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Dental Health: Children

Volume 773: debated on Tuesday 7 June 2016


Asked by

To ask Her Majesty’s Government what is their strategy for keeping children’s teeth healthy.

My Lords, Public Health England is leading a substantial programme of work and NHS England will test new ways to improve children’s oral health in 10 high-need areas. The Department of Health is working with NHS England to test a new NHS dental contract focusing on improving oral health. We also expect that measures to reduce sugar consumption will have a positive effect on reducing tooth decay.

My Lords, this is all excellent news, because shocking reports by the LGA, dentists and surgeons warn that the growing lack of children’s oral health practice, especially in deprived areas and communities, is costing the NHS millions. Huge numbers of hospital admissions for tooth decay and painful extractions are affecting children’s education, well-being and mental health. But this crisis is preventable with early intervention, co-ordinated strategies and funding. How will the Government’s new preventive programme to improve children’s dental health work, how soon will it happen and where will the funding come from?

My Lords, I think that the obesity strategy, which will be announced later in the summer, will answer part of the noble Baroness’s question. The new contract for dentists, which will have prevention at its core, is being piloted and will be introduced in 2018. This is a very high government priority.

My Lords, my noble friend talks about the dental contract. Will he tell us when the Government will complete the long-standing delay on dental contract reform? Will they ensure the new contact works for both dentists and patients?

My Lords, the new dental contract is under discussion as we speak. Prototypes will be tried in a number of areas over the next two years, I believe. It will be heavily weighted towards prevention, with a high degree of capitation in the contract. It will be very much outcomes-based. I believe that we expect the new contract to be introduced fully in 2018.

My Lords, will the Minister agree that the quickest, easiest and cheapest way to ensure that children do not get and suffer as much from tooth decay is to ensure that all water supplies have the right levels of fluoride in them?

My Lords, there is no doubt that fluoridisation is a critical part of good oral hygiene. This is up to local authorities. Public Health England will assist local authorities that wish to introduce fluoride into their water. I add that 3.5 million children in 2014-15 received a fluoride varnish. It is not the same as putting it in the water, but it is fully recognised that fluoride is a critical part of good oral hygiene.

My Lords, is the Minister aware that Manchester, which has had reports about hospitals being completely blocked by young children requiring full clearance under general anaesthetic, has no fluoride in the water? Australia has it pretty well everywhere, unless you live in the country, where there is only rainfall and a river. Birmingham, which has had it since the 1960s, has no difference with Manchester in its general health pattern except for the dental difference between the two. I have asked questions on this repeatedly and had Written Answers. Does he think that when Manchester has this new super-authority it might do something about this at last?

I agree with my noble friend. Fluoridisation has a huge and direct impact on oral hygiene. It will be up to Manchester to make that decision in due course. To pick up a point made by the noble Baroness, Lady Benjamin, social deprivation also plays a big part in the variation in the quality of people’s teeth. Interestingly, 75% of all children have no tooth decay now, but in some parts of the country—Blackburn, for example—the figure is as low as 40%.

My Lords, does the Minister agree that a healthy diet, including milk, fruit, vegetables and enough vitamin D, is as important to the development of children’s teeth as not eating too much sugar? The Healthy Start programme provides those eligible with free vitamins and vouchers to buy those healthy foods but I understand that the uptake is poor. What are the Government doing to improve the uptake of this programme and to ensure that the lessons learned by those authorities that choose universal distribution of vitamins are spread throughout the country?

My Lords, there is no question but that a low-sugar, healthy diet is good for people’s teeth. The noble Baroness will have to wait until we produce the children’s obesity strategy later in the summer, in which we will reveal the full strategy.

My Lords, I am glad that the Minister focused on the question of social deprivation. What will the government strategy do about that?

The best way of addressing social deprivation is to have a strong economy. As I am sure the noble Baroness will agree, the Government have the perfect economic strategy to address that issue.

My Lords, my noble friend emphasised the fact that sugar is bad for teeth and that the Government are trying to reduce the intake of sugar by private individuals. What is the effect on teeth of the substitutes that will be introduced into many products to replace sugar?

I am afraid that I cannot answer that question as I simply do not have the knowledge. I will research it and write to my noble friend.

My Lords, this used to be picked up through schools and nurseries, where most children are seen. What happens now in education establishments, particularly academies, where children’s teeth are found to be poor and action needs to be taken?

Schools clearly have an important role to play. Interestingly, in Bradford the Building Brighter Smiles programme involves not just a community-based fluoride varnishing application but also supervised tooth-brushing in schools and nurseries. I am sure that that has a very important role to play.

My Lords, the number one reason for primary school children to be admitted to hospital is for multiple tooth extraction as a result of poor diet and the other things that have been mentioned. These are children who generally do not drink water; they drink juice and fizzy drinks. Can my noble friend please confirm that the Government will give this a priority in the obesity strategy later this summer?

My noble friend will be aware that a part—only a part—of the obesity strategy includes a levy on fizzy drinks. That will be a levy on the manufacturer not the consumer. That is a very important part of trying to improve the diet of young children.

My Lords, I should remind the House of my presidency of the British Fluoridation Society. I come back to the issue of fluoridation. The noble Lord has been rightly positive about its impact. The real problem is that the law gives responsibility to local authorities but local authority boundaries do not always fit with the way that water is produced by the water companies. Given that, does the noble Lord agree that there is a role for the Government, working in partnership with those local authorities, to give impetus to water fluoridation? Will he also pick up the point raised by his noble friend and work with the Greater Manchester Combined Authority to see whether Manchester could be brought up to the level of the health of people in the West Midlands?

My Lords, of course Public Health England has a role to play here and works with local authorities that wish to introduce fluoridisation schemes. The noble Lord is quite right that this is not always co-terminous with local water supply. Public Health England agrees entirely with the sentiments of the noble Lord. I assure him that it will work with Greater Manchester or any other local authorities considering water fluoridation.