosion has increased over the past ten years. About 50 percent of recruits in 2008 had acid erosion on one or more tooth surfaces. The injuries are of varying severity. Half of those with acid erosion (total 23%) had one or more areas where acid damage had gone through the enamel.

 
 
Antall tenner med karieserfaring hos 18-åringer i 2008. Søylediagram. Kilde: SSB..
Figure 3. 18-year-olds in Finnmark have the most teeth with caries experience. The graph shows the average number of teeth with caries experience among 18 year-olds in 2008 by county. Source: Statistics Norway

The acid erosion is probably caused by soda drinking. In 2008, 47 percent of recruits drank at least 1 litre of soda or equivalent per day (NIPH 2009).

County differences in child and adolescent dental health

Dental status among schoolchildren varies from county to county. Among 5 year-olds in 2010, Oslo had the lowest proportion of children with completely cavity-free teeth. Among 12 year-olds, Finnmark had the lowest percentage – in 2010, 37 percent had cavity-free teeth (Statistics Norway).

Dental health among 18 year-olds reflects the dental health promotion that this group has received over the past 18 years. In 2008, the 18 year-olds from Finnmark had on average of 6.5 teeth with caries experience, while 18 year-olds in Oslo had four affected teeth (Statistics Norway).

Adult dental health

In 2004, between 60 and 77 percent of adults under 70 years of age rated their dental health as good while 5-13 percent rated it as poor. Half of those without their own teeth considered their dental health to be good in this nationwide survey of self-rated dental health (Holst 2005).

Fluoride toothpaste has been in use since the 1970s, and from the same time children and adolescents have been offered a systematic, public dental service. Dental health has improved particularly in the birth cohorts who had these offers. Therefore, we see the greatest progress among 35-44 year olds, who today have significantly better dental health than a few decades ago. Studies from Trøndelag in the period 1973-2006 show that the number of teeth with cavity experience was halved among 35-44 year olds in this period. The number of own teeth rose from 20 to 27 on average (Holst 2007, Schuller 1998).

 
 
figur 4
Figure 4. Among 60-year-olds the proportion without their own teeth fell significantly from 1975 to 2002. The chart shows the percentage without teeth in different age groups - 20-34 years, 35-59 years and over 60 years. The survey was conducted in the four years 1975, 1985, 1995 and 2002. Source: Health and living conditions survey / Holst 2008/NIPH 2009).

The 50-60 year and older age group have better dental health. Today most people retire with their teeth intact.

In 1975, half of people over 60 years had no teeth. In 2002 the proportion had fallen to just over 15 percent, and half had more than 20 of their own teeth intact, see figure 4.

Dental health in adults still varies with education and income, but we have scant information about the current differences. In the 2004 health and living conditions survey 75 per cent of college and university educated people reported good dental health, compared with 60 percent of high school graduates (Holst, 2008, Hauge Earth 2008).

Periodontitis - gum inflammation

Gum inflammation affects significantly fewer today than in the 1980s and 1990s according to a study among 35 year-olds in Oslo. The proportion with periodontitis decreased from 21.8 percent in 1984 to 8.1 percent in 2003. The incidence of the most serious degree of periodontitis was higher in non-Western immigrants and lower in Western immigrants and ethnic Norwegians (Skudutyte-Rysstad 2007).

Dental health in elderly

Those who belong to the oldest age groups had limited dental care in childhood which is significant for their current dental health. In addition, there are many who use drugs that affect salivation and thus dental health.

In the nationwide survey in 2004, 63-69 percent of people over 70 years living at home assessed their dental health as good and 9.6 percent rated it as poor (Holst 2005, Ambjørnsen 2002).

Table 1 Dental status among the elderly living at home in 1996-1999 (Henriksen, Axelle et al 2003).

 

Just own teeth (%)

Own teeth and implants (%)

Only prosthesis (%)

Number of participants

Whole country

40

28

32

582

Oslo

69

24

7

86

Elderly people living in the cities have more own teeth and better dental status than those living outside the cities. This applies both to those living at home and in institutions. On average 60 percent of the elderly living at home had one or two dentures in 1996-99, compared with 31 percent in Oslo, see table 1 (Henriksen, Ambjørnsen et al, 2003, Henriksen, Axelle et al 2002 and 2003).

While many are satisfied with their dental health, despite missing teeth and maybe one or two prostheses, there are groups with largely unmet dental treatment needs, particularly those requiring nursing care. A study of people needing care who either lived at home or in an institution in 2004 shows that: 

  • 15 percent had pain when eating and 30 percent had difficulty eating because of dental problems. 
  • Approximately 1 in 3 nursing home residents had problems with dry mouth.

The proportion of elderly living at home who are toothless has decreased, almost halved from the 1970s and 1980s to 1996-99. Also among those needing geriatric care, several had their own teeth intact, see figure 5. At the same time, the incidence of both caries and periodontal diseases has increased among those with their own teeth (Ministry of Health and Care Services 2004, Samson 2008).

 
 
figur 5 tannhelse
Figure 5. All age groups of nursing home dwellers had better dental health in 2004 compared with 1996-97, but people over 85 years (column group to the right) had clearly poorer dental status than 67-84 year olds (the two bar groups on the left). The columns show the proportion of own teeth, only prosthesis, own teeth and dental prosthesis and toothless without prosthesis. Age groups 67-74 years, 75-84 years and 85 years plus. 1996/97 - blue and 2004 - red. Source: Ministry of Health and Care Services 2006/NIPH 2009.

In the future when more people over 85 years of age still have their own teeth, new caries attacks will become an increasing problem. A new challenge will be maintenance of crowns, bridges and implants for new generations of elderly.

Dental health among groups with special needs

Those who receive home care and those living in institutions are entitled to free dental services. Other vulnerable groups can have full or partial health insurance reimbursement for dental procedures. Mentally handicapped, the elderly, long-term sick, prison inmates, drug addicts outside institutions / rehabilitation and people with chronic illness can also use public dental services if their health authority approves it. People with chronic diseases that affect dental health will be reimbursed expenses.

Several individual studies show an underuse of dental services by groups with special needs. Disabled adults with mental or physical disabilities or chronic diseases have poorer dental status than their peers, and many rarely visit the dentist.

Dental problems include chewing problems, oral pain, dry mouth, caries and missing teeth. 

  • Of the 227 drug addicts who were examined in 2002-2003, about 100 percent needed dental treatment because of pain, problems or caries attack. 
  • One in three prison inmates assessed in 2002-03 reported their dental health as poor or very poor. 70 percent of the prisoners had drug problems. 
  • Of the chronically ill who were admitted to hospital, 42 percent had problems with teeth or dentures. (Ministry of Health and Care Services in 2004, TAKO Centre, 2008, Friestad 2004).

People with mental handicaps have been entitled to public dental health care since 1984. In 2005-2007, nearly 80 percent of the mentally handicapped received dental health care, but this varies widely between counties. Many were examined / treated less frequently than once a year (NIPH 2009, p. 36).

Among the elderly in institutions, between 41 and 76 percent were examined / treated in 2007 but the proportion varied between counties. Among recipients of home care, 12 to 35 percent were offered examination or treatment (Statistics Norway 2008).

International

Dental health developments among adults in Norway are in line with developments in other Western countries for both caries and gum diseases.

According to World Health Organization statistics from European countries, Norwegian 12 year-olds have better dental health than the other Nordic countries, but the statistics are somewhat uncertain.

World Health Organization (WHO) statistics on dental health

Sources

The text above is based on the following report on dental health (Norwegian only): 

  •  Norwegian Institute of Public Health (2009). Tannhelsestatus i Norge. Rapport 2009:5.

Links to statistics:

The figures from the WHO are difficult to compare, because the year of examination and age groups vary widely.