Children’s oral health: Urgent action needed

The pandemic and lockdowns have shone a harsh spotlight on some long-standing issues including the persistent and immoral inequalities we see in children’s oral health. I believe it is fair to say that paediatric dentistry has been one of the hardest hit specialties – and the slowest to recover.

Dental decay is a preventable disease and therefore a multi-system approach focused on prevention is required to address this and ensure that vulnerable children are not suffering unnecessarily. A targeted public health approach is vital to address the inequalities. However, the current access problems require urgent attention and cannot be ignored.

As a Society, BSPD responded to the package of initial revisions to the NHS dental contract presented in July 2022. We welcome this first step – especially the recognition of the role of the dental team. We all recognise the enormous pressure NHS dentistry is under currently and the resulting demand to find appointments and access services – but we hope these first stages will help children in areas of high need and those from disadvantaged groups. It is important that every child has a dental home – an ongoing and preventively-focused relationship with their oral healthcare team, beginning with a DCby1 (Dental Check by One).

However, it is crucial to emphasise that we see these reforms as just the first step towards changes needed to address the current problem. We have to insist that the next stage needs to go further.

Delivering for the vulnerable

It is right that the focus of recent reforms is on delivering care to higher needs patients and improving patient access to NHS dental services, and the challenges involved. At BSPD we are prioritising support for the most vulnerable children in our society, since the pandemic and other world events have shown us that they are often the first to suffer.

During my presidential year, I have instigated the translation of our BSPD Practical Guide to Children’s Teeth from English into 8 languages covering the main ones spoken by refugees in the UK, including Ukrainian, Kurdish (Sorani), Amharic, Tigrinya, Farsi, Arabic, Pashto and Dari. It is important for the Society to deliver simple, oral health guidance in the mother tongue so that parents and children can easily understand the basics of good oral health behaviour. This is key to prevention, which we know is fundamental to turning around a community’s oral health. In addition, BSPD will be collaborating with RCPCH to distribute materials through their network and to doctors who come across refugee children.

I am very proud of our BSPD members, who are working hard to prioritise the wellbeing of children. Our members, many of whom were redeployed to support the Covid response, are going above-and-beyond to recover children’s dental services equitably and fairly but this will take time. In some regions, teams are working at 180% of pre-Covid capacity as the profession strives to reduce the currently unacceptable waiting times for procedures under general anaesthesia.

However, there is a clear shortage in the number of specialists and their distribution across the country – and the Society continues to call for investment in training.

Positive steps

There has been progress in many areas including the establishment of managed clinical networks in England, upskilling of general dental practitioners to Tier 2 level and initiatives like paediatric-focused practices in many areas in England. Utilising the dental teams is another area seeing progress. BSPD is currently working with GIRFT to ensure accurate data recording. Collaboration with stake holders is designed to ensure oral health is fully integrated in all our work being focused on children’s health and wellbeing.

There have been some positive steps during the crisis. In November 2020, national guidelines were issued on ‘Surgical Prioritisation for Children and Young People Requiring Paediatric Dental Treatment Under General Anaesthetic’. This guide gives clear categorisation of urgent and less urgent oral health conditions to support paediatric dentists on how to assess and prioritise children and young people. Crucially the guidance supports the dental team to prioritise children and young people on the basis of clinical need, and not just waiting time. This means that as capacity becomes available, we are treating those that need us most. This now aligns us with the process that our paediatric medical colleagues have been using for some time.

In addition, we welcomed the introduction of ‘Welfare Check for Children and Young People Awaiting Dental Care Under General Anaesthesia’. Whilst patients wait for treatment, it is imperative that welfare checks are in place so that those most urgently requiring care are identified and prioritised. In line with NHS operational planning guidance, there is a requirement to collect data on patients so that recovery is fair and equitable. The checks will identify the longest waiting patients and work backwards until every patient waiting longer than 6 months has received a welfare check.

BSPD’s role

BSPD is the expert voice of children’s oral health and the Society’s role to find solutions is important. There is a lot of work currently underway to improve the data collected in paediatric dental services. The bringing together of hospital and community data will reveal a more comprehensive and accurate picture from which the profession can develop a comprehensive recovery programme.

I’ve am also a keen advocate of water fluoridation, as a proven public health measure to address health inequalities. Again, this is something we have supported at BSPD this year. We recognise that this isn’t part of the immediate solution – but an additional long-term intervention that will help improve children and young people’s oral health.

Oral health is integral to children’s overall health and well-being. Wealthy societies should invest in the health of their children to ensure a better future. This is the time for collaboration across all health care professionals to target, assess and treat those most in need. Dental decay is preventable – and we need to work together to deliver a paediatric dentistry service that meets and treats our youngest members of society. This is now urgent. ·