We were interested in the BBC’s news topic “More children having teeth out in hospital” on Saturday 13.1.18. The president of the British Society for Paediatric Dentistry, Claire Stephens, was interviewed and correctly identified that dental caries (decay) is an entirely preventable disease. This is demonstrated in England, in 2014/15, 75.2% of five year old children had no visible decay. In Wales, at the same time, only 64.6% of five year olds had no visible decay.
Jonathan Ashworth, the shadow Secretary of State for health, was also interviewed and correctly pointed out that dental disease was associated with deprivation. Indeed Professor Jimmy Steele’s 135th anniversary lecture at the British Dental Association in July 2015 sent a clear message that dental caries is no longer a significant disease in higher socio-economic groups.
With this in mind we investigated the problem of caries in young primary school children using a qualitative methodology, interviewing parents, in order to identify issues and highlight possible solutions. Our results showed that parents felt responsible for their children but were poorly informed and not supported to act responsibly. The parents were not aware of the need for toothpaste to be of an adequate strength and for the need to avoid rinsing following brushing.
With regard to those parents who had experienced their children having multiple extractions under general anaesthesia, they felt blamed. Attempts from professional personnel delivering the service were unhelpful to nurturing future positive behaviours. Furthermore, instructions to find a dentist for future care were followed by the parents but it was impossible to find an NHS dentist to facilitate this instruction.
However the campaign Design to Smile in Wales, a school supervised toothbrushing scheme, has been of value in supporting responsible behaviours in two ways. Firstly, parental consent was obtained following pestering from the child to be involved in the activity. Secondly, home tooth brushing was promoted by the child, when prior to involvement in the scheme the parent was unsuccessful in directing home tooth brushing.
It seems to us that in order for improvements in oral health to be facilitated and thus impact on the need for hospitalised extractions it is necessary to:
- Improve access to services for deprived populations through primary care policy and implementation. The access should include long term continuing care and not only pain relief.
- Target supervised tooth brushing to schools servicing high need populations.
- Improve the clarity of oral health education to include the need to attend the dentist, use fluorides of adequate strength and avoid rinsing following tooth brushing.
This begs the question “Has the power given to primary care organisations through the legislation enabling the new contracts of 2006 and beyond been effective?” Claire Stephens holds the government to account for the increase in hospitalised extractions even though the mechanisms for developing services are localised and have a dental professional input.
It is possible that improvements in oral health could be achieved through implementing the above. These could be facilitated within the current structures provided by government since 2006, if managers and dental care providers choose to administer and deliver services appropriately.
(Three authors Wayne Richards, Anne-Marie Coll, Teresa Filipponi)