Dental surgeons call for England schools to go ‘sugar-free’

Dental surgeons say all schools in England should be encouraged to become sugar free to tackle worrying levels of child tooth decay.

The call comes as analysis by the Faculty of Dental Surgery (FDS) at the Royal College of Surgeons of England (RCS) shows more than 100,000 hospital admissions for children under the age of ten in England due to tooth decay over a three year period. This is despite the condition being almost entirely preventable. 

The FDS has published a new position statement today (15 August) on children’s oral health which is an update to their January 2015 report ‘The state of children’s oral health in England.’ The statement also calls on the new Government to stand by previous commitments in the Childhood Obesity Plan and Prevention Green Paper.  The FDS says supervised tooth brushing schemes in England should be put in place before 2022 so that more children at risk of decay can benefit.

Key statistics on children’s oral health in England:

• There were 102,663 hospital admissions due to tooth decay among children under the age of 10 between April 2015 and March 2018.
 23.3% of five year old children have visible decay.
 33.7% of five year old children living in the most deprived areas of England have tooth decay, compared with just 13.6% of those in the least deprived areas.
 41.4% of under-18s did not visit an NHS dentist during 2018, rising to 77.0% of young children aged between one and two.

As well as being distressing in itself, dental decay can have wider consequences for children, such as making it difficult for them to sleep, eat, socialise and putting them at risk of acute sepsis. Dental pain caused by decay can be detrimental to performance in school, affecting children’s concentration in lessons and potentially requiring them to take time off for dental appointments. At worst, children with untreated tooth decay may need to have multiple teeth out under general anaesthesia. 

While important progress has been made since the FDS launched its children’s oral health campaign in 2015, for example the introduction of the soft drinks industry levy, it is vital that policy-makers and the oral health profession remain focused as there is still work to be done. The FDS would like to see a national public health campaign introduced highlighting that all children should see a dentist at least once a year as recommended by the National Institute of Health and Care Excellence, and that NHS dental care is free for under-18s. 

Professor Michael Escudier, Dean of the Faculty of Dental Surgery at the Royal College of Surgeons of England, said: “It is incredibly worrying that levels of tooth decay among children in England remain so high – especially when you consider that it is almost entirely preventable through simple steps such as brushing twice a day with appropriate strength fluoride toothpaste, visiting the dentist regularly and reducing sugar consumption.

“The FDS believes that limiting the availability of surgery foods and drinks in schools is essential to reducing the amount of sugar our children consume. While the Government has committed to reviewing school food standards, we would like to see them go beyond this to encourage all schools in England to become sugar free. We would also support the publication of nutritional guidelines for packed lunches.

“The scourge of child dental decay cannot be allowed to continue. Everyone needs to play their part in ensuring our children have healthy, happy teeth.”

The dental surgeons add that it is vital to children’s oral health that the new Government stands by previous commitments on sugar reduction, in particular, proposals to restrict price and location promotions for products high in fat, sugar and salt (HFSS) and tightening regulations on TV and in online advertising. 

Other key recommendations made in the FDS position statement include:

• The new Government should maintain the soft drinks industry levy, and follow through on a commitment in the Prevention Green Paper to extend the levy to include sugary dairy drinks. Consideration should also be given to including other products that do not meet government reformulation targets. Some of the revenue raised from the levy should be used to fund oral health improvement programmes.

• Government should remove funding barriers that local authorities face to fluoridating their water supplies, as proposed in the Prevention Green Paper.

• Action should be taken to reduce the sugar content of commercial baby foods.

• There should be no further cuts to local authority public health budgets.

• The new NHS dental contract should be introduced at the earliest possible opportunity.

• The Government should commission an urgent review into the factors affecting access to primary, secondary and emergency dental care.

• Oral health should be included in pre-registration training for all public health professionals.

• The Child Oral Health Improvement Programme Board should continue to co-ordinate action to improve children’s oral health, and relevant epidemiological research programmes must be maintained.

Professor Escudier adds: “Since we launched our campaign in 2015, we have seen the state of children’s teeth improve in parts of England but worryingly, inequalities persist in different areas of the country. We know that children living in the most deprived parts of England are much more likely to experience tooth decay than those in the most affluent. There’s a real opportunity to build on the progress that has already been made and stamp out these inequalities, so that all children in England can benefit from good oral health.”

Dentists challenge Jeremy Hunt to prove his mettle by investing in prevention

The British Dental Association has challenged Jeremy Hunt to put prevention at the heart of government’s NHS ‘birthday funding’ pledge, as dentists warn that a rush to reduce political pressure on hospital targets will fail to tackle the pressures facing the wider service.

In an open letter to the Health Secretary the dentists’ union has demanded clarity on investment in primary care and public health services, which appear conspicuous by their absence, stating that any settlement geared purely around chasing targets for acute care stands entirely at odds with the preventive philosophy set out in the Five Year Forward View.

It has sought clarity on issues around the government’s successive manifesto commitments to reform dental primary care services, its increasing over-reliance on patient charges, threats to training budgets, and its unwillingness to engage meaningfully on public health programmes.

The BDA has stressed that a new prevention-focused NHS contract will only now be viable if ministerial contributions taken out of service since 2012 are restored, to boost quality, access and time spent with patients. Recent figures have shown spending per head has fallen £41 to £36 per person in just five years. Recent evaluation reports have demonstrated prototypes currently being tested are not financially sustainable.

Dentist leaders have also urged the government to engage with modelling from Public Health England on the huge returns of investment yielded by spending on prevention, and requested details on plans for public health budgets for cash strapped local authorities. £1 spent on early years prevention programmes of supervised brushing yield £3.06 in savings after just five years.

Tooth decay remains the number one reason for child hospital admissions in the UK, with a growing number of children facing more than six-month waiting lists. The BDA has documented the multi-million-pound costs hospitals are now facing for failure to tackle tooth decay, a wholly preventable disease, on GP services, emergency and secondary care.

BDA Chair, Mick Armstrong, said: “If Ministers fail to invest in prevention in primary care and public health services they will be on the wrong side of their own strategy for the health service.

“It is wrongheaded to focus on cure over prevention, treating the symptoms but not the causes of the pressure on our NHS. More and more children face six-month waits for tooth extractions in hospital, but the solution cannot be throwing cash at the surgical workforce.

“This is about targeted investment. Reform of the failed NHS contract has reached an impasse, and the government’s stated goals of improving both access and prevention simply cannot be delivered on a standstill budget. To make this work all we need is the cash Ministers have quietly siphoned out of the service since 2012.

“The government’s own figures show a pound spent on preventing decay can yield three back in savings. Reducing exposure on hospital and emergency targets is politically useful, but it isn’t a sustainable or cost-effective basis for a healthcare strategy.”