The importance of Prevention Child Oral Health The importance of Prevention Professor Eric Rooney MBE Deputy Chief Dental Officer, England

Aims Update on the state of Children’s Oral Health Discuss the aetiology and prevention of dental decay in children Consider the Strategic approach to improving Children’s Oral Health Highlight the current work in Blackpool as an example

Children’s Oral Health

National Dental Epidemiology programme for England: oral health survey of five-year old children 2015

National Dental Epidemiology programme for England: oral health survey of five-year old children 2015

National Dental Epidemiology programme for England: oral health survey of five-year old children 2015

National Dental Epidemiology programme for England: oral health survey of five-year old children 2015

National Dental Epidemiology programme for England: oral health survey of five-year old children 2015

National Dental Epidemiology programme for England: oral health survey of five-year old children 2015

National Dental Epidemiology programme for England: oral health survey of five-year old children 2015

National Dental Epidemiology programme for England: oral health survey of five-year old children 2015

National Dental Epidemiology programme for England: oral health survey of five-year old children 2015

5 year old children with caries in Better Start and other areas 2015

Average number of decayed, extracted or filled teeth among 5 year olds in Better Start and other areas

National Dental Epidemiology programme for England: oral health survey of five-year old children 2015

Aetiology and Prevention

Aetiology and Prevention

Aetiology and Prevention

Development of tooth decay + = Bacteria Sugar Acid + = Acid Teeth Tooth Decay Aetiology and Prevention

Caries: De- and Remineralisation Tooth Demineralisation Remineralisation = Minerals (Calcium etc.) Aetiology and Prevention

Caries: De- and Remineralisation Aetiology and Prevention

Caries: De- and Remineralisation Aetiology and Prevention

Caries: De- and Remineralisation Aetiology and Prevention

Free Sugars and Intrinsic Sugars Through processing, such as the mechanical juicing or drying of fruit, natural (intrinsic) sugars are released from the cell and then reattach themselves externally. These free sugars are harmful to teeth – intrinsic sugars are not. Natural fruit can be eaten between meals, dried fruit can not Raisins sometimes come coated in white powder: free sugar Free sugars are often referred to as “Hidden Sugars” or by manufacturers as “Added Sugars” and include, amongst many others, glucose, sucrose, fructose, lactose, dextrose, maltose, molasses… Read nutritional content labels and cross check with ingredients Rule of thumb: “Anything that has been fiddled with, will most likely have released sugars that are harmful to teeth” Aetiology and Prevention

Healthy Eating Advice The frequency and amount of sugary food and drinks should be reduced Investigate diet and assist to adopt good dietary practice in line with the Eatwell Guide Aetiology and Prevention Update and Revision

? What else can we do ? Healthy Eating Advice The frequency and amount of sugary food and drinks should be reduced Investigate diet and assist to adopt good dietary practice in line with the Eatwell Guide Aetiology and Prevention Update and Revision

Caries: De- and Remineralisation Demineralisation Remineralisation with Fluoride Application of Fluoride (toothpaste/ varnish etc.) = Minerals (Calcium etc.) = Fluoride Aetiology and Prevention

Factors Affecting Effectiveness of Fluoride Toothpaste Frequency Concentration Rinsing Amount Aetiology and Prevention

Summary of Clinical Trials Aetiology and Prevention

The impact of variables on the effectiveness of fluoride toothpaste OPTIMAL Twice daily No beaker 1450 ppm F Sub-optimal Once daily Beaker 1000 ppm F Approximately 40-50% difference in caries prevalence Aetiology and Prevention

Principles of Toothbrushing for Oral Health: Children up to 3 Years Parents should brush or supervise brushing twice daily as a minimum as soon as teeth erupt – last thing at night before bed and at least one other time each day Use only a smear of toothpaste containing no less than 1,000ppm fluoride Do not allow children to lick or eat toothpaste from the tube Aetiology and Prevention

Principles of Toothbrushing for Oral Health: Children 3 – 6 Years Brush last thing at night and on one other occasion Brushing should be supervised by a parent/carer Use a pea-sized amount of toothpaste containing more than 1000ppm fluoride Do not allow children to lick or eat toothpaste from the tube Spit out after brushing and do not rinse Aetiology and Prevention

Aetiology and Prevention

Taking a Strategic Approach

Taking a Strategic Approach Source: Watt RG. From victim blaming to upstream action: tackling the social determinants of oral health inequalities. Coommunity dent Oral Epidemiolohy 2007;35: 1-11

Commissioning responsibilities Improving England’s oral health Commissioning responsibilities Local Government

Evidence Base Local Authorities NHS England

System Organisation Child Oral Health Improvement Board Upstream National sugar policy - reformulation Fiscal policy – sugar levy Legislation – water fluoridation Potential for Co branded/ quality marked Smile4Life Healthy settings - Evidence based initiatives by Local Councils e.g. supervised toothbrushing, fluoride varnish programmes, workforce training System Organisation Potential for Co branded/ quality marked Smile4Life Child Oral Health Improvement Board Professional Organisations initiatives Local Media activity Starting Well Preventive Practices Children’s dental care pathway and Dental Check by 1 A Smile4Life Initiative GDS, PDS and DCR Downstream

The approach in Blackpool

Improving Children’s Oral Health: Blackpool

School Breakfast Scheme – Fluoridated Milk In excess of 11,000 breakfasts have been delivered daily in 33 schools since the start of the scheme, with children having the opportunity to enjoy a variety of breakfast products including: •Toast •Cereal •Brioche •Pancakes •Malt loaf •A piece of fruit In addition, the children are provided with a carton of milk. 78% of all milk consumed in primary schools as part of the free school breakfast scheme is fluoridated

Public Awareness Campaign

Public Awareness Campaign

Toothbrushing Support

Supervised Tooth brushing Scheme Children in childcare settings are having their teeth brushed with fluoride toothpaste once a day Over 1000 children involved Council Private Voluntary Independent

Starting Well is NHS England’s response to ministerial commitment in May 2016: “I have agreed with NHS England that they will work in ten of the identified high needs areas within England to pilot more creative ways of using their commissioning expenditure to improve children’s oral health…”

Starting Well Preventive Practice Champion Prevention Pathway Staff Meetings Audit Action plans Locality Network Oral Health Promotion Displays Staff Training

Starting Well Advanced Practice Work with health and Social care professionals Open Days Reaching Out Working with a High-risk group Adopting a setting Understand local oral health strategies

STPs and Dental Services

Aims Update on the state of Children’s Oral Health Discuss the aetiology and prevention of dental decay in children Consider the Strategic approach to improving Children’s Oral Health Highlight the current work in Blackpool as an example

The importance of Prevention Child Oral Health The importance of Prevention Professor Eric Rooney MBE Deputy Chief Dental Officer, England ENGLAND.CDOExecutive@nhs.net