Schools and nurseries should help children to brush their teeth

The National Institute for Health and Care Excellence (NICE) has urged local authorities to tackle a growing crisis in the state of people’s teeth in disadvantaged areas of England.

Tooth decay and gum disease are the two most common, largely preventable dental problems. At risk are those who are among the most vulnerable in our society and who are dependent on others to care for them, such as young children and frail older people who need help to stay independent.

In new and wide-ranging guidance, NICE has said that carers, parents and children in many areas need support to stop tooth decay and diseases linked to poor oral hygiene.

Severe tooth decay has been reported in children as young as three and in many cases is starting much earlier. Tooth decay can have a lifelong effect on health as well as a person’s self-esteem, their ability to eat and socialise normally.

NICE has provided advice to local authorities to improve their whole community’s health through better advice and support in oral hygiene, by encouraging people to visit the dentist regularly, and through eating and drinking more healthily.

NICE suggests local authorities consider supervised tooth-brushing and fluoride varnishing programmes in nurseries and primary schools in areas where children are at high risk of poor oral health.

The Director of the Centre for Public Health at NICE, Professor Mike Kelly said: “Children, as young as three, are being condemned to a life with rotten teeth, gum disease and poor health going into adulthood. Many children have poor diets and poor mouth hygiene because there is misunderstanding about the importance of looking after children’s early milk teeth and gums. They eat too much sugar and don’t clean their teeth with fluoride toothpaste. As a society we should help parents and carers give their children the best start in life and act now to stop the rot before it starts.”

“We know from Public Health England that there are wide regional differences in oral health. The situation is bleak for many adults as well as children in disadvantaged areas.

“Diet, poor oral hygiene, smoking, alcohol, and a lack of understanding about oral health are causing tooth decay, gum disease, tooth loss and increasing the risk of mouth cancers. 

These are also the risk factors causing many chronic conditions, including heart disease and diabetes.”

The guideline aims to help local authorities to promote and protect oral health through: better training of staff and commissioning of personal care services including those provided to frail older people; policies and services that support better diets; activities to promote better oral hygiene and increase the availability of fluoride toothpaste; encouraging families and individuals to visit the dentist regularly, and increasing access to dental services for those who can’t.

The guideline recommends that all schools encourage good oral health – by working with parents and carers, and by ensuring that people have access to the right information about oral health and healthy food and drinking water.

Professor Elizabeth Kay, Foundation Dean for the Peninsula Dental School, Plymouth University, said: “Around 25,000 young children every year are admitted to hospital to have teeth taken out. Given that we know how to prevent dental disease this really should not be happening. If there were a preventable medical condition which caused thousands of young children (mostly around five years old) to end up in hospital to have body parts removed there would be an outcry.

“These guidelines offer local authorities an opportunity and evidence as to how they can stop the most vulnerable children and adults in their areas from suffering from the pain, trauma and lifetime negative effects of tooth decay.”

Mandy Murdoch, an Independent Health Strategist with experience of commissioning oral health promotion programmes, said: “The publication of these guidelines will be welcomed by Local Authorities as it will give them the opportunity to review their oral health strategy against evidence-based recommendations.

“Unfortunately, poor oral health disproportionately affects the most vulnerable people in society, including children. Many people believe that the health of a child’s first teeth does not matter as ‘they will fall out anyway’. However, severe tooth decay at a young age can have negative consequences in later life.

“Local Authorities can use their links with the local community to implement oral health promotion services that work with settings such as nurseries and schools to ensure that consistent messages are promoted to children and families. For example, advice on good oral hygiene, a healthy diet and promoting regular visits to the dentist from when a child’s first tooth appears, can be complemented by the provision of free or discounted fluoride toothpaste and toothbrushes. Local Authorities may also consider commissioning supervised tooth-brushing or fluoride varnish programmes in nurseries and schools in line with the recommendations in these guidelines.”

Dr Sandra White, Director of Dental Public Health at Public Health England, said: “PHE welcome this publication which provides evidence based advice to local authorities to help them commission the most appropriate and effective oral health improvement programmes to meet the local population’s needs. The guidance, which is strongly aligned with PHE’s Commissioning Better Oral Health, makes important recommendations to help local authorities review and develop their oral health improvement strategies to tackle oral diseases like tooth decay.

“Tooth decay is the most common oral disease affecting children and young people in England, yet it is largely preventable. Whilst children’s oral health has improved over the past 40 years, one in eight (12 per cent) three-year-olds have suffered from the disease which can be very painful and even result in a child having teeth removed under general anaesthetic.

“Oral health is everyone’s responsibility and by expanding oral health education to the wider community so that nurseries, children’s centres and primary schools all play a role we can reduce dental decay and ultimately improve the oral health of the local population.”