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  • Dental Health in Norway - fact sheet

Fact sheet

Dental Health in Norway - fact sheet

Published Updated

Since 1980, there has been a significant improvement in dental health. However, dental health still varies with age, economy, location and belonging to vulnerable groups.

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Foto: Colourbox.com

Since 1980, there has been a significant improvement in dental health. However, dental health still varies with age, economy, location and belonging to vulnerable groups.


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An updated version of this fact sheet will be published in 2019. 

Main points

  • Dental health in children and adolescents has improved since 1970 and is now stable.
  • Around one in four 18-year-old has never had cavities.
  • Children of immigrant background seem to have more cavities than children with a Norwegian background.
  • Dental health in children varies between city districts and counties.
  • Dental health in adults varies with socio-economic status.
  • Some groups have large unmet dental health needs.
  • In the years to come, taking care of the dental health of new generations of elderly who grew up with bad dental health and a lack of dental health services will be a challenge.

Data sources and definitions

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

The Municipal User and Patient Registry was established in 2018, but so far, does not cover dental health. (Link to Norwegian content.)

Definitions:

DMFT: the sum of teeth with cavities and/or fillings and missing teeth. Abbreviation for “Diseased, Missing, or Filled Teeth”. This is a commonly used indicator for dental health. For deciduous teeth (milk teeth), dmft is used.

Dental health in children under 5 years

The youngest children are supposed to be examined in children’s health clinics at 2 years of age for possible referral to a dentist. Data for 3-year-olds are supposed to be registered by a dentist.

The Municipal User and Patient Registry, established in 2018, will over time include data on the dental health of the youngest children, and the Norwegian Institute of Public Health will apply for permission to show this information in the NorHealth statistics bank.

Dental health in 3-year-olds

The newest national data about dental health for 3-year-olds comes from a 2003 study. Emphasis was placed on measuring caries incidence. The results showed that 87 per cent of the examined 3 year-olds had completely caries-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, page 7).

The project “Småtann” in Oslo in 2002 – 2004 showed higher incidence of caries among children of immigrant background. The project “Puss fra første tann” started in Oslo in 2017 and confirmed this find. This project additionally shows that there are great differences between city districts in Oslo regarding dental health in the youngest children, with greatly varying proportion of 5-year-olds who have never had caries.

Dental health in children between 5 and 18 years

Caries in 5- and 12-year-olds

County data from KOSTRA show the following for 2017:

  • 73-85 per cent of five-year-olds had healthy, completely caries-free teeth (dmft =0)
  • 53-70 per cent of the twelve-year-olds had healthy, completely caries-free teeth (DMFT =0)

For Norway as a whole, the proportion has risen steadily over the past years, see figure 1.

diagram
Illustration: NIPH

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 dental health have less frequent check-ups. Dental health cannot therefore be better than that shown in the 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 who did have caries, on average had fewer than two teeth with caries. In 1985, the figure was approximately 3.5 teeth (Statistics Norway).

Since 2000, dental health has probably 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. Nevertheless, three fourths of the age groups 5-, 12- and 18-year-olds were examined in 2017.

Dental health among 18-20 year olds

Positive development

The dental health of 18-20 year olds has also 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.

  • 6 per cent of the 18-year-olds in 2017 had never had caries.

Results from examinations of young adult 18-20-year-olds in the Armed Forces show:

  • In 1985, about 1 percent of the surveyed 18 year-olds had never had cavities.
  • In 2018, one fourth of the ones examined, or almost 27 per cent, have never had cavities.
  • The requirement for fillings increases from age 18 to 21.
  • Among the almost 50 000 18-year-olds who were examined by the county dental health services in 2017, the average number of teeth with caries exposure was 2.6. In 2010 this number was just under 5, and in 1985 10.

According to a 2018 report from the Armed Forces Health Services, dental status in recruits has been relatively stable since 2010. However, statistics from county health services show that there also has been improvement in this group after 2010. The ones who do have caries have fewer carious teeth than before.

Table 1. Number of teeth with caries exposure 1968 – 2018, 18-year-olds. Registered by county dental health services. A tooth with caries exposure means that the tooth has caries, fillings or has been extracted due to caries.

Table 1. Teeth with caries exposure in 18-year-olds

Year

2017*

2010

1985

1968**

Number of teeth with caries exposure, average

2,6

5

10

20

Number of teeth pulled due to caries  - rare

sjelden

 

 

2

*50.000 examined. 

3-5 per cent have a lot of caries

A small group has a lot of caries, with 11-19 affected tooth surfaces at examination. Military figures from 2008 indicate that this applies to about 3 per cent. The 2018 report does not include this indicator.

1 per cent of the recruits in 2018 needed at least one root canal because of large cavities.

County health services show data of the same magnitude; a bit over 5 per cent of the 18-year-olds in 2018 have or have had cavities in 9 or more teeth.

Dental injuries and acid erosion

Dental injuries
Children can also have other types of dental problems than caries. This includes tooth loss or injury during play. We have no current data on these dental injuries, but hope that data will become available from the Municipal Patient and User Registry (see above).

Cleft lip and palate

Children born with cleft lip and palate often need extensive dental health care. Up to 2005, this affected about 14 out of 10000 new-borns, while numbers for later years are lower. In 2017, 8 out of 10000 children were born with this condition.

Acid erosion
The problem of acid erosion has increased over the past decades. About half the recruits in 2008 and 2018 had acid erosion on one or more tooth surfaces. The injuries are of varying severity. In 2008, half of those with acid erosion (total 23%) had one or more areas where acid damage had gone through the enamel.

Dental health among children of immigrant background

Children with immigrant backgrounds seem to have more dental caries than children with a Norwegian background. This is shown in several older studies from Oslo. 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).

The project “Puss fra første tann” (“Brush from the first tooth”) in Oslo municipality (2017), where the Norwegian Institute of Public Health was involved, was a preventive intervention among small children in two city districts. The results with be available in 2019-2020.

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

County differences in child and adolescent dental health

Dental status among children varies from county to county.

5-year-olds

In all counties, except Finnmark and Oslo, more than 80 per cent of the examined five-year-olds have never had a cavity.

12-year-olds

In many counties around 60 per cent of the 12-year-olds have never had caries (DMFT = 0).  Finnmark has the lowest percentage, 47 per cent in 2017 (Statistics Norway).

18-year-olds

Dental health among 18 year-olds reflects the dental health promotion that this group has received over the past 18 years. In almost all counties, over 20 per cent of the 18-year-olds have never had caries, see figure 2. In 2017, the percentage was highest in Hedmark, 37 per cent, and lowest in Finnmark, 18 per cent. The latter figure is a great improvement since 2010, when only 8 per cent of the examined 18-year-olds in Finnmark never had had caries.

diagram
Illustration: NIPH

Figure 2. The percentage of 18-year-olds in 2017 who never have had a cavity. Source: Statistics Norway.

Dental health services for children and adolescents 0-20 years

National guidelines for dental health services for children and adolescents aged 0-20 years were updated by the Directorate of Health in January 2019:

  • The guidelines require systematic cooperation between child health clinics, school health services and youth clinics.
  • Dentist or dental hygienist should perform a diagnostic examination of teeth and oral cavity on all children and adolescents at the ages of 2, 3, 5, 12, 15 and 18. Additionally, children and adolescents should be examined according to risk evaluation either annually or every two years, and otherwise according to need.
  • In addition, National guidelines for child health clinics and school health services recommends that infants are given an oral examination at the ages of 6 weeks, 6 months, 1 and 2 years.

Adult dental health

In Statistics Norway’s Health and Living Conditions survey in 2015, there was a question asking the participants to evaluate their own dental health. As much as 76 % evaluated their dental health as good or very good; 74 % among men, and 79 % among women.

A report from Statistics Norway in 2016 compares dental health in Sweden and Norway and emphasizes that there are lasting social inequalities in dental health in both countries, both according to education and according to income.

Developments over time in adult dental health

Fluoride toothpaste has been in use since the 1970s, and from the same time, children and adolescents have been offered systematic, public dental services. Dental health has improved particularly in the birth cohorts who had access to this.  Therefore, we see the greatest progress among the mature adults, 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. We believe that these positive developments have continued. (Holst 2007, Schuller 1998).

Socio-economic differences

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 basic school graduates (Holst, 2008, Hauge Earth 2008).

In 2013, Statistics Norway wrote that there is broad agreement among professional environments that adult dental health is improving, but that all groups in society has not shared the improvements. Factors like high age, low income, receiving social security, and living in the North of Norway are all connected to worse self-reported dental health and also higher unmet needs for services. (Statistics Norway 2013).

According to the Eurostat database, which has data from the EU-SILC survey back to 2008, in 2017 in Norway, 10.2 % of the poorest fifth of the population had not consulted a dentist, despite unmet needs, for economic reasons. This is much higher than the European average, which is 5.7 % of this part of the population. Only four countries in Europe have higher proportions than this.

Among the richest fifth of the Norwegian population, 0.5 % have replied that they have not gone to the dentist for economic reasons. This is close to the European average.

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 6 - 9 percent rated it as poor (Holst 2005, Ambjørnsen 2002). 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 from 2004 of people who needed care and who either lived at home or in an institution showed 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.

Data from KOSTRA show small changes in the number of elderly living in institutions or receiving home care services, who are under the care of a dentist or are treated by the public dental health services, though the inhabitants and the patients have aged.

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. 

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). Data from KOSTRA show a slight increase in the proportion of this group who are examined.  

Internationally

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

Compared to many other European countries, a higher proportion in lower socio-economic groups cannot afford to go to the dentist, se above in the paragraph about adult dental health.

Sources and links

The sources referred to in the fact sheet, are either in the reference list in this report, or directly linked in the text.

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

Links to statistics: