A report has urged the government to tackle England’s oral health crisis by banning the sale of energy drinks to under 16s, expanding sugar taxes and rolling out a toothbrushing programme.

Child of the North, Anne Longfield’s Centre for Young Lives think tank and co-authored by researchers from the University of Sheffield's School of Clinical Dentistry, published a report on September 13, 2024, which revealed the substantial and wide-ranging extent of tooth decay for children across England.

The report is entitled ‘An evidence-based plan for improving children’s oral health with and through educational settings.

It recommended reducing sugar consumption among children, optimising fluoride exposure, increasing dental care access and creating a national child oral health strategy.

Paula Waterhouse, president of the British Society of Paediatric Dentistry, said, “This report reveals how higher levels of deprivation and associated unmet dental need are more seriously impacting children and young people living in the north of England compared with their southern counterparts.

“It is time to establish an oral health strategy for children and young people across England. The evidence base garnered by existing oral health research should be used to inform government strategy and implementation of both national and local policies.

She added, “We need to act now. Our children’s health depends on it and it’s everybody’s business – parents, dental and medical teams, health visitors, industry, education colleagues, and policy makers. We all have a part to play.”

Spotlight on poor dental health

Untreated disease can cause toothache, sleepless nights, and altered eating habits. It may also impact negatively on the development of speech and language. Poor oral health can lower confidence and affected children may be less likely to reach their developmental potential.

Anne Longfield, executive chair of the Centre for Young Lives, said, “It is staggering that so many children, particularly in the north of England and those living in low-income families, are now growing up with tooth decay and suffering from toothache and discomfort. This can affect their quality of life, sleep patterns, eating habits, and impact on school readiness and attendance, speech and language development, and overall confidence. In some areas it has sadly become the norm.

“Many children are not only missing out on NHS dental healthcare but are more likely to suffer tooth decay from a younger age.

“The government’s proposals for a programme of supervised teeth-brushing in schools is a positive step forward, as is its overall focus on boosting children’s wellbeing.”

There is also evidence to suggest that even when accounting for the different levels of tooth decay, the burden of tooth decay on the lives of children living in deprived areas is more severe.

Zoe Marshman, co-author and professor of Dental Public Health at the University of Sheffield, said, "Treatment for tooth decay is the most common reason why young children - over 33,000 youngsters each year - are admitted to hospital, costing the NHS over £40m every year.

"In deprived areas of the country up to 50 per cent of five-year-olds have tooth decay, which causes pain and suffering, as well as affecting what children eat, their speech, sleep, quality of life and attendance at school.

"This report shines a spotlight on the impact of poor dental health on children's lives and recommends a new national strategy to focus attention on providing much needed solutions.”

The document is the eighth in a series of Child of the North/Centre for Young Lives reports published in 2024. The series is focused on providing recommendations to the government on ways to make young people's life chances the heart of policymaking and delivery.

Key findings

  • Overall, fewer than four out of 10 children in England have good oral health.
  • One in 10 three-year-olds in England already have tooth decay, rising to three in 10 by the age of five.
  • One in five year 6 school children in north east England and Yorkshire has experienced tooth decay in their permanent teeth.
  • Research led by the University of Sheffield involving year 7 and year 8 children from deprived areas in the north of England, Scotland and Wales has found that over one-third had tooth decay in their permanent adult teeth. Four in ten reported that their oral health impacted their daily lives.
  • Families living in deprived areas are more than twice as likely to have tooth decay.
  • There are much higher levels of tooth decay in children in the north than elsewhere in England.
  • Tooth decay is also the most common reason for hospital admission in five-to-nine-year-olds.
  • In 2023, only half of children had visited an NHS dentist within the recommended maximum period of 12 months. For under-fives, it was less than a third.
  • In 2023, 27,000 children in England were on NHS waiting lists for dental care by specialists, with 12,226 children waiting for dental procedures under general anaesthetic with average waiting times of up to 80 weeks.

The report recommended that the government develop and implement a national child oral health improvement strategy to improve children’s oral health and reduce social inequalities, particularly those experienced by children and young people in the north of England.

This would be overseen by a national board including representatives from government departments, local government, dental organisations and specialist societies, universities, citizen representatives, and charities.

Strategy recommendations

  • Reducing sugar consumption through policy action such as expanding the ‘Soft Drinks Industry Levy’ to include other sugar-sweetened beverages such as sugary milk drinks.
  • Restrictions on food marketing, advertising and promotions.
  • Banning the sale of caffeinated energy drinks to under 16-year-olds.
  • Optimise fluoride exposure through community water fluoridation and increase the number of targeted programs such as supervised toothbrushing.

The report set out proposals to maximise the impact of early years and education-based interventions, co-designed by health visitors, nurseries, and schools.

It has also called for dental services to be re-orientated towards preventing dental diseases among children and young people.

This would mean:

  • Working with the dental profession, dental system reform, and innovative commissioning - led by integrated care boards - to provide opportunities to prioritise improving dental services for children, particularly for those with additional needs.
  • Better mechanisms for allocation and distribution of funding based on need, and consideration of providing dental services with and through schools and nurseries.
  • A renewed emphasis on clinical prevention, including better use of fluoride treatments, dental sealants and behaviour change interventions to support families and children’s oral health behaviour.

Local community approaches

The report highlighted the innovative approaches that already address children’s oral health problems. It also set out the role of local government in reducing sugar consumption. The authors acknowledged that many local authorities have their own strategies to reduce consumption of foods and drinks high in fat, sugar, and salt.

The report showcased interventions like Sheffield’s ‘Sweet Enough’, a five-year initiative commissioned by Sheffield City Council to support residents' understanding of the harms of consuming too much sugar, working in the most deprived areas.

It also highlighted projects like the BRIGHT trial led by the University of Sheffield. The trial evaluated a behaviour change intervention to promote toothbrushing in secondary school children.

Peter Day, co-author and professor of Paediatric Dentistry at the University of Leeds and Community Dental Service, Bradford District Care NHS Foundation Trust said, “I welcome the opportunity to write this report with colleagues across the north of England and shine a light on children’s oral health.

“As a paediatric dentist, I see the impact of tooth decay on children every day in my clinic. There is still much to do. This report lays out strong evidence for what works. We need to reorient and coordinate national and local public services towards prevention and ‘turn the taps off.’ All children deserve the best start in life, and this includes having a healthy set of teeth.”

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