Community dentist, Charlotte Waite considers the impact the coronavirus pandemic is having on oral health inequalities and calls on the Government to include oral health in public health planning.
There are 177 operations to remove teeth in hospitals in England every working day. This is astonishingly high. New data also shows that the problem is increasing. There were 44,685 extractions of multiple teeth performed on under-18s in England in 2018/19. This is an increase of 17% when compared to the 38,208 extractions in 2012/13.
This comes at a huge cost, to young patients and their families and a £40 million bill to our NHS.
But where is the response? The Government has unveiled its new obesity strategy, and urged the country to ‘lose weight to beat coronavirus and protect the NHS’. However, oral health is being overlooked. Our message has been clear: a pandemic is precisely the wrong time to lose sight of the oral health challenges we’re facing.
Oral health inequalities are stark
Tooth decay is the number one reason for child hospital admissions. But since March it’s been too easy to lose sight of the challenge. We have been working alongside partners to make government take heed for many years. For a genuinely national effort on prevention, and for more effort to create a healthy food environment for our children.
At the onset of lockdown, Public Health England published its Children’s Oral Health Survey almost unheralded. It showed a tenfold difference in severity of tooth decay between the richest and most deprived communities. And around a third of local authorities saw a higher percentage of children with decay in 2018-19, than in the 2016-17 cohort.
A postcode lottery of decay: % of 5-year old children with decayed, missing or filled teeth (PHE, 2020: note some local authority data is missing)
The impact of lockdown
"These grotesque inequalities among our children look set to widen."
After months of public health programmes being suspended, and free check-ups and school meals off the menu, these grotesque inequalities among our children look set to widen. We don’t accept the oral health gap between children from wealthier and more deprived communities is inevitable. This is the time to act.
The Government’s focus is obesity, which is understandable as living with excess weight puts people at greater risk of serious illness or death from COVID- 19. But the impact on oral health must not be forgotten in this debate – those rising figures for teeth extractions on children in England should make us all pause and think.
The scrapping of Public Health England
is also a cause for concern. Responding to coronavirus and other infectious diseases are, of course, highly important. However, the suspension of public health programmes, coupled with lockdown diets, may fuel poor oral health outcomes and impact most starkly on those in the most deprived communities.
Checks needed on aggressive marketing
The Prime Minister is known not to be a fan of ‘nanny state policies’, but we are glad the Government has seen the light in terms of the need for checks and balances on the hard sell of junk and sugary foods to children.
As a dentist and a parent, I am very aware of the pester power of children and that the decisions we make for them soon become their own as they gain independence.
We hope that the ban on TV and online adverts for food high in fat, sugar and salt before 9pm will help. It is important to remember though that most children today don’t watch regular TV – they are a generation that has lived through lockdown online and ‘On Demand’ entertainment isn’t included in this watershed. Indeed, the Government’s strategy is strangely silent on this issue.
Apart from the sugar levy, the industry has almost been given free rein on pushing their products. Through its messaging it has trained consumers to think that sugary food is something they deserve.
"I am concerned about... the lack of knowledge of what is unhealthy."
Fuelled by the power of advertising, treats are often now seen as every day, rather than occasional. As a dentist, I am concerned about the dental problems being created for the future. Parents and children must of course make their own choices. But the issue is the lack of knowledge of what is unhealthy and the damage their daily treats can do.
Prevention works – let’s invest in it
As a profession, we are acutely aware of the fact that tooth decay is almost always a preventable disease. In 2020 tooth decay shouldn’t happen.
Yet, some of my patient’s parents believe there is an element of inevitability about their child developing tooth decay. They had it as a child, their children’s older siblings have had it, and baby teeth don’t really matter, do they?
So, we need more support and decisive action from Government on the impact the world around us has on our health and what action it can help us take, to break damaging behaviours.
As a profession we know that a whole team approach to prevention works well, one model is to use dental care professionals to deliver and support prevention, that is tailored to the individual and acknowledges the circumstances of that child and their family. Remote consultations could be used to deliver this advice. The BDA’s call to put prevention front and centre of the dental contract reform process must be heard and acted upon by government.
"Supervised brushing works and pays for itself."
Prevention also requires concerted effort beyond the practice. We must follow the example of Scotland and Wales, where over a decade of this sort of work has secured record breaking reductions in decay. Supervised brushing works and pays for itself. So, government must not allow the set-up of these schemes to become yet another casualty of the pandemic.
Prevention takes time and skill, as does managing children’s oral health. It is time that prevention is put at the heart of our fight against tooth decay and backed by a real commitment to and proper investment in dentistry.
Chair, England Community Dental Services Committee