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Northern Ireland: What’s next for children’s oral health?

Blog Author Laura Orr

Blog Date 15/04/2021

​How has the pandemic impacted children’s oral health, and what can we do to improve things?


It will be some time before we know the full impact of the continuing COVID-19 pandemic on oral health. What we know is that in a year when routine care and prevention activity all but ceased and lockdown lifestyles took over, our teeth will have suffered the consequences.


Our children are no exception to this. In the place of regular six-monthly check-ups and prevention activity like the Happy Smiles programme, emergency only activity became the default. So, what is the potential impact of all this on our children’s oral health?


High extraction rates and ever-longer GA lists

“Patients who may live just 10 minutes apart, can face vastly different waiting times for GA access.”

One of the most damning indictors of the state of children’s oral health is the high levels of paediatric extraction under general anaesthetic in Northern Ireland. In 2019-2020, 21,720 teeth were extracted from 3,820 young children. Of these, 2,623 were permanent teeth; a shocking 12% increase on the year before.


The number of GA sessions carried out varies between Trusts. In 2019-20 this ranged from 86 sessions in the Belfast Trust to 227 in the South Eastern, with 291 and 994 cases treated, respectively. Trust boundaries are strict, meaning that patients, who may live just 10 minutes apart, can face vastly different waiting times for GA access.


At the height of the pandemic only the most urgent cases received GA treatment. Sessions are being reintroduced, but the pace is slow. In some areas, paediatric waiting lists have increased from 6-10 weeks to 6-10 months. Some are over two years. This is simply untenable. General Dental Practitioners need to be able to prioritise routine care, otherwise waiting lists will only increase.


Welcome innovations

“There is good news in the form of a new pre-school prevention promotion group.”

During the pandemic, Belfast Trust accessed some GA paediatric sessions in the South Eastern Trust, cutting down the waiting list. A regional GA service is now under development by the Health and Social Care Board. This may be a chance to break the cycle and give prevention its necessary platform. All crafts of dentistry must be included in these conversations if the efforts are to succeed.


There has also been good news in the form of a new pre-school prevention promotion group, which facilitates access for 19,000 parents and children. This is highly welcomed as schools provide a key engagement touchpoint for a wide range of ages. Our dedicated Community Dental Services teams are leading the way in delivering this work.


Making the case for children’s oral health

BDA Northern Ireland has ensured an unprecedented level of engagement with our elected representatives throughout this pandemic. Your concerns are being heard at the highest levels. MLAs are now well versed on the issues, and we stand ready to ensure that this knowledge translates to what we desperately need; commitment, investment, and action.


The Budget Bill passing has made over £430m of additional COVID-19 funding available for the health service. A further £100m is being held for allocation early in the new financial year, pending an assessment of the Health Department’s requirements. This is good news but the Health Minister will still be faced with difficult decisions. A much-needed multi-year budget will not be forthcoming and the 2022/23 budget could be very difficult if the Chancellor significantly reins in spending.


The right people are around the table working out what can feasibly be done, and how it can be done well. The long-awaited Oral Health Options Groups to examine both children’s and older adults’ oral health have been established. We were disappointed to learn that the children’s meetings will be facing unavoidable delay, but are still hopeful that a much-needed status report can be produced to offer wide-ranging recommendations for improvements, and to make a compelling case for additional funding.


Co-production is the current Executive modus operandi and outcomes-based models are the favoured approach. This was evidenced in the recent Programme for Government, to which we responded. We are committed to continuing our engagement with the Department of Health to ensure that their approach results in sound policies, better decision making and long-term accountability.


Getting back to prevention

“As we ease out of lockdown, we must reassess our habits.”

There are growing concerns that lockdown led to a nutritional crisis in the UK, with Ipsos Mori’s recent polling suggesting that 35% of respondents have eaten more food or less healthy food than normal during this time. As we ease out of lockdown, we must reassess our habits. Dentists may have a role to play, as parents seek to navigate their children towards better nutritional choices and away from a ‘junk food reward’ culture.


Children’s oral health matters, so we’re campaigning on many fronts to help get prevention back on the agenda. With the Government reneging on plans to ban online and television adverts for foods high in sugar, salt or fat before the 9pm watershed, for example, we have supported calls from the Obesity Health Alliance for the Prime Minister to reconsider his position. We’ll continue to press the Government in Westminster and Stormont to make real commitments to prioritize prevention.


Laura Orr

BDA Northern Ireland, Committee and Administration Support Officer