New support for children’s oral health – Bruce Vernon

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  Posted by: The Probe      3rd January 2018

Improving children’s oral health is central to preventive dentistry. Instruct and support good habits to stop decay in its tracks at an early age and you will reduce the risk of serious dental problems in later life and also help an individual avoid chronic illnesses associated with poor mouth hygiene.

However, with every positive piece of news – the last survey from Public Health England on the dental health of five-year-olds confirmed the downward trend in childhood decay is continuing – we seem to take one step back, or at least get a reason to put any celebration on hold. For example, despite the improvements, in 2017 the Royal College of Surgeons reported a 24% increase in extractions for children aged 0–4 years in the last decade. Tooth decay was also the most common reason for hospital admission in children aged 5–9 in 2014/15 – that’s over 26,000 admissions for a disease that is almost entirely preventable.

In last Child Dental Health (CDH) Survey, 58% of 12-year-olds said their daily life had been affected by their oral health problems, with over a third being embarrassed to smile or laugh due to the poor condition of their teeth. The figures relating to adolescents’ oral health are also damning, with multiple extractions for under-18s in England on the rise. So if an adolescent or teen had poor oral health as a child, they might not have to wait long to see the impact – decay in childhood will severely compromise their oral health as they grow up.

It’s hard not to feel frustrated. After all, this is a 1+1=2 issue; if a patient takes good care of their teeth and gums when they are very young they will decrease their chances of needing invasive procedures in the future, and also be rewarded with a healthy smile to be proud of. The numbers may be going down, but even one child with decay so bad that it requires an intervention is one too many. So what are the missing pieces of the puzzle?

We have to go back to the central tenets of good, preventive dentistry – effective daily cleaning, regular dental appointments and a healthy diet – and look at new ways to support them. Education for families is key. Worryingly, a third of parents said it was “acceptable” for children to have experienced some degree of decay before they reach their teens. Their offspring clearly don’t share this complacency if they are feeling ashamed by their bad teeth (as per the CDH Survey). Engaging with and educating parents and carers will help change attitudes and enable positive, proactive behaviours. When it comes to regular appointments, there may be confusion over the fact that NHS dentistry is free to under-18s. If a family has chosen private dentistry, they may think that when there is no visible problem or pain, regular check-ups are not a priority, but they are.

The latest CHD survey, as with the previous two, found that geographical areas with high levels of deprivation tend to have high levels of childhood decay. Practices in these areas must work with local schools and health/social care institutions to help children in these communities understand why they must visit the dentist regularly. With regards to good food choices; the consumption of sugary food and drink isn’t exclusive to poorer families. The problem of ‘hidden’ sugars in meals that regularly appear on the dinner table (in some shop-bought pasta sauces, for example) is one that the government is trying to tackle with its so-called ‘sugar tax’. All parents know that it is hard, if not impossible, to stop children accessing all sweet treats completely, so balance and learning how to clean properly, to remove optimal debris, is key. Brushing should be supervised, too – good technique will become second nature if children are taught early.

As for that missing puzzle piece, new technology can support clinicians in practicing preventive care, by helping them to detect active demineralisation at an early stage, and therefore possibly prevent caries. CALCIVIS is a new imaging system that can be used with patients from the age of six. The concept is both simple and non-invasive – a recombinant protein which produces light (bioluminescence) as a reaction to the presence of free calcium ions released from actively demineralising tooth surfaces. The dentist can then recommend action to minimise further damage and repair the enamel structure (if necessary) using non-surgical methods.

Ongoing research and analysis into children’s dental heath is appropriate and important. Positive progress has to be balanced with statistics that show there is still much work to be done. Supervised brushing, regular check-ups and a healthy diet that restricts sugar consumption are fundamental, as is parent/carer education. Technology can also support practitioners to detect decay early. Most oral health problems in children are totally avoidable – support preventive care for very young patients and the long-term benefits for all of us will be immeasurable.

For more information visit www.CALCIVIS.com
or call 0131 658 5152

Benjamin RM. Oral health: the silent epidemic. Public Health Reports. 2010 Mar; 125 (2): 158.
Public Health England. National Dental Epidemiology Programme for England: oral health survey of five-year-old children 2015: A report on the prevalence and severity of dental decay. Published May 2016. Link: http://www.nwph.net/dentalhealth/survey-results%205(14_15).aspx (accessed October 2017).
Shocking 24% increase in tooth extractions performed on children aged 0-4 in last decade. Royal College of Surgeons, 21 March 2017. Link: https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/child-tooth-extractions-24-per-cent/ (accessed October 2017).
Public Health England. Launch of the Children’s Oral Health Improvement Programme Board. 26 September, 2016. Link: https://www.gov.uk/government/news/launch-of-the-childrens-oral-health-improvement-programme-board (accessed October 2017).
Child Dental Health Survey 2013. HSCIS, 19 March, 2015. Link: http://content.digital.nhs.uk/catalogue/PUB17137 (accessed October 2017).
LGA – Hospitals spending £35 million on “rotting teeth” in children. 18 April, 2016. Link: https://www.wired-gov.net/wg/news.nsf/articles/LGA+Hospitals+spending+35+million+on+rotting+teeth+in+children+18042016141000?open (accessed October 2017).
Moving oral health higher up the government’s agenda. Dentistry.co.uk, 13 January 2017. Link: http://www.dentistry.co.uk/2017/01/13/moving-oral-health-higher-up-the-governments-agenda/ (accessed October 2017).


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