To accompany the report, a presentation was provided to Members addressing health and social risks associated with obesity and poor oral health. The following areas were addressed by the Panel in detail.
Barriers to oral health in infants – in response to concern expressed, relating to when an infant’s dental check was deferred to when they reached 2 and half hear years old, it was hoped this was the exception rather than the rule. Members stressed that deferring their first treatment would create a barrier and by which time the child could already have poor oral health. Therefore it was outlined that parents needed to be more aware of what was available for their child, for example, the offer of fluoride varnish for any child.
School health/dental visitor – It was confirmed that there was no additional funding for dentists to make school visits however Members learnt that a community dental facility was available for school children with special educational needs who may have additional care requirements. The facility was based at the Flying Scotsman with strong criteria used when assessing whether a child was eligible to receive treatment. Unfortunately it was noted that the traditional school dental nurse was no longer a service that could be provided.
Due to schools efficient use of global text messaging systems it was suggested that they could be asked to send an annual information message reminding parents that children should be registered with a dentist and that the offer of fluoride varnish for any child should be made available to them.
It was confirmed that the Health Visiting Service was commissioned to provide families with a toothbrushing pack before their child reached 1 year old and supervised toothbrushing clubs were available in nurseries and key stage one settings. It was stressed that the the toothbrushing club was also available to older primary school children but barriers to provision were sometimes created by school curriculum timetabling.
Education packages – The approach to poor oral health by schools was questioned but Members learnt that despite educational packages being in place and promoted, it was dependent on school take up.
It was suggested that the large screens provided in some schools be used to provide public information about the importance of good oral health.
Preventative work - Members were aware that tooth decay was the most common oral disease affecting children and that it was largely preventable. It was noted that when a child started primary/infant school a health questionnaire was circulated to all families and included a section on whether their child was registered with a dentist.
In response to proposals for the use of images showing poor oral hygiene, it was noted that when such material was used as part of promotion to improve dental health, it had mixed results with initial success tending to wear off quickly.An initiative that had made a difference was supervised tooth brushing schemes that built good habits at an early age. It was also noted that Sheffield University had devised an App that played music for 2 minutes to aid the length of time tooth brushing should be undertaken.
Dentist availability – it was noted that Doncaster had a good coverage service therefore there should not be many problems for a family to register with a dentist.
Obesity – In response to a query relating to when obesity becomes an issue of neglect and a safeguarding issue, Members learnt that research undertaken by Sheffield University resulted in being inconclusive. It was stressed that obesity was not something that could be taken as a sole safeguarding issue, but other elements relating to health and wellbeing of a child or young person needed to be taken into account, before such a judgement could be made.
It was noted that families also received information from school nurses providing them with the opportunity for assistance but obesity was a was a very sensitive issue and parents could become resistant to help if their child was identified as being obese. Therefore a gentle approach to families was required and unfortunately some families do not take up the offer of help.
Community Food Educators – Members recalled that in recent years volunteers helped with parenting skills including how to provide a good diet rather than living on takeaway food, and indicated that this may be something that could potentially be investigated for the future. It was noted that the Adult Education unit still provided cook and eat sessions.
Teeth extraction in young children – in response to concern relating to the eldest child in a family requiring teeth extraction and what preventative methods were in place for vulnerable sibblings, it was explained Public Health had links with clinics and provided preventative information but positive activity it was dependent on parental initiative.
Concern was expressed with regard to the statistics for teeth extraction in Yorkshire and Humberside and sought reassurance that performance was being recorded correctly. It was recognised that reducing the numbers were outside their control but hoped that any initiative would make a positive difference.
Members stressed that it was distressing for a child to have their teeth extracted and questioned what considerations were given by the Department of Health and NHS England to the cost of such procedures against better preventative work being undertaken by clinicians.
The Executive be requested to:
1. Consider writing to NHS England asking them to investigate the cost of tooth extraction in young children compared to the cost of providing better preventative initiatives in dental practices.
Reason: Members were aware that tooth decay was the most common oral disease affecting children and that it was largely preventable. Strong concern was raised relating to the physical and emotional impact of a child losing their teeth through extraction and the financial cost of being anaesthetised in comparison to further preventative work being provided in dental surgeries.
Tooth decay preventative work undertaken by Public Health was recognised, for example, supervised tooth brushing schemes, but the Panel believed strongly that NHS England be encouraged to investigate the benefits of providing more support for preventative work in dental practices to offset the cost of a child being anaesthetised; and
2. To consider encouraging schools, in collaboration with Public Health, to provide oral hygiene public information on the large TV Screens in schools and through an annual school texting service. The information provided could include a reminder that children should be registered with a dentist and that the offer of fluoride varnish for any child should be made available to them.
Reason: Again, prevention was key to combatting poor oral health and the Panel hoped that using new technology to provide public information may help combat this issue.