Across the country there are now hospital wards full of young children having their teeth removed. Extraction of decaying teeth is the leading cause of hospital admission for children aged six to 10 in England, and a pediatric dentist says I that he had to remove all 20 baby teeth from the mouths of children as young as two years old.
Elsewhere, parents are turning to DIY dentistry, undertaking repairs at home – with their untrained eyes – using items they buy online, including tooth filling products to try and fill their children’s teeth, says Professor Claire Stevens, a spokeswoman for British Society of Pediatric Dentistry. (BSPD), or toothache relief gel, which can burn a child’s gums. “Naturally [filling] it can cause more harm than good as often the tooth requires extraction rather than filling. DIY dentistry is of course not recommended,” he says.
And if parents don’t yet do this, many rely on charities that come to their children’s school for help because they can’t access NHS dental care or afford private treatment.
Too often, Stevens says, children’s oral health is completely overlooked – perhaps because there’s a feeling they’ll lose those teeth later anyway – but the consequences can be huge. “While a child has a toothache, they may not be eating or sleeping, so we see children failing to thrive. They fall below their predicted growth rate, they live with chronic pain, and that affects their concentration, which affects school readiness,” she says. NHS figures show that 60,000 school days a year are lost due to children being hospitalized for tooth extractions.
In worst-case scenarios, poor oral health in children can lead to infection, facial swelling or even decay. And then there are the social effects: being seen as the dirty kid, the poor kid, which has its own long-term psychological effects. “It’s just not acceptable for this to happen in a modern society. It’s Victorian and heartbreaking to watch,” she says.
But how did we get here? In theory, all children are entitled to free NHS dental care.
We only have to look at the wider crisis in dentistry, where patients of all ages are struggling to access care. In 2023, the British Dental Association (BDA) was mentioned that half of dentists had cut their commitment to providing NHS treatment, with more planned to follow, due to objections to the current NHS contract. A BBC investigation found that 90 per cent of dental practices across the UK were no longer accepting young adult NHS patients and 80 per cent were not taking on children. The BBC too I establish that one in 10 local authorities did not have a single practice accepting under-16s for NHS treatment.
“It’s a multifactorial issue that’s been on our radar for over a decade,” says Professor Stevens. “Covid certainly made the problem worse, but our concerns about children’s oral health predated the pandemic by many years.”
Alex, from Norfolk, has been completely unable to get NHS dental appointments for his sons, aged two and four, despite trying since his eldest’s first teeth came out. “They had their first date six months ago, privately, as we would have run out of other options. Fortunately, he’s fine, but obviously we were concerned that we might have overlooked something at the time,” he says. “We paid £25 per child for someone literally to take a look in their mouth.”
In Gloucestershire, Jessica faced similar problems after her dental practice announced they would no longer offer NHS treatment. “I approached 10 different practices and couldn’t find any near me that offered NHS dentistry,” he says. Her family eventually paid £39 each for her two children, aged eight and 11, to see them privately – but she says they now go less often as a result.
“They used to go religiously, every six months. we were really conscientious. It was a non-negotiable for me because I had a lot of problems with my teeth when I was little, but there’s really no incentive to get them every six months now. It is such a shame and there must be many people who [can’t afford] to take their children at all,” he adds.
Indeed, says Professor Stevens, oral health inequalities are widening. The numbers show Children in the most deprived areas of the country are almost three times more likely to develop tooth decay (35.1%) than those living in the least deprived areas (13.5%).
But access to NHS dental care is only part of the problem. “I’d love to see every child have access to an NHS dentist, but that alone doesn’t solve it,” says Professor Stevens, pointing to the cost-of-living crisis and wider social determinants of health. “Unfortunately, children who cannot access dental care are often the same children who do not have access to as many fresh fruits and vegetables. who eat more processed foods. whose families live above or below the poverty line. These guys get the raw deal every time.”
Professor Stevens says to solve this “we really need a plan that targets those who need it most, to start reducing health inequalities across the board”. Labor announced proposals this month, including supervised brushing in schools – a policy welcomed by the BSPD.
One group uniquely placed to advocate more holistically is school nurses, says Sallyann Sutton, Professional Lead at the School and Public Health Nurses Association (SAPHNA). “Historically school nurses work with schools and parents to promote dental hygiene from an early age, look at diet and other factors, and take a whole systems approach to preventing these problems,” she says. “We are qualified NHS nurses with postgraduate level training in public health, so this is exactly where our expertise lies. But unfortunately, we’ve lost around 30 per cent of our capacity in recent years due to cuts in public health funding.’
Labour’s proposal is to introduce a national program of targeted, supervised tooth brushing for three to five-year-olds in free primary school breakfast clubs. Similar schemes are already widely used in Scotland and parts of England and data shows they pay for themselves within three years, with a five-year return on investment of £3.06 for every £1 spent. But school leaders say a much clearer plan is needed to deliver it nationally.
“Primary schools clearly do not have the staff, time or funding at the moment that would be necessary to do this. We do not believe that this can be left to teachers, as their job is to teach children, and in fact it would require special staffing and training for this purpose, as well as ensuring that there are suitable spaces and facilities in schools that are often very small says Geoff Barton, General Secretary of the Association of School and College Leaders (ASCL).
One area that already has a multi-layered approach is Doncaster, where children’s oral health is among the worst in the country. More than a third (37.2 per cent) of children in the city have experienced tooth decay, compared to the national average of 23.4 per cent, with each child having about four teeth affected. Since 2016, Doncaster’s children’s public health team has been working alongside school nurses to support tooth brushing clubs, education for both children and their parents and referrals for particularly vulnerable children.
“We have children who don’t even have a toothbrush or toothpaste or who can use their finger instead of a toothbrush,” says Jayne Ashby, Specialist Community Public Health Nurse and team leader at Doncaster Children and Young People’s Health. and wellness service. “There is a huge gap in good education for parents about effective brushing and dental pain is one of the biggest causes of poor school attendance. We work in schools to provide parents with this education and we also link up with a local charity to provide toothpaste, toothbrushes and distribute them in schools to the most vulnerable children,” she says.
School nurses in Doncaster also help with training for school toothbrushing clubs. “The brushing itself takes about 15 minutes at the start of the school day and is supervised by the teacher. That doesn’t sound like a long time in the grand scheme of things, but we appreciate that it’s a commitment for schools and can be a barrier to enrolment,” explains Ashby.
“But it’s about more than just cleaning teeth,” he adds. “This is about access to free school meals and good, affordable, healthy food. It’s about educating parents, improving access to dentists and promoting healthy decisions and choices throughout children’s lives.”
Professor Stevens says: “We would always ask parents to check the arrangements for emergency dental care in their area and if they are experiencing problems, to call 111 who can provide advice and access to emergency dental care if required.”
For advice and support, use this BSPD Guide.
