It is the end of an afternoon in theatre and I have extracted more than 100 teeth from my operating list of eight patients, the youngest a two-year-old who needed all 20 baby teeth removing because they were so decayed. I watch in silence as a child younger than my own is transferred from the operating table and I wonder how we reached this point as a society where I don’t believe we truly value oral health, nor realise the implications of failing to do so.



Nearly 20 years after observing my first general anaesthetic as a student it doesn’t get any easier. I regularly see parents overcome by guilt and emotion as they watch their child being put to sleep, or recovering dazed and confused in the recovery suite. Sometimes after a busy afternoon I sit in the theatre and wonder if there is more I can do, sometimes I have nothing left to give.

Responsibility for oral health promotion has been devolved to cash-strapped local authorities

As an NHS consultant in paediatric dentistry, it sadly comes as no surprise to me that removal of decayed teeth remains the most common reason for a child aged five to nine years to be admitted to a hospital in England. In these straitened times, it seems so wrong that every year we spend around £35m on operations to treat a disease that is almost always preventable.

The frustration is that the solutions are already out there. Ten years ago, the Scottish government agreed to invest in a programme of oral health prevention called Childsmile. Now every child in Scotland has access to free daily supervised toothbrushing in nursery and free dental packs to support toothbrushing at home. Dental registration is encouraged and those communities and individuals who are higher risk have more support. The result? Scotland is reducing the millions of pounds it spends on general anaesthetics and turning around the oral health of its children, for the princely sum of £17 per child per year.

Wales has a similar Designed to Smile programme but in England, responsibility for oral health promotion has been devolved to cash-strapped local authorities. This means that it is a postcode lottery with some excellent programmes, such as Teeth Team in Hull, while in other areas existing services are being decommissioned.

England needs urgent investment in oral health prevention. It is actually more cost effective to prevent, rather than treat, dental disease but more importantly we could be preventing tens of thousands of young children, and their families, from potentially experiencing pain, swelling and sleepless nights and time away from school or work.

Every child has a right to good oral health yet still we see one in eight three-year-old children with obvious signs of decay. We need a more radical approach to reduce the persistent inequalities in oral health, which are immoral in this day and age. We need more compassion, an accelerated programme of product reformation so that the sugar content is reduced, and a war on marketing of high sugar products aimed at children.

Two years ago after a particularly frustrating consultation with a parent whose child’s diet was limited to Ribena and biscuits, I decided to begin writing a blog as a way of delivering practical information. I have reached many more families than I would in my day job, but I still feel as though I am wading in a sea of untreated decay. Education is important but it forms only part of the solution. It is too simplistic, and frankly unhelpful, to apportion all blame to the parents. Yes, as parents we have responsibilities and a vital role to play – but we could all be more proactive when it comes to children’s oral health.

I am delighted at the growing number of organisations that are now beginning to collaborate with me and colleagues via the British Society of Paediatric Dentistry. Health visitors can and are encouraging a dental check before a baby’s first birthday; sports and education settings can lead by example, adopting low-sugar menus and refusing to place sugary drinks in their vending machines; and communities should campaign for water fluoridation. Above all, we need strong, visible leadership by local and national government that says, “This is not acceptable and we are going to do something about it”. Children’s oral health should be everyone’s business.

The subheading on this article was amended on 10 April 2017 to better reflect the content of the piece.

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