‘Urgent action is needed’: a new report has laid out a strategy for the government to improve children’s oral health as research demonstrates high levels of dental disease.
The report features a comprehensive review of the existing evidence surrounding children’s oral health. It found that the cost of hospital admissions for childhood dental extractions had reached £40.7 million in 2023.
The report says that while waiting for extractions, 67% of children are in pain, 38% have sleepless nights and 26% miss school days.
Overall, only 39% of children were considered to have good oral health. Tooth decay was found to be the most common reason for hospital admissions in five- to nine-year olds.
Evidence of poor oral health
Several statistics from the report show the prevalence of oral health problems by age group, such as:
- Three in 10 children aged five in England have tooth decay
- Tooth decay is present in 11% of three-year-olds, with the an average of three teeth affected
- More than one third (35%) of 12-year-olds report being embarrassed to smile or laugh due to the condition of their teeth.
The accessibility of dental services to children was also considered. For example:
- Around 27,000 children in England were on NHS waiting lists for specialist dental care in 2023
- In 2023, the average waiting time for children to receive dental treatment under general anaesthetic was 80 weeks
- More than half (53%) of children in England have not seen an NHS dentist in the past 12 months.
The findings revealed stark disparities between the oral health of children in the most and least deprived areas. Key figures include:
- The likelihood of tooth decay is two and a half times higher in the most deprived areas in England
- One quarter of children who are eligible for free school meals have reported toothache. This is compared to 15% of all children.
Recommendations
The N8 Research Partnership then made policy recommendations based on the evidence gathered. These are to:
Develop and implement a national child oral health improvement strategy
- Reduce sugar consumption through measures such as expanding the sugar tax and restricting advertisement and sales
- Increase fluoride exposure through programmes including water fluoridation and supervised toothbrushing
- Implementation of this strategy should be overseen by a national board including members from national and local government, dental organisations and societies, universities, charities and the public
- Data should be collected and evaluated to measure the impact of the strategy.
Maximise the impact of early years and education-based interventions
Improvements to the oral health component of education policies including:
- Statutory guidance for Early Years Foundation Stage
- The school curriculum
- The 0-19 Healthy Child Programme
- Family hubs.
Re-orient dental services towards prevention of dental diseases in children and young people.
- Increased access to dental services
- Greater emphasis on preventive care (fluoride treatments, dental sealants and behaviour change interventions)
- Earlier diagnosis and management of dental diseases in primary care
- Improved pathways for those who require specialist care
- Better mechanisms for allocation and distribution of funding.
The recommendations are based on seven principles
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- Putting our children first
- Addressing inequality
- Adopting place-based approaches
- Working together effectively across our public services
- Putting education at the heart of public service delivery
- Establishing universities as the research and development departments for local public services
- Using and sharing information across public service providers effectively.
‘National oral health strategy’
Zoe Marshman is a professor of dental public health at the University of Sheffield and one of the main authors of the report. She emphasised that its release had come at a crucial time for paediatric dentistry following the general election.
She said: ‘In their manifesto, the Labour Party put an emphasis on children’s health and had also talked about oral health and tooth decay. We wanted to capitalise on that and make sure all of the evidence was in place for the new government to start putting a national oral health strategy together.
‘There have been lots of reports published in the past, but we wanted this one to be in a format that’s appropriate for policy makers to read. We’ve demonstrated the state of children’s oral health with evidence from research, and then we wanted to put forward some solutions. It’s not just a traditional survey which shows how bad things are, it also puts all the solutions in one place.’
‘A collaborative approach’
The researchers hope that the report can be used to close the gap between academic analysis and policy implementation. Professor Marshman continued: ‘Sometimes the evidence is there but it doesn’t always get used by the policy makers. Those of us who work in universities want to make sure that our research has a voice.’
Contributing author Samantha Watt described a ‘disconnect’ between academia and general practice, hoping that the recommendations of the report could feed into everyday dental provision.
Paula Waterhouse, outgoing president of the British Society of Paediatric Dentistry, also called for greater involvement of professional associations in government decision making. She said: ‘The evidence is clear so we are ready to consult – we want policy to be implemented and effective strategies to be put in place. The state of children’s oral health needs to be addressed at both a national and a local level as there are geographic differences.
‘Crucially, we want to be part of the process. Historically the government made a decision and we went with it, now we want a collaborative approach and the BSPD is committed to being a part of it as an expert voice in children’s oral health.’
‘We should be shocked’
The report was produced collaboratively between the Centre for Young Lives and Royal College of Paediatrics and Child Health (RCPCH). Anne Longfield CBE, executive chair of the Centre for Young Lives, and Dr Camilla Kingdon, former president of the RCPCH, introduced the report.
They said: ‘We should be shocked at the poor condition of many of our children’s teeth, particularly as the trajectory of dental disease suggests oral health in childhood predicts oral health in adulthood.
‘The impact of tooth decay on the lives of children are of course more than just cosmetic. Tooth decay has a direct impact on a child’s quality of life. Untreated disease can cause toothache and pain, sleep disruption, and alter eating habits.’
Dr Camilla Kingdon is immediate past president of the Royal College of Paediatrics and Child Health. She said: ‘I am really thrilled with this report because the state of our children’s teeth should be a source of national embarrassment.
‘This shows that there is so much that can be done to tackle the problem. The many spin offs of a robust national strategy to improve children’s oral health would be potentially significant – benefits for tackling obesity as well as mental health issues, and potentially improving school attendance, amongst other things.
‘The impact of poor oral health stretches way beyond childhood and so every one of us should see this as a key health promotion and disease prevention strategy that benefits the whole nation.’
Holistic dentistry
The oral health report is one of several publications on the topic of children’s health produced by the N8 group. The oral health researchers have contributed to the other documents, consulting on the impact of dentistry on other areas of healthcare.
Professor Marshaman said: ‘We’ve had input into reports on early years education and autism as well as the full oral health report. In particular, we’ve been able to help with developing resources for parents of autistic children which includes advice on oral care. There’s also another report coming up which will include some of our research on how oral health impacts speech and language development.’
Writing in the report, Professor Waterhouse said: ‘We should be looking to a future where multiple measures are blended across not only dental services but wider health services, education, and social care to target those in most need, whether that is due to socioeconomic deprivation, geography, ethnicity, or disability.’
She concluded: ‘Policies should not only look good, but also do good.’
The researchers also emphasise that there is ‘more to be done’. The report suggests areas for future research which could fill gaps in the knowledge base that policy makers draw on.
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