‘Urgent action needed’: a new report sets out a strategy for the government to improve children’s oral health as research shows high levels of dental disease.
The report includes a comprehensive review of existing evidence on children’s oral health. It found that the cost of hospital admissions for childhood tooth extractions had reached £40.7m in 2023.
The report states that while waiting for exports, 67% of children experience 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 cause of hospital admission 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, including:
- Three in 10 five-year-olds in England have tooth decay
- Dental caries is present in 11% of three-year-olds, with an average of three teeth affected
- Over a third (35%) of 12-year-olds report being embarrassed to smile or laugh because of the state of their teeth.
The accessibility of dental services to children was also examined. 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 anesthesia was 80 weeks
- More than half (53%) of children in England have not seen an NHS dentist in the last 12 months.
The findings revealed stark differences between the oral health of children in the most deprived and least deprived areas. Key elements include:
- The likelihood of tooth decay is two and a half times greater in the most deprived areas of England
- A quarter of children entitled to free school meals have reported a toothache. This compares to 15% of all children.
recommendations
The N8 Research Partnership then made policy recommendations based on the evidence gathered. These are for:
Development and implementation of a national strategy to improve children’s oral health
- Reduce sugar consumption through measures such as extending the sugar tax and limiting advertising and sales
- Increase fluoride exposure through programs that include water fluoridation and supervised tooth brushing
- Implementation of this strategy should be overseen by a national board comprising members from national and local government, dental organizations and societies, universities, charities and the public
- Data must be collected and evaluated to measure the impact of the strategy.
Maximize the impact of early years and education-based interventions
Improvements in the oral health component of education policies, including:
- Statutory guidance for the Early Years Foundation Stage
- The Healthy Child Program 0-19
Reorientation of dental services towards the prevention of dental diseases in children and young people.
- Increased access to dental services
- Greater emphasis on preventive care (fluoride treatments, dental sealants and behavior change interventions)
- Early diagnosis and treatment of dental diseases in primary care
- Improved pathways for those requiring special care
- Better funding allocation and distribution mechanisms.
The recommendations are based on seven principles
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- Putting our children first
- Tackling inequality
- Adopting place-based approaches
- We work together effectively in our public services
- Putting education at the heart of public service delivery
- Establishment of universities as research and development departments for local public services
- Effective use and exchange of information between public service providers.
“National oral health strategy”
Zoe Marshman is professor of dental public health at the University of Sheffield and one of the lead authors of the report. He pointed out that its launch came at a critical time for pediatric dentistry after the general election.
He said: “In their manifesto, Labor emphasized children’s health and had also talked about oral health and tooth decay. We wanted to capitalize on this and make sure all the evidence was in place for the new government to start putting together a national oral health strategy.
“There have been many reports that have been published in the past, but we wanted it to be in a format that was suitable for policy makers to read. We showed the state of children’s oral health with research data and then wanted to propose some solutions. It’s not just a traditional survey that shows how bad things are, it also puts all the solutions in one place.’
“Collaborative Approach”
The researchers hope 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 is not always used by policy makers. Those of us who work in universities want to make sure our research has a voice.’
Contributing author Samantha Watt described a “disconnect” between academia and general practice, hoping the report’s recommendations could inform everyday dental care.
Paula Waterhouse, outgoing president of the British Society of Pediatric Dentistry, also called for greater involvement of professional associations in government decision-making. He said: “The evidence is clear, so we are ready to consult – we want policy to be implemented and effective strategies put in place. Children’s oral health status needs to be addressed both nationally and locally as there are geographic differences.
“Mostly, we want to be part of the process. Historically, the government made a decision and we followed it, now we want a collaborative approach and the BSPD is committed to being a dedicated voice in children’s oral health.’
“We should be shocked”
The exhibition was produced in collaboration between the Center for Young Lives and the Royal College of Paediatrics and Child Health (RCPCH). Anne Longfield CBE, executive chair of the Center for Young Lives and Dr Camilla Kingdon, former president of RCPCH, presented the report.
They said: “We should be shocked at the poor state of our children’s teeth, particularly as the trajectory of dental disease suggests that oral health in childhood predicts oral health in adulthood.
“The effects of tooth decay on children’s lives are of course more than cosmetic. Tooth decay has a direct impact on a child’s quality of life. Untreated disease can cause toothache and pain, sleep disturbance and change in eating habits.’
Dr Camilla Kingdon is Immediate Past President of the Royal College of Paediatrics and Child Health. She said: “I’m really excited about 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 side effects of a strong national strategy to improve children’s oral health would be potentially significant – benefits in tackling obesity as well as mental health issues and potentially improving school attendance, among others.
“The impact of poor oral health extends far beyond childhood and so each of us should see this as a key health promotion and disease prevention strategy that benefits the entire nation.”
Holistic dentistry
The oral health report is one of many publications on the topic of children’s health produced by the N8 team. Oral health researchers contributed to the other papers, consulting on the impact of dentistry on other areas of health care.
Professor Marshaman said: “We have been involved in early years education and autism fairs as well as the full oral health fair. Specifically, we were able to help develop resources for parents of autistic children that include oral care tips. There is also another report coming up which will include some of our research on how oral health affects speech and language development.
Writing in the report, Professor Waterhouse said: “We should be looking to a future where multiple measures are combined not only in dental services but also in wider health, education and social care services to target those most in need, whether this is due to socio-economic deprivation, geography, nationality or disability’.
And he concluded: “Policies should not only look good, but also do good.”
The researchers also stress that there is “more to be done.” The report suggests areas for future research that could fill gaps in the knowledge base on which policy makers draw.
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