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Complete neglect? A picture of children’s oral health in Scotland by dentists

Blog Author Graham Smith

Blog Date 15/03/2018



"It is complete neglect and an outrage that our children are still being put under general anaesthetic to have teeth extracted." – BDA survey respondent

Following a commentary piece published in The Herald by a journalist who had spoken to a Public Dental Service dentist about young children being given Irn Bru in baby bottles and the resulting shocking levels of decay, we asked you to help us paint the picture of children's oral health across Scotland.

I'd like to thank those of you who took the time to respond – I appreciate how busy everyone is and sometimes another survey just feels like another chore.

But only by capturing and highlighting your voices, can we make a stronger case to Scottish Government, about the state of children's health and why we believe it is both shocking and an unacceptable state of affairs in 2018.


What you said

Of those who replied to our survey, 62 per cent of you were GDPs, 28 per cent Public Service Dentists, six per cent hospital dentists, and two per cent academic or 'other'.

Dentists from all of the 14 NHS Board areas responded – 17 per cent were working in Lothian, 15 per cent in Greater Glasgow & Clyde and 13 per cent in the Highlands. This is interesting, because we know that these areas have some of the highest levels of oral health inequalities in Scotland.

Forty-seven per cent of you say you are seeing 50 per cent or above, cases of visible signs of decay in children under five.

Encouragingly, only 40 per cent of you said you saw only between one and 30 per cent visible signs of decay. It's great that we are making some progress, but I'm saying only in italics here, because as we know decay is an entirely preventable disease, we believe anything above a few per cent is truly a failure for our kids. We can do better.

We asked what other preventable oral health problems you are seeing in children and many of you flagged up poor oral hygiene, erosion, dummy usage, gingivitis, thumb sucking, caries and dental phobia.

Some of you report seeing the early loss of baby teeth molars, which then leads to a lot of crowding and impactions in the patients grown up teeth – painful and totally preventable.


Advice on diet and the scourge of sugar

"The public have lost sight of what 'moderate' consumption or 'healthy diet' is." – BDA survey respondent

One of the common themes from your responses, was the importance of providing information about diet, and the ills of sugar.

Two respondents (both in NHS Lanarkshire) reported seeing an increase in erosion once children start school which is very concerning. North Lanarkshire is one of the nine 'challenge authorities' in Scotland with the highest levels of deprivation, with over 20 per cent of children living in low income households. It's great to see provision being made for free school meals for children during school holidays, but we hope those meals are both healthy and tooth-friendly. 

The issue of what breakfast clubs in schools are serving to the children also came up – some of you said breakfast clubs are serving cereals high in sugar, which reinforces the idea to parents that these are acceptable. This is very concerning and something that needs to be tackled.

And this isn't just for the more deprived communities, some of you reported that some of the more 'educated' parents you see think that the organic food their give their children is healthy, highlighting the impact of food marketed at young children as healthy, which often contains a huge amount of sugar.

Ninety-four per cent of you said you agreed, or strongly agreed, that "Scottish Government should be doing more to inform parents of young children about the dangers of sugary food and drinks for good oral health" – reductions in sugar content are not enough to address the challenges we face.


The need for investment to tackle oral health inequalities

"It's the relationship between schools, health visitors and GDPs. We see kids whose parents have an interest and the kids we see don't have an issues. The problem is the kids we don't see, or the ones only brought in for an emergency." – BDA survey respondent

"I see greater differences between children's oral health who are more deprived and those whose families are better off. The inequalities are getting worse."- BDA survey respondent

I was heartened to hear that 70 per cent of you reported doing some form of unfunded oral health promotion activities in your practice. As caring and diligent dental professionals, I would expect no less. But I also believe that doing this work unfunded is neither sustainable nor as effective as it could be if it was being done in a centrally-coordinated way with investment put behind it.

Many of you flagged up the need for education and more oral promotion, amongst children and their parents. And the feeling is this should be done by properly trained staff rather than support workers. This obviously requires more investment and is something we definitely support. Some of you expressed concerns about Childsmile staff not being adequately trained.

Some of you also expressed concerns that Childsmile may be facing cutbacks. We are pleased to see that the new Scottish Oral Health Improvement Plan highlights the success of Childsmile in improving children's oral health and that 'the good habits learned through the Childsmile programme need to be maintained in older children'. We look forward to seeing this plan backed up with the necessarily investment to make it a reality.


You can give your views on this plan, and we strongly encourage you to have your say on our survey, what you say will help us in our official response to Government.

Having a joined-up approach from early years through to older children in school is the only way to tackle the problem head on. The issue of falling oral health amongst teenagers is a big issue that Government doesn't appear to want to tackle.

The issue of fluoridation is really key for some of you – you say that MSPs need to show political courage and lend their support to the scientific evidence which shows that it is safe, effective and cost-effective, and helps reduce oral health inequalities.

We've called for the sugar levy (tax) to be extended beyond sugary drinks, to include food and confectionary, to help reduce Scotland's oral health inequalities and almost 90 per cent of you agreed with this.

And 96 per cent of you said you agreed or strongly agreed that Scotland requires more investment in dentistry, to help prevent oral health inequalities and that money from the sugar levy (tax), when implemented in 2018, should be used to help fund oral health promotion schemes


Funding dentistry to do what it does best

"Joined-up thinking across the health spectrum: more regulation is needed regarding sugar production and progressive remuneration is needed for dentists for carrying out preventive and restorative treatments." - BDA survey respondent

"I note that there is no mention of children's dentistry in the latest Scottish Oral Health plan, especially regarding specialist dentists. It is quite clear that whilst registration figures present an improving picture, the treatment index remains very low. Providing actual treatment is required, both preventative and interventive, as the appropriate time. Annual figures should be reported on the number of GAs/extractions, to increase public awareness." – BDA survey respondent

The elephant in the room is always going to be dedicated funding. But surely the cost of treating the fallout of decay is far higher than the cost of funding prevention.

You talked about difficulties in recruiting paediatric specialists in dental schools in Scotland. Our evidence shows that there are a high number of vacant posts in dental schools and hospitals, and in a number of specialities, although this has improved slightly in recent times.

You also said there is a need to maintain funding for PDS to support dentists to provide sedation and GA services.

Clearly there is more that can be done, but we need Government's support and investment to do it. 


We have to keep up the pressure

Thank you for taking time to respond – the more voices we have and more we can illustrate the problem using case studies from dentists who are working on the front line, helps bring to life the shocking state of kid's teeth and helps us push for better.

With the financial pressures the NHS is under, we know that our task – ensuring dentistry, and our children get the best oral health we know is possible - is not an easy one.

But we will keep up the pressure and by highlighting your experiences, we hope to be able to tip the balance.

Graham Smith, Chair

Scottish Public Dental Service Committee


BDA Scotland

BDA Scotland supports, represents and promotes, the interests of all dentists working in Scotland. Working with elected committee members, we negotiate on behalf of the profession on terms and conditions, and pay and contracts. Join us.