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Health Matters: Tackling child dental health issues at a local level

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Tooth decay can have a huge impact on a child’s life.

Having decayed, missing or filled teeth is not a rite of passage that we can ignore; it can cause pain, sleepless nights, days off school and can stop children from doing the things they enjoy most, like playing games and socialising with friends.

It can also be a sign of other health-related issues. Tooth decay can be a sign of a poor diet – in particular excess sugar consumption – which can lead to obesity and long-term conditions such as heart disease and Type 2 diabetes.

However, poor oral health can be prevented. Simple, accessible information – such as how often children should brush their teeth with fluoride toothpaste and which foods should be limited – can help parents make informed choices about their child’s health and avoid the impact of poor oral health.

At a community level, local authorities (LAs) across England are working with partners to tackle oral health and ensure better outcomes for their children.

At an individual level, dental practices are working with their patients to offer preventive advice and treatments, but the wider health, social care and educational workforce have a part to play too.

What are the challenges?

Health inequalities are linked to poorer health outcomes across England, and oral health is no exception. With 33% of children in the North West experiencing poor oral health, compared to just 20% in the South East, more work must be done to bridge the gap and give every child the opportunity to grow up free from tooth decay.

Whilst deprivation is a strong predictor of poor oral health, ethnicity can also play a part, with the last 5-year-old dental survey showing that Chinese and Eastern European children are more at risk.

Ensuring that commissioned programmes are appropriate to local needs and informed by intelligence and scientific evidence is key to addressing these inequalities.

Equitable access to quality dental services can also be an issue. All young children should have access to services that focus on dental health improvement, but many do not currently visit their dentist where they would receive preventive advice and treatment from the dental team.

Sustaining and developing the workforce for children is also important, to ensure children have access to consistent evidence based advice from their early years and right across the life course.

All early years staff across healthcare, social care and education should have sufficient knowledge and understanding to give advice and signpost to local services.

What is being done on a local level?

Across England, LAs are trying different evidence-based approaches to best meet the specific needs of their population.

There are several LAs funding water fluoridation schemes, benefiting around 6 million people across England. We know 5-year-olds are 28% less likely to have dental decay and there are 55% fewer hospital admissions for dental extractions in these areas.

Water fluoridation has operated successfully for 50 years in England; other LAs are now looking into consulting on future schemes as, in addition to the dental health benefits, there are savings of £12.71 over 5 years for each £1 spent.

Some LAs have opted for other evidence-based solutions, making positive change to their services and demonstrating significant improvements to the oral health of 5 year olds in their areas.

Bradford is one of the most deprived areas in England, with a high prevalence of dental disease in 5 year olds.

The local authority recently revised its oral health strategy to highlight areas for improvement and interventions include a community-based fluoride varnish programme, supervised toothbrushing in early years settings and training for the early years and dental workforce.

In addition there is a targeted programme with children attending mosque study classes and Islamic schools.

In Nottingham, oral health training is provided for the wider health, social care and education workforce. This allows them to incorporate oral health improvement in their daily roles to make every contact count in helping to change behaviour.

Training professionals (such as nurses, midwives, health visitors, school nurses, early years professionals, school staff, health improvement professionals and care assistants) ensures oral health messages are appropriate, evidence-based and consistent.

Fluoride toothpaste distribution, advice from health visitors and school nurses and supervised toothbrushing programmes are a main focus for pre-school children in Liverpool.

Toothbrushing programmes (including regular take-home dental care packs) were established in all children’s centres across the city, with over 95% of children participating.

The London borough of Tower Hamlets is one of the most deprived boroughs in England with a large multi-ethnic community.

Historically, it has had high levels of dental disease in children combined with low uptake of dental services and they regularly conduct census surveys of five year old children to enable small-area analysis.

Organisational support from the director of public health, the Health and Wellbeing Board and elected members has helped to ensure funding and is key to the success of the programme.

London Borough of Hammersmith and Fulham’s ‘Book and Brush at Bedtime’ project became part of a wider oral health promotion programme across London.

The project helped establish bedtime routines to promote positive oral health behaviours (including brushing teeth last thing at night) and bedtime stories (to help support literacy, pre-literacy skills and school readiness).

Evidence shows that developing night-time routines early, including brushing teeth with fluoride toothpaste and bedtime reading, is taken forward into the rest of childhood and adult life.

As part of the programme, stories featuring key oral health messages are read with groups of young children at local libraries and children’s centres.

What next?

These initiatives show that local authorities can be very influential in improving the oral health of our children.

Key to their success has been having child oral health high on the agenda, integrating oral health in all children’s services and commissioning oral health programmes that evidence tells us work - PHE’s Local Authorities improving oral health: Commissioning Better Oral Health for Children and Young People toolkit supports local authorities to do this.

Child oral health is a complex problem and there are challenges each region must deal with appropriately. Every area is unique; PHE’s Dental Public Health Intelligence Programme provides the most up-to-date insights about the make-up and needs of populations across England to help them do this.

The latest edition of Health Matters highlights the strategic work of the Child Oral Health improvement Programme Board; this brings together a wide range of partners and stakeholders with the collective ambition that every child grows up free from tooth decay, as part of our vision for every child having the best start in life.

Consultants in dental public health based in our PHE centres work closely with local authority public health teams, NHS England and other partners to support oral health improvement across the life course, to help us achieve this vision.

Health Matters features other tools developed to support local authorities, such as the supervised toothbrushing toolkit.

Using these tools can promote good habits, while delivering consistent messages throughout the life course to help our children not only practice positive behaviours, but to carry this knowledge and confidence into adulthood and to pass onto future generations.

Health Matters
Health Matters is a resource for professionals which brings together the latest data and evidence, makes the case for effective public health interventions and highlights tools and resources that can facilitate local or national action. Visit the Health Matters area of GOV.UK or sign up to receive the latest updates through our e-bulletin. If you found this blog helpful, please view other Health Matters blogs.

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  1. Comment by Carole Kelly posted on

    Please be aware that children with autism, sensory processing difficulties and other neurodiverse conditions may find daily oral care and visiting the dentist particularly challenging. Support should be given to these children, who represent a significant percentage of the population, to help them develop and maintain good oral health.

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