A blueprint for transition to adult services?

The transition from specialist paediatric dental care to an NHS adult service for children who have suffered a traumatic dental injury (TDI) should be underpinned by an adaptable pathway, according to Emma Morgan, an Academic Clinical Fellow and Dental Core Trainee at Liverpool School of Dentistry and Alder Hey Children’s Hospital.

Her views are based on the feedback of patients who suffered a TDI in childhood and who are referred onwards into an adult service, usually for specialist restorative treatment.

Emma is the 2021 winner of the Max Horsnell Travel Award for her study examining the experiences of young patients as they make the transition from a paediatric to an adult service. She interviewed a group of young people aged 16-21 to get their perspectives.

She explained: “There is no nationally defined transitional care pathway (TCP) and we have limited evidence of what our patients want and need. If the transition is not handled well, it may lead to a failure to engage with adult services and a subsequent gap in care.”

Emma continued: “I got a vast array of opinions from the participants, including a lot of observations about communication. I learned it’s important not to make assumptions about what young people want and need. Young people discussed a number of powerful comments, highlighting the need for involvement of children and young people in research regarding dental trauma.”

Clear communication and involvement of young people in decision making was identified as a vital factor to facilitate a successful experience. The information shared with the patient must be adaptable and driven by them and their needs. For instance, said Emma, “Ideally, our young patients want just the right amount of information to suit them, with both patient and parent involvement. They also want the clinicians in the adult service to be appropriately briefed about their injury and how they feel so they are not forced to discuss potentially distressing experiences with a new clinician.”

Emma hopes that her study entitled The transitional care pathway following traumatic dental injuries: patient perspectives will help to forge a blueprint for a TCP which can be adapted around the country.

She will be presenting her study at the International Association of Dental Research (IADR) meeting in July. Traditionally, the winner of the prize is funded to make a trip to an international meeting. IADR is this year is in Boston, USA. Unluckily for Emma, due to COVID-related travel restrictions, she will not be able to attend in person but the £500 prize money she is being awarded will fund her IADR registration fee.

The Student Elective prize in 2021 was won by Nabeela Caratela, an undergraduate at Birmingham Dental School who has been awarded £300 for her abstract examining whether the oral health needs of children in independent schools are being met. Nabeela explained that when she takes diet histories of young patients referred into the Birmingham Dental Hospital, she is aware that children at independent schools appeared to have greater access to refined sugars and was motivated to research whether there is a difference in state and independent school food policies.   “I am interested in specialising in paediatric dentistry, to have won this recognition from BSPD is a real privilege.“ More information on Nabeela’s elective will be made available following completion and publication of the study.

BSPD Editor and Chair of the Conference Abstracts and Prizes Committee, Dr Chris Vernazza commented: “Although the pandemic has restricted travel opportunities we had a number of high quality applications to our Max Horsnell Travel Award and Student Elective prizes. It was great to see that UK-based paediatric research will still be promoted globally.”

BSPD and the Faculty of Dental Surgery of the Royal College of Surgeons award research grants

Two exceptional research proposals focusing on the needs of young patients have been awarded grants jointly by the British Society of Paediatric Dentistry (BSPD) and the Faculty of Dental Surgery of the Royal College of Surgeons (England). One proposal is for research into jaw pain in young people and the other a feasibility study for genetic testing of children with a rare developmental condition. The joint FDS/BSPD pump-priming grants are awarded annually and are worth up to £10,000 each.

The two successful BSPD members in 2021 are:

  • Julia Palmer of Newcastle Dental School, who was awarded £5272
  • Armaana Ahmad of UCL Dental Institute, who was awarded £9297.88

Prominent BSPD member and Chair of the FDS Research Committee, Professor Helen Rodd commented: “We were overwhelmed by the quality of the research proposals this year. The two winning proposals were exceptional in terms of the benefit to patients. Both were ranked highly by five reviewers from different dental specialties.

“These grants don’t just support the research but the individual researchers too who have shown great promise and whose academic careers will benefit from the recognition that such a prestigious grant confers.”

The funding received by Julia will help fund her research into understanding the experience and needs of young people who have Temporomanidublar Disorder (TMD), or jaw pain. There is currently no research relating to adolescent experience of TMD and young people with the condition are managed in the same way as adults.

Julia Palmer

Julia said: “This is very often a persistent problem which can come and go and can cause pain and discomfort throughout life. An adolescent focus to treatment of TMD should be developed.” She believes that by helping young people understand the condition and how to manage it at an early age, dentists can prevent it becoming a lifelong chronic condition.

Since there has not been any qualitative research among under 18s the pump-priming funding will help her set up focus groups comprised of patients to understand their concerns and needs. She will also undertake qualitative research with dentists in primary and secondary care who treat these adolescent patients and devising a questionnaire to get a picture of how the condition is managed and whether prevalence is increasing.

Julia’s aim ultimately is to devise an intervention to help young people suffering from TMD for whom the condition might otherwise become a lifelong chronic ailment. She has already undertaken an initial service evaluation which she is presenting to the International Association of Dental Research (IADR) meeting next month.

Armaana Ahmad’s proposal is a feasibility study examining Genetic Investigations for Children who have Type II Dentinogenesis Imperfecta (DI).

There are two main types of DI, one is part of a medical condition affecting teeth and bones, Osteogenesis Imperfecta, better known as brittle bone disease. The other main type manifests as a dental condition featuring discoloured teeth which are weak and prone to fracture.

Armaana Ahmad

Her research interest has been inspired by her clinical care of patients who have the inherited condition. Children who appear to have only dental symptoms and no bone symptoms are not currently able to have genetic testing to confirm which type of DI they have.

Armaana said: “The feasibility study has been co-designed with 5 patients who live with the condition and with their parents. We are making the case for genetic testing of all children who present with DI. It will help us identify any children who may unknowingly have a mild form of brittle bone disease and also understand how the condition progresses.

“Having heard that I was selected out of many applicants makes me feel very proud of this achievement and very grateful for this opportunity. It is especially exciting to share the news with the children and parents who co-designed the study as this also reflects the time and effort they put into designing the research.”

BSPD welcomes ban on online advertising of ‘harmful’ food

The announcement in the Queen’s Speech this month that advertising of foods high in fat, sugar and salt (HFSS) is to be restricted from April of next year is welcomed by the British Society of Paediatric Dentistry (BSPD).

New legislation will introduce an outright ban on online promotions and a watershed of 9pm for TV advertisements; BSPD hopes the restrictions will reduce children’s exposure to advertising of products that are contributing to unacceptably high levels of childhood obesity and dental decay, especially in areas of greatest deprivation.

Laura Warrilow


In response to a consultation last year, the BSPD set out the reasons why HFSS food and drinks are detrimental at an individual level as well as having a wider long-term societal impact. Children and young people are currently consuming up to three times the recommended sugar intake, increasing their risk of dental decay, obesity and other chronic health conditions such as Type 2 diabetes.

The evidence underpinning our consultation response was developed into a position statement by two BSPD members, Laura Warrilow and Jessica Large. They highlighted that children are spending more time online, a trend exacerbated during the pandemic, when schools were closed.

Due to shared risk factors, there is a clear link between obesity and dental caries as set out in an earlier BSPD position statement, which is why they must be addressed together.

Jessica Large

BSPD spokesperson Claire Stevens said: “I am delighted that the Government has listened to all the organisations that have been campaigning for advertising of junk food and drink to be restricted. April 2022 cannot arrive soon enough. Frequent snacking of foods which are high in sugar leads to children and young people being at high risk of dental decay. Currently, there are too many products which are marketed at children claiming to be good for growing children because they have “no added sugar” but are laden with hidden sugars as well as salt and fat.

“Our advice to parents and carers is to seek out products which contribute to a balanced diet and combine with plenty of fresh fruit and vegetables, while keeping any sugar-containing food and drink to mealtimes. We would like a general reformulation of products to make the foods on shop shelves healthier as well as a complete overhaul of food labelling, so that it’s easier for parents to assess which food products are the most nutritious.

“Along with Jamie Oliver, Public Health England, Sustain and a plethora of other organisations wanting to reduce obesity and dental decay in children, we have been at war on sugar for years. The sugar levy has had a positive impact, but more steps are needed. We would like to see greater incentivisation of healthy food and drink choices to protect our children’s oral health.”

BSPD applauds Mini Mouth Care Matters programme

The oral health of children in hospital is recognised as fundamental to their well-being thanks to The Mini Mouth Care Matters programme. The British Society of Paediatric Dentistry (BSPD) applauds the programme which is benefiting thousands of children throughout the UK and the work of one of our members, Dr Urshla (Oosh) Devalia, the national lead for Mini MCM.

A Consultant in Paediatric Dentistry, Dr Devalia began devising Mini Mouth Care Matters (Mini MCM) nearly three years ago. At the heart of the programme is training for ward staff in hospitals to ensure that young in-patients always benefit from an oral health check. Hospital teams are taught to ‘lift-the-lip’ so they have the confidence to look inside the mouth of young patients and understand any warning signs.

Dr Urshla (Oosh) Devalia

In addition to training, a range of resources, including an assessment tool, is made available to hospital-based healthcare practitioners. The programme branding includes a little elephant by the name of Elwood, a reminder to “never forget’ tooth brushing. Images of Elwood are now to be found in hospitals up and down the country beside the beds of paediatric patients, and also on posters and leaflets in hospital staff rooms and waiting areas.

Claire Stevens, BSPD’s spokesperson commented: “It’s incredible to see the way in which this programme is not only embedded as routine in hospitals with paediatric wards but also that it’s extending into other settings including the training of health visitors and hospice staff.

“The small adaptations in care delivered by Mini MCM can significantly improve the quality of life of this cohort of children and young people and also provide new knowledge and skills for healthcare practitioners who learn to ‘lift the lip.’ As an innovative and transferable programme, Mini MCM has outstripped its vision.”

Mini MCM was modelled on the Mouth Care Matters programme devised and led by Mili Doshi to benefit older patients in residential and hospital settings by training their carers in mouth care.

The Mini MCM resources can be downloaded from our website: https://www.bspd.co.uk/Professionals/Resources/mini-mouth-care-matters.

A vision for child’s first 1001 days, without teeth?

The Early Years Healthy Development Review led by Andrea Leadsom provides a vision for the first critical 1001 days of a child’s life in its newly published report. The omission of oral health from The Best Start for Life has been condemned by the British Society of Paediatric Dentistry (BSPD).

Commissioned by Boris Johnson to improve the health and development outcomes for babies in England, there is scant mention of the mouth or of dentistry.

“This is a report which appears to deny the importance of oral health to the health and well-being of the nation’s children,” says Claire Stevens CBE, BSPD spokesperson. “It’s hugely frustrating that the contribution of paediatric dentists has not been sought despite an offer to pull together an expert group, making this a missed opportunity.”

She said the word ‘dentist’ is used once: “With childhood dental extractions under general anaesthetic being the most common reason for a child to be admitted to hospital, this omission is breath-taking. The report is 147 pages, yet there is sadly not a single mention of children’s oral health.”

Dr Stevens continued: “I am urging Andrea Leadsom and the Government to take up our offer and engage with paediatric dentists so that in the coming months, the oral health needs of children can be factored into the vision for a child’s first 1001 days.

“Our data shows that Covid-19 has had a disproportionate effect on young children and those from a lower socio-economic groups and waiting lists for general anaesthetics are unacceptably long. As such, it’s imperative that oral health is included in the context of general health. Every child deserves a smile for life.”

BSPD has been urging Government to ensure that oral health is included in the review. A Dental Check by the Age of One, for instance, gets children into the routine of seeing a dentist and gives parents access to all-important oral health and dietary advice.

Dr Stevens continued: “While the pandemic was a barrier to routine dental visits, as we return to some semblance of normality, we need to be encouraging parents to engage with dentistry and caring for their children’s teeth. We know that dental disease is nearly always preventable.”

The mouth is factored into the report under the heading of infant feeding with a brief reference to tongue-tie. Mrs Stevens said: “We welcome the inclusion of tongue-tie. That any baby should be struggling to breastfeed due to tongue-tie is worrying. What we would like to see is a mouth check included as routine in the newborn check on every baby before they leave hospital so tongue-tie can be picked up early.”

BSPD President: “Children with craniofacial conditions need to be integrated with their overall NHS management and treatment”

The dental care of children in the UK with craniofacial conditions needs to be integrated with their overall NHS management and treatment says Sarah McKaig, President of BSPD. A team member in the West Midlands supra regional craniofacial unit at Birmingham Children’s Hospital, she was, until recently, the only paediatric dentist working within a specialised craniofacial unit.

Mrs McKaig has been on a mission to highlight the oral health needs of children and young people with a craniofacial deformity since she became our President in 2019. Her long-term aim is that a national pathway for this cohort of children with complex oral health needs should be established and funded.

As a result of the Covid-19 pandemic, Mrs McKaig stayed on as President for an additional year and is now resuming her Presidential tour of the branches, a BSPD tradition. She has visited the Wales branch study day as well as the Merseyside BSPD branch to deliver her lecture: Meeting unmet needs: a voyage of discovery.

In the course of the lecture, she outlined craniofacial conditions along with the diverse oral health needs of her young patients. She explores the dental care of these patients drawing on over a decade of experience. She described the responses to questionnaires sent to parents which demonstrated there is a huge variation in how children with craniofacial conditions access dental care and that they were all at high risk of developing dental caries. In a bid to provide further information to parents and carers an information leaflet had been developed to provide key oral health advice.

Around one fifth of children she sees on the clinic have untreated dental decay. She said: “We realised we were not capturing these children early enough and there is a need to establish their dental care pre-school.”

Prior to the pandemic, Mrs McKaig said, it was the intention to roll out the audit to the other highly specialised craniofacial units. “Although other units did not

have a dentist involved, they were enthusiastic about being involved with the audit with a view to building a better picture on the dental needs for this group of patients.”

Having for years been the only Consultant in Paediatric Dentistry working within a highly specialised craniofacial unit, there is now a second person, Joanna May, a Consultant in Paediatric Dentistry based at Alder Hey Hospital, Liverpool.

“Moving forward, we want to understand what the national picture looks like and how we can support one another in developing a robust preventative strategy and dental pathway for the management of children with craniofacial conditions. I hope that by engaging with the people and organisations involved we can understand the challenges and move ahead.”

She is making virtual presentations to the BSPD South East branch on April 21§st at 6.30 and to the Midlands Branch study day on June 15th.

BSPD welcomes new trial examining the role of CBT in the management of dental fear

Giving every child the best possible start to a lifetime of good oral health is our over-riding mission. But one of the many challenges we face is dental anxiety, a reality for many children, who may require special measures to help them cope with having a dental appointment as well as treatment. Children with dental anxiety are frequently referred to specialist services in hospital or clinics for a general anaesthetic which has additional challenges and risks.

To help anxious children cope with their dental appointment or treatment, BSPD recommends a resource developed by the University of Sheffield School of Clinical Dentistry. Entitled ‘It’s your teeth, you are in control’, the resource is underpinned by Cognitive Behavioural Therapy (CBT).

Professor Zoe Marshman

Now, working with other dental schools, Sheffield is undertaking a £1.6m trial funded by the National Institute for Health Research (NIHR) to investigate the approach. The study will involve 600 children aged 9-16 and will examine whether CBT helps them manage their dental treatment at their family dental practice.

Principal Investigator, Professor Zoe Marshman from the University of Sheffield’s School of Clinical Dentistry and Honorary Consultant in Dental Public Health at Sheffield Teaching Hospitals Foundation Trust, said: “Traditionally, children with dental anxiety have been referred by high street dentists to specialist services for sedation or general anaesthetic. This approach does nothing to stop their fear, and they may go on to spend a lifetime avoiding the dentist.

The study will involve children from 30 dental practices and clinics across England and Wales. Working together, dental professionals, children and their parents will set out to understand what specifically is making the child anxious; they will be given information and choices about the procedures they may need, activities to help them cope, and support with talking to the dentist.

Professor Marshman added:  There is strong evidence to support the use of CBT, a talking therapy, for anxiety and mental health conditions; however there is currently very limited research into CBT delivered specifically by dental professionals for children with dental anxiety.”

“If our study finds CBT resources delivered by dental professionals are effective, then children can be helped directly in high street dental practices without the need to travel for dental treatment in hospitals,” said Professor Marshman.

Claire Stevens

Claire Stevens, spokesperson for BSPD, commented: “Any approach which helps children get the care they need in their local dental practice is to be welcomed. We would like to see evidence that empowering children to voice their anxieties and talk to their dentist helps build a long and trusting relationship that allows them to receive their care closer to home.”

The four-year trial also involves Sheffield Hallam, Cardiff, King’s College London, Leeds, Newcastle and York. It is called CALM: ‘the clinical and cost-effectiveness of a guided self-help cognitive behavioural therapy intervention to reduce dental anxiety’ and is overseen by Sheffield Teaching Hospitals NHS Foundation Trust. The collaborative team of researchers are looking to recruit 60 dentists to take part in the study which will start in September 2021.

Dental professionals or practices interested in taking part in the study can contact z.marshman@sheffield.ac.uk for more information.

BSPD appoints new safeguarding representative

Marielle Kabban, a Consultant in Paediatric Dentistry at Guy’s and St Thomas’ NHS Foundation Trust, has been appointed as British Society of Paediatric Dentistry’s (BSPD) new Safeguarding Representative.

She has been a passionate advocate for child safeguarding since early in her career. Marielle worked for 10 years in the community service in South London and for a time was the dental safeguarding lead for that service. She remembers well an early experience which made her appreciate the role that dentists could have in protecting children.

A boy aged about five was brought to the clinic with fractured teeth. Marielle asked him what had happened and he said his father had hit him. His mother said nothing to contradict him. “As soon as I had treated him I picked up the phone, discussed my concerns with the safeguarding lead and made a referral to social services.”

Marielle continued: “As part of my role in the community, I worked on the school screening programme. This took me into inner city schools and gave me greater insight into the needs of some of the most vulnerable children. We would screen the children for dental disease and offered dental treatment to those who needed it. There was always a cohort of children who, no matter what you did, would not be brought in for a dental appointment. This inspired me to highlight the issue of dental neglect at every opportunity.”

Her next role was as King’s College Hospital Dental School where she worked as a Consultant in Paediatric Dentistry, also taking on the lead safeguarding role. She recently accepted the new consultant position at Guy’s and Thomas’.

As BSPD’s safeguarding representative, Marielle is taking over from Jenny Harris. A member of BSPD’s executive committee, it is Jenny’s vision that has shaped the role. Jenny has made it her mission to ensure that the safeguarding of children is integral to dentistry and that all members of the dental team are supported with training and resources to take on this sometimes challenging task.

It is thanks to connections Jenny made that the BSPD is represented at the NSPCC Health Liaison Committee and Marielle takes on this responsibility as part of the BSPD safeguarding remit. She will continue as a trainer on the Child Protection Recognition and Response Course, run by the Royal College of Paediatrics and Child Health.

Marielle commented: “I am excited and honoured to be taking on this role. Jenny has always inspired me greatly, and whilst I have big shoes to fill, she has already given me a great deal of support and remains a much-valued mentor.”

NHS reforms set to deliver on BSPD’s key campaigning aims

The government’s plan to reform the NHS has been welcomed by BSPD which believes that joined-up care in the interests of children is now on the horizon. Claire Stevens, BSPD’s spokesperson, says the proposed legislation set out in the White Paper has the potential to make a significant difference to children’s oral health.

“There are three reforms which are most relevant to paediatric dentistry – reducing barriers to community water fluoridation, a reduction in advertising of high sugar products and an emphasis on joined up care.”

Claire said: “ BSPD supports water fluoridation as a highly effective measure for preventing dental disease. Only 10% of the UK has access to fluoridated water yet this public health measure can reduce general anaesthetics for the extractions of decayed teeth in young children by as much as 68% in the most deprived areas. “

“For some time BSPD has been pressing for improved food labelling and for a restriction on the advertising of products high in fat, sugar and salt (HFSS). According to the plans, the government will proceed with both, which we welcome.”

Claire continued: “Once enacted, the proposed new legislation should ensure that dental leaders  are working collaboratively with medical, public health and commissioning teams to make decisions about health provision in the best interests of their local population.”

Nationally, Claire is already briefing medical leads on dental issues. “They are beginning to understand that good oral health is critical to the overall health and wellbeing of young patients. Paediatric dentistry is recognised as a national priority and this will allow us to work with the developing Integrated Care Systems to reduce the unacceptably long waiting times for dental treatment under general anaesthesia. 

“A perfect example of greater integration would be that services recognise the links between obesity and caries and collaborate so children who are at risk of both get the care and support they need. This is already happening in some places but needs to be developed.”

She added: “There is a long way to go but I have genuine hope that we are on the cusp of significant and positive change.”

BSPD’s position statements on water fluoridation and dental caries and obesity can be found here: https://www.bspd.co.uk/Professionals/Resources/Position-Statements

ADG welcomes Government water fluoridation action plan

Neil Carmichael, Chair of the ADG, has welcomed the announcement today by the Secretary of State for Health of plans for “streamlining the process for the fluoridation of water in England by moving responsibilities for doing so from local authorities to central government,” as part of the NHS reforms in the White Paper published today.

Neil said: “This is a significant moment as water fluoridation is probably the single most important step any Government can take in protecting the country’s oral health.”

The Covid-19 pandemic and the cancellation of routine appointments, treatments and supervised toothbrushing programmes has highlighted the need more than ever for the introduction of preventative measures such as water fluoridation across the country.

Thousands of children could soon require hospital operations to remove unsavable teeth due to the pandemic. Before the pandemic, hospitals in England already carried out an average 177 operations a day on children and teenagers last year to remove teeth, costing the NHS more than £40m. It is estimated by the British Society of Paediatric Dentistry that water fluoridation could reduce this by as much as two thirds in the most deprived areas.

Neil Carmichael added: “It is widely accepted that water fluoridation is the most effective measure that can be taken to prevent dental disease. Only a tenth of the UK has access to fluoridated water showing that the previous approach was not working. We welcome the proposals outlined today as a clear resolution by the Government to take action on water fluoridation.”

“Moving a focus onto flexible commissioning and preventative measures is one way the Government can limit and recover the damage to the nation’s oral health in the future. Water fluoridation requires no behaviour change and the evidence shows it is highly effective. The next step must now be wider flexible commissioning of services to help those most in need.”