Children’s oral health has barely been out of the UK news since my last post. I guess it’s a good thing that we are all talking about children’s teeth (as you know, it’s a subject close to my heart and the reason I write this blog) but why the sudden interest?
At the heart of it all is some data published by the Health and Social Care Information Centre which showed that dental disease was the most common reason for a child aged 5-9 to be admitted to a Hospital in England for the year 2013/14. That’s more children needing an admission for their teeth than for tonsillitis or broken bones. I’d like to say I’m surprised, but I’m not. For those of us working in Paediatric Dentistry, it sadly reflects what we see on a day to day basis. In all likelihood this has been the case for sometime, it’s just that the process of collecting the data has got better, but that’s another story!
So why does oral health matter?
Well on a patient level, that’s 70,000 children a year having an operation for an essentially preventable disease. In the 21st century, I think that’s appalling. General anaesthetics are still sometimes the kindest and safest way to complete dental treatment but it frustrates me that so many are avoidable. That’s a lot of families having the stress and worry of taking a child to hospital, a lot of time away from work and school and of course a massive cost to the NHS. The Department of Health estimated the cost of providing this care at £30 million/year. To be honest, I think that’s a conservative figure. So why is it still happening?
The answer is not a straightforward one.
Firstly, I think we (as a profession) need to look at new ways of reaching our patients and their parents. It’s not enough to expect everyone to come to us in our surgeries and our hospitals. There are still massive inequalities in children’s oral health and recent data shows that the percentage of the child population accessing dental care has actually slightly fallen in the last 8 years. We need to provide education and support in schools and nurseries, via social media, by working with health visitors and other health professionals.
Public Health England has recently published a survey of the oral health of 3 year old children which showed an average of 12% of children had ‘visible dental caries’ (decay which is easily seen without using x-rays) and this in itself shows us that we need to look at reaching children before they get to school age. Yes, all of the prevention that takes place in dental surgeries up and down the country is important but it is vital that we deliver key messages to parents when their children are much younger. When we consider that the survey is likely to underestimate the scale of the oral health problem (because of the fact that parents had to agree to their child taking part amongst other reasons) we can begin to see the size of the challenge ahead.
So, as part of our solution, I think we need to explore public health measures. For example, a recent report found that areas with water fluoridation have 45% fewer hospital admissions for children aged 1 to 4. There has also been talk of a ‘sugar tax‘ whereby healthy drinks are cheaper to encourage their purchase. It is quite a clever idea. Bottled water might be say 75p, a diet fizzy drink £1.25 and a non-diet fizzy drink £1.75, rather than the current situation where all drinks are fairly similar in their pricing and it is easy to understand why when faced with this situation, many will go for the fizzy, dentally unhealthy, option. We also need to make sure that our colleagues working in the General Dental Services are supported to deliver oral health preventive measures such as topical fluoride, fissure sealants, diet advice and oral hygiene instruction which we know are important.
Finally, I truly believe that we, as a Society, need to start valuing children’s oral health. I get so frustrated when I read statements to the effect of baby teeth being disposable, so why bother? Yes, they are eventually lost but sometimes not until the age of 12 and in the meantime they are quite capable of developing pain and infection which can cause problems eating and may necessitate time off school and an entirely preventable hospital admission. Thousands of children having multiple dental extractions every week is not acceptable. Baby teeth really do matter.