Children’s dental health – where are we heading?
In February, Americans raised awareness on the topic of children’s dental health. In a conversation with Claire Stevens, Jeylan Ramis questions why we aren’t doing the same here in the UK and what the children’s oral health currently looks like following the Covid pandemic.
In the USA, February is National Children’s Dental Health Month.
With Covid-19 and the rise of poor oral health amongst children, this puts forward the question why we don’t have such a month in the UK.
Here we take a look at ways we can improve efforts to ensure child patients maintain good oral health habits. The aim is to prevent cavities and gum disease and keep a healthy mouth.
In a conversation with professor Claire Stevens from the BSPD, the effect of the pandemic on children is explored, as well as what we’re doing to improve it.
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Jeylan Ramis (JR): What role do dentists play in the wellbeing of children and young people?
Claire Stevens: The BSPD believes that the dental team has a role to play not only in advocating for improvements in oral health and providing accessible oral health care for children and young people in the UK – but also ensuring that it is framed within the objective of promoting their overall wellbeing.
We need to ensure that we make every contact count, and encourage non-dental healthcare professionals to do the same.
For example, dental teams may be the first to signpost an obese child to dietetic services. They can help them to get the support they need (see BSPD position statement on obesity and oral health).
It is important that all dental practices promote diversity, equality and inclusion. All members of our community should feel welcomed. The most disadvantaged and vulnerable children in our society should be supported.
JR: What impact has the pandemic had on children’s oral health?
Claire Stevens: We have seen a detrimental impact of the Covid-19 pandemic on children accessing a dentist.
A downturn in bookings was inevitable. There were no face-to-face dental appointments in primary care except emergencies from March to June 2020.
Then, when lockdown ended, patients in pain were appropriately prioritised.
However, there is now a renewed focus and urgency for us to get the message out there about the importance of infants seeing a dentist. Appointments for babies and children should be available as they were before the pandemic.
It should also be noted that there were some positive developments that came out of the spirit to pivot when the pandemic started.
There was fantastic collaboration with Dental Trauma UK with the swift development of trauma guidelines to manage urgent cases during the first wave of the pandemic, which remain valid still.
Our BSPD president, Professor Sondos Albadri led on this initiative. He worked with BSPD colleague Professor Peter Day and Doctor Serpil Djemal of Dental Trauma UK.
The society also worked with our clinical improvement and research committee to provide an evidence base and information regarding alternative treatments to manage dental disease while most clinics were operating at a reduced capacity – and we had limited access to general anaesthesia.
Our Dental Check by One (DCby1) initiative inevitably slowed in early 2020 with the lockdowns.
However, this is picking up as we continue to get the message out there about the importance of infants seeing a dentist by the time they celebrate their first birthday.
JR: Is the oral health of children improving?
Claire Stevens: Whilst children’s oral health has improved over the last 20 years, there is still much work to do.
In some parts of England 50% of children start school with visible decay and removal of decayed teeth remains the most common reason for a five to nine-year-old child to be admitted to hospital.
The other frustration is that oral health inequalities have widened as shown in Inequalities in oral health in England on the Gov.uk website.
In order to address these persistent and immoral inequalities we need to consider targeted interventions for those most in need.
Campaigns such as DCby1 and our support of water fluoridation are just examples of the areas of influence the society can have.
While focusing on prevention, we also need investment in those areas where decay is still highly prevalent. This is to ensure that every child has a dental home.
We are now witnessing the impact of the pandemic on children from deprived areas who are disadvantaged by poor oral health.
Millions of UK children and young people may be looking at a future of tooth decay due to the pandemic.
Once we are beyond the pandemic, the oral health of children must be re-thought with revised models of care. This includes the upskilling of primary care colleagues to provide oral health intervention where needed.
This must happen on a broader scale and be given priority.
Further integration between general dental practice, community dental services and hospital services systems is required. This ensures that we are able to understand the full picture to improve care.
BSPD believes there needs to be more focus and attention on prevention, support and care.
JR: Tell us a bit about DCby1, and how things have gone since the launch.
Claire Stevens: The BSPD’s DCby1 campaign encourages infants to see a dentist before the first birthday.
We know that taking a baby to the dentist when their teeth first come through or by the age of one at the latest gets them off to a healthy start.
It is this insight that drove the successful Dental Check by One campaign. This is now established as national guidance in the UK.
The BSPD is immensely proud of DCby1. This is the society’s flagship campaign launched to the dental profession in May 2017.
In just two years the BSPD was able to confirm that there had already been an improvement.
2.5% more children aged 0 to two accessed a dentist in the year ending December 2018 – compared to December 2016.
Whilst this may seem like a small percentage increase, it represents an additional 99,000 young children accessing NHS dental services.
JR: Besides attending the practice, what message can dentists pass on to parents to help their children’s oral health?
Claire Stevens: Before detailing other advice dentists can give to parents, it is crucial to emphasise the important role dentists play in encouraging regular visits to the dentist – and making them a normal and pleasant experience for a child.
This is the best way to ensure that prioritising their oral health becomes a habit for life.
However, over and above that, dentists should see these early appointments with parents and care givers as opportunities to pass on messages about brushing twice a day, using the appropriate amount of fluoride toothpaste, encouraging children to spit rather than rinse after brushing, supervising children until they are seven. Also, offering guidance on food and drinks that promote good oral health.
You can also offer parents guidance on teething, the use of soothers, dummies and thumb sucking habits. As well as, the best types of bottles and cups to choose.
This information is contained in our free guide [BSPD: A practical guide to children’s teeth].
JR: How can dental practices get involved in drawing attention to children’s oral health?
Claire Stevens: Getting babies into the dentist’s chair before their first birthday is one of the best things that dental practices can do to encourage lifelong good oral health.
Supporting, promoting and engaging with the DCby1 initiative are ways to do this. There is a wealth of information and materials available from our website. Discover more about DCby1 at dentalcheckbyone.co.uk.
Then as the dentist’s relationship with the child develops over the years, the messages given to children should include the concept of learning to take responsibility for their teeth as they get older to maintain good oral health.
Good oral care should become an ingrained habit for life. In turn, they will pass on to their children in years to come!
This is how we can change behaviour on a greater society scale.
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