Up to 50 per cent of five-year-olds in England suffer from pain due to untreated tooth decay or dental caries, according to research from the University of Manchester. Many of those children have to undergo dental extractions under general anaesthetic in hospitals.

In an article by Policy@Manchester, George Kitsaras, Michaela Goodwin, and Tanya Walsh identified several ways health leaders could tackle the problem of child tooth decay in England.

Three research projects from the university’s Dental Health Unit, in partnership with Manchester’s Oral Health Improvement Team, have shown that making oral health a family priority and working closely with parents of young children can lead to changes in habits for the entire family, delivering sustained benefits for children and parents alike.

The projects

The projects include Bedtime Routines Intervention for Children (BRIC), through which the researchers co-designed and co-developed a text message-based intervention to promote beneficial bedtime routine activities, including oral hygiene practices and reduced sugar intake.

They explained, “As a result, young children brushed their teeth more at night with a 16 per cent increase in brushing behaviour; avoided sugary snacks and drinks around bedtime, with a 24 per cent reduction in consumption of snacks/drinks before bedtime; and generally, parents’ mood and overall family functioning was improved with less mood disturbance around bedtime.”

The projects also included Leapfrog, a school-based oral health promotion programme which incorporated student activities, provision of tooth brushing and text message support for oral health behaviour change for families. The researchers said, “This work targeted six primary schools in the areas of highest disease prevalence in Manchester. It led to improvements in their brushing behaviour following the intervention, with more children brushing their teeth twice a day at the end of the study.”

The third project, a community-based oral health intervention known as Healthy Routines, Healthy Teeth (HeRo), is ongoing. It involves the provision of oral hygiene packs and behaviour change techniques designed to create good oral health habits for newborn children in areas of highest need.

Important findings

The authors detailed several key principles they believe policymakers should adhere to when considering interventions to improve children’s oral health.

The researchers said, “First and foremost, co-development and co-design principles with target populations should be followed from the start, not as an afterthought, to ensure meaningful benefits.

“Interventions should be tailored to target populations, with consideration of personal, local, and regional circumstances. A ‘one-size-fits-all’ approach will not deliver the change required.”

The researchers added, “[these principles] should include theory-informed, evidence-based approaches to sustained behaviour change. There must be recognition that positive changes and habit formation can take time, with funding and other resources provided accordingly.”

While recognising technology’s important role in supporting behaviour change, they advocate that it must be used with a clear rationale in place.

The researchers recommended that “school-based oral health support needs to be easy and attractive for teachers to incorporate into their day-to-day work and utilise social aspects such as class-based activities.”

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