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

2. 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

3. Children’s Oral Health

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

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

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

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

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

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

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

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

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

15. 5 year old children with caries in Better Start and other areas 2015

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

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

18. Aetiology and Prevention

19. Aetiology and Prevention

20. Aetiology and Prevention

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

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

23. Caries: De- and Remineralisation
Aetiology and Prevention

24. Caries: De- and Remineralisation
Aetiology and Prevention

25. Caries: De- and Remineralisation
Aetiology and Prevention

26. 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

27. 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

28. ? 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

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

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

31. Summary of Clinical Trials
Aetiology and Prevention

32. 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

33. 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

34. 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

35. Aetiology and Prevention

36. Taking a Strategic Approach

37. 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

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

39. Evidence Base
Local Authorities
NHS England

40. 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

41. The approach in Blackpool

43. Improving Children’s Oral Health: Blackpool

44. 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

45. Public Awareness Campaign

46. Public Awareness Campaign

47. Toothbrushing Support

48. 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

49. 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…”

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

51. 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

52. STPs and Dental Services

53. 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

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