Paediatric care – setting the foundation

children oral healthYasamin Yousefi and Ama Salaudeen discuss the crisis in children’s tooth extractions and how one initiative can help dental teams support parents to establish good oral health habits for their young children.

Tooth decay remains the number one reason for hospital admissions among young children.

Alarmingly, there were 44,685 hospital operations. 177 per working day. This was for the extraction of multiple teeth in under-18s in England in 2018/19, according to NHS data; an increase of 17% compared to the 38,208 extractions in 2012/13.

Many within the profession fear these numbers will rocket post-pandemic. Particularly with the surge in emergency dental treatments caused by widespread poor oral hygiene and lockdown diets high in sugar, as access to routine dental care remains restricted.

Whatever the future brings, these stark statistics certainly highlight the importance of supporting families to embrace good oral hygiene and healthier lifestyle habits in early life.

Intent, however, can be hampered by mixed food marketing messages in supermarkets and advertisements. This proves to be a minefield for parents to navigate through. Despite being eager to ‘do the right thing’ for their children.

Late last year, pressure group Action on Sugar urged the government to insist on mandatory Front of Pack Labelling (FOPL) to reflect free sugars. They called for a ban on the use of misleading claims on labels. For example, ‘one of your five-a-day’ and ‘made from real fruit’.

So, with all this confusion, alongside numerous other barriers to dental care and a hiatus in routine check-ups, what can dental teams do to turn the tide?

Starting the conversation

Strong Teeth helps dental teams hold effective oral care conversations with parents of young children. This evidence-based resource and training package can be used as a framework to enable meaningful behaviour change conversations with parents and their children.

Underpinned by psychological theory and research, the resources provide necessary support to dental teams to explore the varied challenges parents face when caring for their children’s teeth. While the advice given remains consistent with the Department of Health’s Delivering Better Oral Health guidelines, the nature of the conversation has been updated.

By allowing parents to steer the conversation, they are more likely to pinpoint the pertinent challenges facing their family and find workable, attainable solutions to improve their child’s oral health.

Support parents with young children from an early age

Prevention is always better than cure. Therefore, dental teams have a responsibility to reach out to children and their parents as early as possible. All too often, we see children attend their first appointment as an emergency with extensive caries and established bad habits, making poor behaviours harder to tackle.

Little reminders can make a significant difference. For example, encouraging a new parent to book an appointment for their baby as soon as their first tooth erupts. This is recommended in the Dental Check by One campaign by the British Society of Paediatric Dentistry. In doing so, we help families establish lifelong protective oral health habits from infancy.

Assess motivation from the outset

Motivation is a key component of successful behaviour change; thus, it is important to establish why oral health is important before moving on to the practicalities of how to care for children’s teeth. Parents want the best for their children but may underestimate their personal roles and responsibilities when it comes to their child’s oral health.

Strong Teeth resources include a motivational laminate. You can use this to engage parents by highlighting the widespread consequences of tooth decay on children and their families, in addition to the benefits of developing good habits early on. Once on the same page, the foundation is set for discussion around how to address potential barriers to this shared goal with parent and practitioner.

Take time to ask about (and observe) current habits and tailor your advice

Explore with parents what barriers to oral health their family experience. This could relate to toothbrushing, diet or how care is managed by family members and friends.

Establishing good oral hygiene routines is complex, with influences from individual (child), interpersonal (parent-child) and socioenvironmental (wider community) levels coming into play. Let parents talk freely about their issues or concerns. This information will help identify key areas for targeted advice.

Once challenges you have identified the challenges, you can direct parents to the most appropriate Strong Teeth resource. This will further facilitate the conversation in surgery, or at home.

The leaflets (in print and digital format) are a valuable adjunct but do not replace those personal and supportive conversations. These discussions are what parents truly value and are most likely to lead to behaviour change. You may wish to discuss how to brush teeth effectively, the best products to use, or the importance of parental supervised brushing in a twice-daily routine. Where healthy eating is concerned, highlighting hidden sugars in everyday food and drink and links to tooth decay, obesity and diabetes can open eyes.

Parents often lead busy lives, and finding the time to implement change can be a challenge. Be empathetic and non-judgmental in your approach to form the basis of an open conversation.

Each leaflet finishes with an action plan. You can complete this with the parent to encourage them to commit to taking one positive action towards improving their child’s oral health care. We recommend you stick to one or two goals per visit to make changes achievable.

Adopt a whole team approach to oral health promotion

Everyone in the practice has developed the Strong Teeth resources. This helps to reinforce key health messages through clear and consistent delivery.

The patient’s dental journey starts from the moment they enter the practice. Educational material, such as videos, leaflets and posters, should be made readily available in all areas.

The waiting room tent card (with oral care chat sheet) is an excellent resource used by reception staff. It starts parents thinking about the challenges they face and what they would like to discuss with the team. Each statement on the tent card aligns with a different set of resources.

Receptionists can prompt parents to register younger children for their first or next dental visit and offer parents a chance to look at relevant leaflets. Training of all members of the dental team ensures that you will miss no opportunity to support key health messages.

Instil confidence

Knowing the advice is evidence-based gives dental teams confidence in the quality of the information they deliver.

The Strong Teeth initiative collaborated with dental professionals and their wider teams. As well as parents of small children from a variety of backgrounds and communities. This allowed us to address the challenges faced by parents adopting protective oral care habits. It also allowed us to address the barriers faced by dental professionals delivering these key health messages.

The resources were co-created to maximise their utility to a wide range of different socioeconomic and ethnic backgrounds. This means they form the basis of an effective, structured in-clinic conversation between clinician and parent – whatever the circumstances.

The resources provide support in addressing patient-specific challenges. They facilitate behaviour change conversations with parents by offering the choice of alternative modes of delivery (eg, leaflets, digital resources and videos). In light of COVID-19, this multi-resource platform is especially beneficial. Practitioners are engaging in more and more remote consultations with patients.

Using the Strong Teeth framework, parents can regain control over their children’s oral health. They have confidence that if followed, the guidance given will help to improve the oral health and wellbeing of their child. This sets the foundations for good oral care habits for life.

Key principles of the resources

  1. Listen without judgement
  2. Show empathy
  3. Try not to appear rushed
  4. Use positive and open body language
  5. Personalise the conversation.

Strong Teeth leaflets

  1. Brushing from first tooth to five years
  2. Making brushing fun for children
  3. Healthy eating can help protect teeth
  4. Friends & family can support healthy habits
  5. Make brushing part of the daily routine

This article first appeared in Clinical Dentistry magazine. You can read the latest issue.

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