Keeping the tooth fairy away

15 June 2022

Dr Mando Watson, Consultant Paediatrician at Imperial College NHS Trust and Dr Andrew Read from Whittington Health NHS Trust detail the oral health prevention work taking place across North West London - and highlight how Brent’s holistic approach to reducing dental caries (decay) in the under-5s and primary-aged children is proving extremely effective

Good oral health is vital for a child’s long-term health - it can affect the way children grow, look, speak, chew, taste food, socialise and generally enjoy life.

If oral health is not properly managed then pain and infection may not only lead to tooth loss but can cause sleepless nights, reduced nutrition and growth, delays to speech development, poor concentration and time off school. The appearance of decayed or missing teeth and bad breath can also have a significant impact on a child’s wellbeing.

Data published in 2021 by Public Health England (PHE) showed that in the 2018 to 2019 school year, 23.4% of 5 year olds in England had visible tooth decay, with tooth decay being nearly three times higher in children from more deprived areas than in children from less deprived areas. 

Oral health and deprivation

A poor diet, in particular excess sugar consumption, contributes to tooth decay being the most common non-emergency reason why a child is admitted to hospital in England and Wales (2017-18). Experiencing this amount of pain combined with emergency treatment, whether that’s in hospital or a community setting, can be an extremely traumatic experience, especially for younger children – and it risks having a long-lasting effect on their mental health and attitude towards future dental care.

Additionally, these oral diseases are known to share risk factors with a number of chronic diseases, such as cardiovascular disease, cancer, obesity and Type 2 diabetes. It is not uncommon for a child with dental caries to also be obese, which might require a sensitive whole-family intervention.

Here in North West London (NW London), all of these concerns are pressing, especially as dental decay in the under-5s has increased during the COVID 19 pandemic. Dental decay is especially significant in the most deprived areas, with many boroughs taking their turn to rank high on the dental caries league list. Six of the nine London boroughs with the worst oral health in children are in NW London.

Dental access

Concerns have been raised at national as well as local level about dental access. During lockdown many families found they were unable to go to their dentist and access today is proving to be significant issue. Although there’s a strong argument that dental practices should be located in the areas of high needs (i.e. the most deprived areas), the reality is practices are often located along busy high streets and they are the same practices who may be unable to accept new patients whilst maintaining care for existing patients (a backlog caused by the pandemic).

Hounslow has recognised the oral health challenge and has received Local Authority funding to deliver a fluoride varnish programme for Key Stage 1 children aged three to seven. Although this clinical treatment is highly effective it is expensive to implement on a large scale as it entails employing additional health care professionals to deliver the treatment.

Because of the expense of fluoride varnish programmes, many boroughs are now adopting supervised tooth brushing schemes as an alternative option for prevention. Whittington Health NHS Trust, who have dental contracts across several London boroughs (including five in NW London: Brent, Ealing, Hillingdon, Harrow and Hounslow), believes the reach can be extremely effective. For example, in Ealing, one young child encouraged her whole family to go along and get a dental check, following a school session.

An additional, an interesting picture is emerging in the boroughs of Brent and Harrow who are the current forerunners in the dental decay scale (40.1% and 42.4% respectively).  In these neighbouring boroughs, it’s not uncommon for children aged 5 and under to have several decayed teeth.  Harrow is now following Brent’s lead by commissioning a back-to-basics tooth brushing campaign.

Integrated approach

Brent’s own approach to tackling tooth decay in children is holistic and integrated – their strategic delivery involves midwives, health visitors, school nurses, dietitians, teachers, speech and language therapists, children’s centre staff, social workers, GPs and pharmacists all joining in this prevention work, as well as dentists.

Their oral health promotion starts at a very early stage in a child’s life. Midwives hand out tooth brushing packs to new parents: the message is that once a first tooth appears, this is the time to pay a first visit to the dentist. It’s free – and can be fun!

Making the supervised tooth brushing sessions enjoyable is key. Storytelling and online tutorials proved extremely effective during lockdown at targeting young nursery-aged children and parents with the right messaging.  

Aggie the Alien, who started life in Hillingdon as an animated character sent to earth to promote oral health care, has also been adapted for use as a fun talisman to encourage tooth brushing in Brent. She also appears on Brent’s tooth brushing competition page.

Mobile health promotion

Last year Brent council’s public health team carried out a pilot using a ‘pop up’ health bus, which proved to be an effective means of targeting the most deprived areas of Brent with health promotion messages, applying fluoride varnish and signposting children to a dentist.

Marie McLoughlin, Consultant in Public Health for Brent Council, who manages the bus programme, says it was a great example of effective multi-agency working. Health Education England were instrumental in providing the project with foundation dentists and trainee therapists. In addition to the oral health promotion team from Whittington Health showing parents and children how to brush correctly (explaining they need to do this twice a day and to spit, not rinse), library staff were on hand to help parents to register with their local library and inform parents about activities in their local areas. Brent council’s Early Years Team were also on the bus to register parents at Family Wellbeing Centres and signpost them to available nursery places. Weight management teams (BeeZee Bodies and Brent4Life, CLCH) also advised parents and children on healthy eating.

The programme was so successful that it has been funded again this year [2022] and Ealing has now also implemented a similar project.  

Brent also reaches out to schools and trains teaching assistants and teachers to be oral health champions. They are not only trained to deliver the tooth brushing programme, but they also keep an eye on quality and infection control. School nurses in the borough also play a vital role in helping children to develop healthy habits and a daily tooth brushing routine.

The team in Brent also work with children with special educational needs and disabilities by supplying special three-pronged toothbrushes and non-foaming toothpaste. 

Arguably the most common message that unites all the oral health promotion preventative work across NW London is that effective tooth brushing is an essential - and healthy - skill for life!

National Smile Month runs from 16 May to 16 June 2022

You can search for your nearest dentist here.  

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