Tackling poor oral health in children

oral healthMichael Watson reports on the latest national plan to tackle poor oral health in children.

A year ago, the then Health Minister, Alistair Burt, told the BDA Conference that the number of children going to hospital for dental extractions was a ‘national scandal’, which should not be tolerated.

Since then the profession has been waiting for a national plan to tackle the problem.

This month Public Health England published guidance – Health matters: child dental health (found at www.gov.uk/government/publications/health-matters-child-dental-health/health-matters-child-dental-health), giving advice on ‘how health professionals can help prevent tooth decay in children under five as part of ensuring every child has the best start in life.’

Call to action

The guidance outlines the scale of the problem and the risk factors for tooth decay, well known to all in the profession.

Dental teams will also be familiar with measures to prevent decay and evidence-based interventions to improve oral health.

Finally, it issues a call to action, not just for dental teams, but commissioners, both at NHS England and local authorities, as well as midwives, health visitors and other health workers.

The statistics

A quarter of five-year-olds had experienced tooth decay, having on average three or four teeth affected.

The vast majority of tooth decay was untreated.

Twelve per cent of three-year-olds had decay, with on average three teeth affected.

There is wide regional variation.

In Blackburn and Darwen, 56% of children aged five have tooth decay compared to just 4% in south Gloucester.

The areas with poorer dental health tend to be in the north and in the more deprived local authority areas.

And the statistic we all know – tooth extraction was the sixth most common procedure in hospital for children under five years of age, and it was the most common reason for hospital admission for children aged five to nine years old.

The guidance also stresses the financial cost, being £50.5 million for hospital extractions for under 19-year-olds.

For under five-year-olds there were 9,306 admissions for tooth extractions, at a cost of approximately £7.8 million.

It also notes that ‘there are a number of cost effective interventions to prevent tooth decay that can save money in the long term and reduce the number of children needing time off school because of tooth decay’.


The importance of parental advice on good dental health and reduction in sugar consumption are stressed.

Also, effective interventions for improving dental health are described.

These include targeted supervised tooth brushing, provision of toothbrushes and paste by post, targeted community fluoride varnish programmes and water fluoridation.

Finally there is a ‘call for action’ across the health community.

It says: ‘Achieving good dental health for all children needs the support and commitment of a wide range of partners.

‘The most effective way to improve dental health is to embed it in all children’s services at strategic and operational levels.’

The dental team will play a large part in this.

All members of the dental team, including dental nurses, can offer oral health advice and those nurses that are appropriately trained and competent can apply fluoride varnish as well as providing oral health advice.

Commissioners of dental services, both at NHS England and local authorities will play a pivotal role.

Additionally, all healthcare practitioners, midwives, health visitors and school nurses, pharmacists, as well as all those working in GP practices can play a part.

Specialist societies, the Royal Colleges and consultants in dental public health are reminded of the role they can play.

It is an ambitious programme, but could provide a blueprint for improving child dental health and addressing the ‘national scandal’ to which the Minister referred a year ago.

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