Oral health in children
Introduction
Good oral health is an important part of general health, contributes to wellbeing and allows people
to eat, speak and socialise without discomfort or embarrassment. Oral diseases are among the most
common chronic diseases in the United Kingdom, and levels in Luton are relatively high. Oral
diseases can have serious consequences. Poor oral health can result in disruption to an individual’s
life by contributing to loss of sleep, time off work and school, loss of self-esteem and limited food
choices.i
While children’s oral health has improved over the past twenty years, 28% of five-year olds still had
tooth decay in 2012.
Many factors influence poor oral health including:
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Poor diet and nutrition, particularly the frequent consumption of sugary foods and drinks
Using formula feeds rather than breast feeding young infants
Lack of oral hygiene and tooth brushing
Low exposure to fluoride therapies including using toothpastes with low fluoride concentrations1
Trauma or injury to teeth.
The implications of poor dental health in young infants include malformation and discolouration of
the underlying permanent teeth which can require multiple extractions under general anaesthetic
(GA). This can be a traumatic experience, particularly if this is the child’s first experience of dentistry.
At risk and vulnerable groups
There is a strong association between oral diseases and deprivationii and results of the three-yearolds oral health survey show that inequalities in oral health start from a very early ageiii.
What is the evidence base?
Effective disease prevention and oral health promotion should have both generic and specific
elements. Helping children and their families to develop good dental habits at a young age can help
maintain healthy teeth for life. Children should be encouraged to eat healthy food and drink water.
Sweet snacks and drinks should be kept to a minimum. A diet high in sugary food and drink can also
cause obesity and long term health problems so reducing sugar in the diet at the earliest opportunity
has multiple health benefitsiv.
Children should be supervised when brushing their teeth and should start as soon as teeth are seen
in the mouth. Regular dental check-ups are important to identify any oral health concerns and to
ensure families receive oral health advice or interventions as required.
1
Recommendations are 1000ppm fluoride concentration of toothpaste for children < 3 years old, and 13501500ppm fluoride concentration of toothpaste for older children
Advice for the prevention of caries (tooth decay and cavities) in children includes:
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Brush twice daily with fluoridated toothpaste (1,350 ppm fluoride or above); brush last thing
at night and on one other occasion during the day
Spit out after brushing and do not rinse
Reduce the frequency and amount of sugary food and drinks and when consumed, limit
these foods and drinks to mealtimes. Sugars should not be consumed more than four times
per day
Sugar-free medicines should be recommended.
Guidance published by Public Health England156 and NICEv provides direction, advice and support for
local authorities to commission programmes to improve oral health157 and recommends:
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Developing a locally tailored oral health strategy
Providing leadership for oral health and include oral health as a priority in the health and
wellbeing strategy
Using the Commissioning Better Public Health for Children and Young People Toolkit156 to
ensure all services for children have integrated oral health improvement
Using the opportunities that the changes in 0-5 commissioning brings to integrate oral
health into service specifications particularly for the health visiting service
Having schools and early year settings on board in oral health promotion
Involving the private sector, for example healthy eating awards, limiting sugar intake and
sugar swaps.
Local picture
Figure 40 shows Luton’s dental survey results for 3 year old children in comparison with England and
statistical neighbours. The results show that 22% of 3 year old children in Luton have decay
experience and 21% have active decay compared with 12% and 11% respectively in England.
Compared with statistical neighbours, Luton has the second highest tooth decay.
Figure 40: Active decay and decay experience in three year olds, 2013/14
Active decay and decay experience in three year olds (2013)
30
Percentage
25
20
15
10
5
Active decay
Decay experience
0
By the age of 5 years,vi there is a sharp increase in tooth decay and active disease. 39% of five year
olds in Luton have experienced tooth decay and 34% had active tooth decay at the time of the
survey. This compares to 28% and 25% respectively for England. The results for Luton are similar to
statistical neighbours as shown in Figure 41.
Figure 41: Active decay and decay experience in five year olds, 2011/12
Active decay and decay experience in five year olds (2012)
Percentage
50%
40%
30%
20%
Active decay
10%
Decay experience
0%
Although the results are concerning, the survey results show an improvement in Luton children’s
dental health in comparison with the 2007/08 survey in which 44% had experienced tooth decay and
37% had active tooth decay at the time of the survey. The survey also showed that 15% of children
had signs of early childhood caries; this is closely linked to long term bottle feeding containing drinks
with high sugars, or dummies which have been dipped in sugar and used as pacifiers; this is an
improvement from 18% of children showing signs of caries in the 2007/08 survey.
Table 21: Tooth decay, five year olds (2011/12)
LA
% of
sample
examin
ed
% of
children
with
experience
of tooth
decay
Average
dmft with
dental
caries
experience
% with
active/
current
decay
% with
one or
more
missing
teeth
%
recorded
with
sepsis
present
% of teeth
with decay
which have
been filled
England
65.2%
27.9%
3.38
24.5%
3.1%
1.7%
11.2%
Luton
73.6%
38.7%
4.23
34.0%
7.1%
4.1%
14.9%
Bradford
52.1%
46.0%
4.30
40.4%
6.1%
4.9%
9.9%
Birmingh
am
62.3%
32.7%
29.3%
3.4%
4.0%
11.2%
Enfield
84.5%
43.9%
4.67
37.4%
7.0%
3.6%
13.4%
Slough
65.3%
38.0%
4.35
35.8%
1.9%
2.2%
9.4%
3.57
Figure 42 shows the proportion of decay experience in 5 year olds in Luton by ward (based on the
2011-12 survey). The wards with the highest child decay experience are Bramingham, Dallow,
Farley, High Town, Northwell, Saints and Sundon Park.
Figure 42: Decay experience in 5 year olds (2011-12)
What is being done locally?
Oral health education provided in Luton contains evidence based information on fluoride
interventions to improve oral health.vii Community Dental Services deliver oral health education
programmes in pre-school settings and to looked after children and their carers in Luton.
A fluoride varnish programme is delivered in the areas of Luton where there are a higher proportion
of three year old children with decayed, missing and filled teeth. Children found to have tooth decay
are advised to attend their local dentist while those that have high levels of decay are fast-tracked
for a general anaesthetic (GA) assessment. There is access for all children at local dentists.
Priorities
1. Review current oral health promotion programmes including the fluoride interventions to see if
they are having the expected impact and provide value for money.
2. Develop a locally tailored, evidenced-based oral health strategy, engaging services
commissioned under 0-5, Flying Start programmes, schools and children’s centres.
3. Recommission Public Health dental services in partnership with Bedfordshire and Milton Keynes.
References
i
Public Health England. Local authorities improving oral health: commissioning better oral health for children
and young people: An evidence-informed toolkit for local authorities. [Online] 2014. Available from:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/321503/CBOHMaindocume
ntJUNE2014.pdf
ii
Local Government Association. Public Health England .Tackling poor oral health in children: Local
Governments Public Health role. [Online] 2014. Available from:
http://www.local.gov.uk/documents/10180/5854661/L14352+Tackling+Poor+oral+health+in+children/3dd8097f-35b7-42ba-b3c7-186266da82db
iii
Public Health England. Dental public health epidemiology programme: oral health survey of three year old
children 2013. [Online], 2014. Available from:
http://www.nwph.net/dentalhealth/reports/DPHEP%20for%20England%20OH%20Survey%203yr%202013%20
Report.pdf
iv
Public Health England. Local authorities improving oral health: commissioning better oral health for children
and young people. [Online], 2014. Available from:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/321503/CBOHMaindocume
ntJUNE2014.pdf
v
NICE. Oral Health: approaches for local authorities and their partners to improve the oral health of their
communities PH55 London: National Institute for Health and Care Excellence 2014 Available from:
http://www.nice.org.uk/guidance/ph55
vi
National Dental Epidemiology Programme for England: Oral Health Survey of 5 year old children 2012: Study
of the prevalence and severity of dental decay, PHE, 2013.
vii
Public Health England. Delivering better oral health: an evidence based toolkit for prevention. London: Public
Health England 2014. Available from:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/367563/DBOHv32014OCTM
ainDocument_3.pdf