To improve children’s oral health, dental visits are ‘only part of the story’

shutterstock_86362114It’s time to get our teeth into improving children’s oral health, argues Professor Elizabeth Kay, foundation dean of Peninsula Dental School, Plymouth University Peninsula Schools of Medicine and Dentistry.

In April, the Local Government Association (LGA) issued a report that stated that around 100 children a day were being admitted to hospital for operations to remove rotten teeth. Now, data from NHS Digital shows that almost five million children did not visit an NHS dentist in 2015/16 – an increase of 40% on the year before.

I continue to be greatly troubled by the state of children’s oral health in this country. I think it is a national outrage that the LGA report showed that 40,970 surgical procedures were carried out on children for their teeth in 2014-15 at a cost of £35 million, all to address a health problem that is entirely preventable.

One has to ask the question: would the powers that be, be so sanguine if that many children were being admitted to hospital to have any other body part surgically-removed?

The data from NHS Digital headlines with the statistic that more than 40% of children and teenagers under the age of 18 did not visit an NHS dentist in the past year. We can all agree that this is suboptimal and at worst reflects a lack of concern for children’s oral health, but in many ways I think it is a red herring.

Of course children should visit their dentist to have their oral health monitored and to receive treatment of necessary, but I believe that the emphasis should be on preventing oral disease in children. Oral disease is wholly preventable and prevention should be a priority for oral and public health providers.

Top priority

At Plymouth University Peninsula School of Dentistry, children’s oral health is high on our agenda.

We run special children’s clinics in our Dental Education Facilities, where our students treat NHS patients under the supervision of qualified dental health professionals.

Children’s appointment are about more than check-ups and treatment – they also include support, advice and information for children and their families about how to look after their teeth and maintain a healthy diet, including how to reduce sugar intake. In many ways this sits at the crux of the issue highlighted by the NHS Digital data – it is not necessarily the number of times a child visits a dentist that matters, it is what that child and its parents take away from the session to ensure that good oral health techniques become embedded in everyday routine

Via the Peninsula Dental Social Enterprise, we also go out into the community to spread the message. Students run oral health awareness sessions with a wide variety of groups in the community – including schools and nurseries – as part of their studies and the Community Engagement Team at Peninsula Dental Social Enterprise are also active.

It is my belief that oral health needs to be a seamless part of the community health offering. We recently received a grant from the Medical Research Council to investigate the effectiveness of embedding a dental nurse in the Family Nurse Partnership Programme. The programme supports and advises young mothers and we believe that including a dental nurse as part of its offering will help to improve children’s oral health.

We have also carried out research to evaluate Brush DJ, a free app that encourages youngsters to brush their teeth for two minutes twice a day. The research showed that 70% said their teeth felt cleaner since using the app and 88% said that it had motivated them to brush their teeth for longer.

Two years ago, I played a role in the development of NICE guidelines around children’s oral healthcare, especially in encouraging local authorities, schools and nurseries to support children, parents and carers.

Assistance needed

With the right support and advice there is plenty that can be done at home to assist children’s oral health:

  • Limit the amount of sugary and acidic foods and drinks children consume and try tooth friendly snacks like cheese, fruit and vegetable sticks, breadsticks, marmite or butter on toast, rice cakes, or a bowl of non-sugary cereal with milk
  • Drink only water at night and keep sweets, cakes, fizzy drinks and other ‘treats’ for pudding or as part of a meal
  • Supervise children while they brush their teeth for two minutes twice a day and do this until they are seven years old. Always last thing at night and then at one other time during the day (lots of people choose first thing in the morning – this should be before breakfast). Use a fluoride toothpaste, a small amount about the size of a pea
  • Use a toothbrush with a small head and spit, don’t rinse. Replace a child’s toothbrush regularly. A three-month old toothbrush is 30% less effective at removing plaque than a new one.

We should all be shocked by the data published by NHS Digital, but visits to the dentist are only part of the story when it comes to improving our children’s oral health. In an ideal world a prevention strategy which is easy to follow at home, at nursery and at school should greatly reduce oral disease in children and make a visit to the dentist about monitoring, advice and support, rather than invasive and potentially distressing treatment.

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