Sir, With reference to your report “UK gender divide starts early” (February 17) on child spending: figures from the Office for National Statistics have highlighted that children as young as seven years old are spending their pocket money more on soft drinks than on toys and hobbies.
The evidence clearly links these drinks to tooth decay, diabetes and childhood obesity, not to mention the ongoing socio-economic impact on our society. So by knowingly giving a young child repeated cans of fizzy drinks, I believe this is actually a child safeguarding issue, bordering on neglect.
The Dental Wellness Trust wants to see an age restriction for children under 12 years old from buying fizzy drinks, and an all-out ban on children under the age of six years old from consuming them. As dentists, we sadly have to extract teeth from children as young as three due to their consumption of fizzy drinks. This trend continues right up until teenage years and there is no improvement in sight.
There is no escaping the exposure to these drinks.
Morally, how can we allow this to continue without taking a firmer stance to protect the health of future generations? I believe our proposed ban would have a dramatic impact on their consumption, but more importantly on the overall health of the child.
Around 80% of children in South Africa have tooth decay before the age of six, which is perhaps not surprising with the combination of extremely high sugar consumption and limited access to dental care. Many people do not have basic oral care tools; it’s not unheard of for a whole family to share one toothbrush.
The Dental Wellness Trust (DWT) is on a mission to improve the oral health of children and vulnerable adults around the world. The registered charity is based in London, but making a difference in South Africa, the UK and around the world.
Dentist Dr Linda Greenwall, who is originally from South Africa, founded the dynamic non-profit in 2011, to provide innovative oral health education programmes and treatment for children and vulnerable adults.
“We believe everyone has the right to access oral healthcare, and enjoy a life of dignity, free from pain,” she says. “Prevention is key. Before we start treating tooth decay we need to teach children correct habits.”
The DWT has worked in Israel, Rwanda, Uganda and Ghana. They recently rolled out their Live Smart oral health education programme in Luton, England. “We took what we’ve learnt working with children in South Africa and applied it to the UK,” says Dr Greenwall.
They have been active in South Africa since 2012 and currently work with over 10, 000 pre-school children at 360 schools in low-income areas of Cape Town – Khayelitsha, Mfuleni, Delft and Mitchell’s Plain. They have 33 specially trained ‘toothbrushing mamas’ who run the programme at the schools and in their own homes. Live Smart teaches young children the most important hygiene practices for good health – proper hand washing and correct tooth brushing.
“When we started working in South Africa it was shocking to see the enormous levels of decay in very young children. But we have seen how the Live Smart programme makes a difference and it’s so effective that we’re rolling it out in the UK as well as Johannesburg.” DWT is also working to open a dental clinic and education centre in Mfuleni, where volunteer dental professionals from around the world can come to help treat patients who otherwise are unable to easily access care.
At Ivohealth and our sister company Ivodent, we are committed to supporting the Dental Wellness Trust in South Africa.
You can help! Every time someone signs up for our newsletter in February, we will donate a Sunstar GUM children’s toothbrush to the Trust. Simply sign up here www.ivohealth.co.za/contact-us and give a child in need a new brush and a big smile 🙂
Dr Sandra White asked: in the context of oral health, is there a crisis? Children’s oral health is improving overall, supported by companies like Oral B and Colgate and the work of dentists and their teams. Yes, she admits, people are eating more sugar but there is also more fluoride about to act as a counterbalance. However, yes, there is a regional crisis.
She remembered how she wept when, as a dentist, she once had to remove 20 rotten teeth from the mouth a three-year-old child. She was a little emotional at the time having become a mother just two months before, but even so the damage was avoidable and in an ideal world the extractions would not have been needed.
The overall picture may be improving but in some areas the situation is remaining static if not becoming worse. Recent research showed that 25% of 5-year-olds suffered from dental decay of which 78% remained untreated. Looking at the situation socio-economically the simple fact remained: the poorer you are the poorer your dental health will be.
Only the blind could fail to see the evident regional inequalities in children’s dental health. There is a significant difference between the South-east of England and the North-west, but if you have a mouth full of rot will you be able to even find a dentist? Access to NHS dentistry varies throughout the UK. In some places there is just one NHS dentist per 1000 population, in others that figure rises to 18. Why? What makes the difference?
On average three days of a child’s schooling are missed due to dental problems; and that does not take into account the detrimental effects of sleepless nights and pain on a child’s concentration. Their education will suffer, reducing their chances to rise out of their socioeconomic situation. And there is a cost to the nation. Every tooth extracted from the mouth of a five-year-old under a general anaesthetic costs the NHS £836.00, an expense that is easily preventable.
The legal responsibility for children’s oral health lies with the 353 local authorities, but they have had their funding squeezed over the last several years. The already complex access situation has been aggravated by the wait for NHS dental contract reform, which is why the Child Oral Health Improvement Programme Board (COHIPB) was established in 2015. Its ambition is to see every child grow up free from tooth decay, and to achieve this it has five key aims:
1: Child oral health is on everyone’s agenda
2: The early years and dental workforce have access to evidence-based oral health improvement training
3: Oral health data and information is used to the best effect by all key stakeholders
4: All stakeholders use the best evidence for oral health improvement
5: Child oral health improvement information is communicated effectively
Dr White asks: What else can we do? She lists supervised toothbrushing at school, applications of fluoride varnish, water fluoridation, and free provision of toothbrushes. She would ban Coke machines from schools to take away the choice. Yes, the image of a Nanny State rears its head, but sometimes it works. Look at seatbelt legislation and the banning of smoking in enclosed public places, both initiatives worked.
We need to focus on the 13 highest priority regions of the country where children’s oral health is most at risk. With the creative use of funding it should be possible to establish better preventive practices, while also remembering that we are saving nearly £1000 every time a child doesn’t need an NHS hospital extraction. We should work with high-risk groups: have open days in dental practices and reach out to local partners. And why not reward initiatives by recognising practice champions?
To paraphrase Elvis Presley – we need a little less sugar and a little more fluoride please. Why put a health warning on cigarettes but not high sugar products? The Scientific Advisory Committee on Nutrition (SACN) reviewed the evidence on sugars, and found that:
• High levels of sugar consumption are associated with a greater risk of tooth decay
• The higher the proportion of sugar in the diet, the greater the risk of high energy intake
• Drinking high-sugar beverages results in weight gain and increases in BMI in teenagers and children
• Consuming too many high-sugar beverages increases the risk of developing type 2 diabetes
In light of these findings, SACN recommended:
• Free sugars should account for no more than 5% daily dietary energy intake
• The term free sugars is adopted, replacing the terms Non Milk Extrinsic Sugars (NMES) and added sugars. Free sugars are those added to food or those naturally present in honey, syrups and unsweetened fruit juices, but exclude lactose in milk and milk products
• The consumption of sugar-sweetened beverages (e.g. fizzy drinks, soft drinks and squash) should be minimised by both children and adults
On 22 October 2015 research demonstrated that the marketing of high sugar foods is effective, and such promotional activity in the UK is the highest in Europe. It is also understood that the so-called sugar tax will need to be set between 10-20% to be effective. We will also need a simple gauge and labelling by which to define high sugar foods. Public Health England plans to reduce the nation’s sugar intake by 20% by 2080, but something needs to be done now.
• Fluoride toothpaste is good for primary and secondary teeth, but do people know?
• Fluoride varnish works and should be used on every child’s teeth, but only 38% of children have received it
• There are 55% fewer hospital admissions for extractions in areas of water fluoridation, and 28% fewer cases of child dental decay
• Water fluoridation is cheap and it does no harm
In conclusion, those people who rail against water fluoridation disseminate “fake news” when they describe it as mass medication and say it breaches human rights. Out with fake news, the truth? Fluoridation means poor kids have rich kids’ teeth, and who wouldn’t want that?
Dr Sandra White is Head of Dental Public Health. As a dentist she worked in clinical practice for 20 years and specialised in working with vulnerable children and adults. A consultant in Dental Public Health Sandra worked with commissioning teams to review, restructure, and procure health improvement and care services in local authorities, NHS and clinical services.
She also leads the team responsible for improving oral health and reducing inequalities.
Final year dental students Karolyn John and Jack McSweeny spent three weeks of their summer teaching good oral health in the villages surrounding Cape Town in South Africa as part of the dental elective programme offered by King’s Dental Institute.
The two students helped teach good oral health and hygiene on behalf of the Dental Wellness Trust, a charity that aims to promote general dental wellness to less fortunate communities in both the UK and abroad. They visited a number of small townships outside Cape Town with the goal of teaching children the importance of brushing their teeth and washing their hands.
The people living in the townships suffer extreme hardship and poverty at a level which we in the UK can hardly comprehend. They use water and soap sparingly as it is seen as a luxury.”
The local children attend an after school programme which is run by trained volunteers known as “Mamas”. Unfortunately, there are not enough volunteers to reach all the children, but Karolyn and Jack wanted to help spread messages to more of the children.
Initially, only four classes of approximately 48 students were being targeted in the area Karolyn visited, but by the end of her trip they managed to get 12 classes involved by spreading the word and recruiting more volunteers.
It was extremely challenging logistically to ensure there were enough toothbrushes for everyone. With about 500 children brushing at the same time, monitoring their technique was initially quite a task! However their abundant enthusiasm and happy disposition made the entire operation a thoroughly pleasant experience.”
As well as taking part in the Dental Wellness Trust programme, Jack visited an outreach centre in Mitchells Pain, a township in Cape Town. The centre is run as a community clinic and Jack witnessed how the state healthcare system struggled to deliver oral health care to the local community.
“I found this community clinic and their protocols considerably different to those in the UK,” explained Jack.
For example, a single tooth extraction took 30 seconds to remove, a procedure that would normally take around 45 minutes on an undergraduate clinic in the UK.
Both Jack and Karolyn found their trip to South Africa a life changing experience. “During my elective I saw a sign that read ‘Ubunta: Xhosa for human kindness’ and it hit me how often I saw human kindness on a daily basis,” said Jack. “Reflecting on my three weeks in South Africa, the kindness of the Mamas and everyone I met is largely what made this elective such a great experience.”
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