Tooth decay in five-year-olds now increasing in some parts of England

Survey figures published by Public Health England (PHE) show the state of oral health of five-year-olds in the North West, Yorkshire and The Humber and the West Midlands has worsened since the last survey in 2014-2015, bucking a previous improving trend. Overall, in 2016-2017, 23.3 per cent of five-year-olds in England experienced tooth decay, improving from 24.7 per cent in 2014-2015.

More than a third (33.9 per cent) of five-year-olds in the North West have tooth decay, according to PHE’s data. The proportion of five-year-olds with tooth decay is also very high in Yorkshire and The Humber, where 30.4 per cent have rotting teeth. In the West Midlands more than a quarter (25.7 per cent) of five-year-olds are suffering decay.

The Faculty of Dental Surgery has said that although an overall drop in the percentage of 5-year-olds is welcome and reflects the work that has gone into educating families about oral health in recent years, including through NHS England’s new Starting Well programme, more needs to be done to stop deterioration in the worst affected areas of England.

Stephen Fayle, Board Member of the Faculty of Dental Surgery at The Royal College of Surgeons, said: “We are very disappointed the proportion of young children with tooth decay has increased in some areas of England, especially as this deterioration has occurred in parts of the country where decay levels are already high. This growing inequality is despite efforts to educate children, parents and carers. It is even more concerning when you consider that approximately ninety per cent of dental decay is preventable.

“More work must be done to understand why the message isn’t getting through in these areas, or if it is, why it isn’t leading to the decrease in tooth decay, seen in other parts of the country. With so many children still suffering from decay, we also need to make sure children can easily access NHS dental services, which are free for under-18s.

“We are pleased the overall number of five-year-olds in England with tooth decay continues to decrease. Many, including the Faculty of Dental Surgery, have worked hard in recent years to make people aware of the awful state of our children’s teeth.

“We can’t let children’s oral health fall off the Government’s agenda. We need to be constantly pushing for public health initiatives that remind families to brush teeth regularly with fluoride toothpaste, reduce sugar consumption and visit the dentist routinely.

“We would also like to see the promising ‘Starting Well’ initiative rolled out more widely across the country – for example, there are currently no programmes in the West Midlands even though this region has seen a rise in levels of tooth decay.”

The full results of the oral health survey of five-year-old children 2017 published by Public Health England are available here: www.gov.uk/government/statistics/oral-health-survey-of-5-year-old-children-2017

Dental neglect: Children falling through the cracks in “siloed health service”

The BDA has renewed its call for a joined-up strategy on children’s oral health, as new research reveals that GPs are not given the time or training to spot the tell-tale signs of dental neglect.1

The study, published in the British Dental Journal, surveyed all GPs in the Isle of Wight about their awareness and perceptions of dental health care in the identification of abuse. Among these family doctors, usually the first point of contact with the NHS, the majority had never liaised with a dentist. 96 per cent of respondents had never received any formal dental training and some did not perceive dental health to be important. Only five GPs mentioned a link between a lack of dental registration and childhood neglect and no GPs worked at clinics where child dental registration status was recorded.

Dental neglect is a marker of child neglect. It was defined in 2009 in the UK as “the persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development.” The research demonstrates that GPs lack time, training and confidence to identify dental neglect during routine examination of the oropharynx, and lack awareness of dental neglect as a potential marker of wider systemic neglect.

The study also notes that the sheer ubiquity of dental neglect within the general population may have desensitised many health practitioners to its wider social and health consequences, and blurred the lines between neglect and economic deprivation.

Official data shows that 41.8 per cent of children in England had not been to see a dentist for a check-up in the 12 months up to June 2017. Tooth decay remains the number one reason for hospital admissions among children across the UK. The BDA believes that progress can only be achieved by breaking down silos across the health service, along with co-ordinated and properly funded public health interventions.

The BDA’s Chair of General Dental Practice, Henrik Overgaard-Nielsen, said: “Tooth decay can be a tell-tale sign of abuse or neglect, and many children are falling through the cracks in a siloed health service. GPs bear an enormous burden and it cannot fall to them to ‘multitask’, when government is failing to deal with the problem.

“Tooth decay is the number one reason for child hospital admissions, but dentists are not seeing those at most risk early enough to make a difference. Poverty, neglect or ignorance can be huge barriers to good oral health, and we desperately need joined-up policymaking to tackle them.

“Oral health has such a low profile that it is not surprising that awareness of its importance is low in other parts of the NHS. When we face an epidemic of decay, dentistry can’t be left in a corner. Without meaningful engagement in education, in media and across the health service we simply cannot expect progress.”

  1. See: Colgan, S.M et al (2018). ‘Bridging the gap’ – A survey of medical GPs’ awareness of child dental neglect as a marker of potential systemic child neglect, The British Dental Journal, published 11 May 2018