As Britain’s population ages, new modeling shows that the costs of dental disease are increasingly concentrated in older people, raising new questions about whether NHS dentistry is investing in prevention early enough.
Study: Estimating the direct medical costs of oral diseases in the UK: Projecting the cost of disease to 2050. Image credit: Crystal light / Shutterstock
Oral disease is a collective term for several chronic diseases that are very common in both children and adults. Recent research published in journals Frontiers of public health estimates that direct NHS dental costs related to caries and periodontal disease in adults are expected to increase by 20% to £5.3 billion by 2050.
background
Oral diseases include periodontal disease, tooth loss, and caries, and already result in significant healthcare costs. As the world population ages, the prevalence of these conditions is predicted to increase significantly. For example, in the UK, untreated caries could increase by 75.2% and severe periodontal pockets could increase by 56.7% by 2050 compared to 2020.
The number of adults aged 60 and over in the UK was 16.9 million in 2020 and is predicted to rise to 22.5 million by 2050. According to the latest Adult Oral Health Survey (AOHS), approximately 21% of adults with dentition have at least one severely decayed tooth, and nearly half report that it affects their oral health occasionally or frequently. Oral healthcare costs accounted for 1.5% of total healthcare spending in the UK in 2018, amounting to more than €3.5 billion. However, predictions for the future remain sparse.
The current study aims to predict age- and severity-stratified estimates of NHS direct dental treatment costs for caries and periodontal disease-related diseases in adults by 2050. We combined population projections, disease prevalence data, and treatment costs to estimate future direct medical costs.
The researchers used a cost-of-illness (COI) model based on factors such as cost per course of treatment, number of dental visits by age group according to AOHS, and the predicted number of treatment courses needed for each age group.
The cost of each treatment type was calculated in dental activity units (UDA). Pediatric dental procedures and oral cancer were excluded.
NHS direct dental costs increase by 20%
The total cost of treating caries, periodontal pockets and loss of attachment (LOA) is estimated to increase from £4.42 billion in 2020 to £5.3 billion in 2050.
Caries, the fastest growing cost
The biggest increase was in the cost of tooth decay, which rose by 29% to £1.46 billion, accounting for nearly a third of the total. Almost one-third of these cases can be attributed to untreated tooth decay in adults over 60 years of age.
However, the single largest component of caries costs is likely to arise from routine examinations of caries-free individuals due to population growth. The model takes into account all dental activities related to the modeled oral health condition, not just treatment procedures, so these costs are included in the total forecast.
During this period, the cost of treating caries in the age group 16-59 years will decrease, and the cost of untreated caries in the age group 16-24 years will also decrease. If this happens, the increase in the number of elderly people will be alleviated to some extent.
Emergency medical expenses are projected to increase by 26%, accounting for 2% of the total. The largest single emergency treatment cost was due to untreated caries in adults aged over 60, at £0.03 billion, an increase of 168%.
Periodontal pocket treatment, largest cost share
Costs related to periodontal pockets are expected to account for the largest proportion of costs at £2.16 billion in 2050, an increase of 20%. Most of this will be spent on mild pocketing, an increase of 9% from 2020 levels. Conversely, medium out-of-pocket costs will fall by 21% to around £130m. The cost of treating severe pocketing is expected to increase by 57% over this period to around £810m.
LOA cost
The cost of treating LOA is forecast to increase by 13% to £1.56bn, mainly due to mild LOA, and by 16% to £990m.
In the sensitivity analysis, predicted total cost was most sensitive to UDA contract amount.
Impact on dental care policy
The authors report the first COI estimates of NHS direct health expenditure for oral diseases in the UK, using national parameters and stratified by disease subtype. This estimate differs significantly from that of the most recent study, likely due to differences in methodology, the authors said.
That is, previous studies only used costs that were specifically stated to be incurred by each disease subtype. However, the current authors believe that this approach underestimates disease costs by capturing all costs by disease type rather than by treatment code.
The estimates suggest that as the UK population ages, costs will rise disproportionately among older people and people with more severe disease. The authors suggest that severe oral disease may become more common among older adults because competing, more urgent medical needs tend to delay preventive dental care.
Currently, in the UK, the focus is on treating dental problems in older people in institutions and care homes, rather than prevention, unlike the policy for children. According to the authors, this points to the need for broader preventive care for older adults to reduce future treatment costs.
“This study provides an economic rationale that future policies need to focus more on the prevention of poor oral health rather than reactive treatments and interventions.” Programs like Mouth Care Matters demonstrate that improved oral health provision in hospitals improves care and leads to savings for the health system.
Similar cost pressures across healthcare sectors
The increase in dental care costs is lower than, but comparable to, the expected increase in costs for several other chronic conditions, many of which are also affected by aging. By comparison, the direct cost of cardiovascular disease in the UK in 2021/22 was estimated at £16.62 billion. Separate UK-based projections estimate cost increases of 40% for cancer, 54% for coronary heart disease, 100% for dementia and 85% for stroke from 2018 to 2050. Previous research estimated the direct cost to the NHS of chronic kidney disease at £1.4 billion and the direct cost of diabetes at £10.7 billion.
Research limitations
This study has some limitations, including extrapolating the NHS dental band system from England to the whole of England. Dental reform will likely widen disparities between regions in the UK. Similarly, several assumptions were made, including uniform attendance rates across disease severity, lack of data on ED attendance rates, and linear interpolation between available disease prevalence time points.
conclusion
The NHS should plan dental care to take into account the increasing burden of treatment for older people, which requires economic planning for preventive and early treatment. Direct comparisons are difficult because policymakers need to consider the indirect costs of these diseases, such as lost productivity and reduced quality of life.
However, tooth decay and periodontal disease-related conditions in adults will represent a significant portion of future NHS dental costs. Although many oral diseases are preventable, the prevention of oral diseases is especially important as they can be an economic burden if they progress.
Click here to download your PDF copy.
