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Children: Oral Health

Volume 787: debated on Monday 4 December 2017


Asked by

To ask Her Majesty’s Government what action they are taking to address the problem of child tooth decay, in the light of the finding by Public Health England in its most recent oral health survey that 25 per cent of five year olds had experienced dental decay.

Public Health England, NHS England and the Department of Health are working together to improve children’s oral health. For example, the “Starting Well” initiative will support outreach to children not currently seeing a dentist in the areas of highest need, while dental contract reform supports our longer-term aim for all care to have a preventive focus. Furthermore, we are taking steps to reduce the amount of sugar consumed by children.

My Lords, I thank the noble Lord for that Answer. We all need to ensure that everyone fully understands the importance of oral health practice, which, ideally, should start when babies are six months old. It is therefore great to hear that NHS England has introduced the “Starting Well” programme. However, this is being delivered in only 13 local authorities, despite the fact that many children across the country suffer from tooth decay; indeed, it is the No. 1 reason for hospital admissions. Will the Government therefore consider taking further action by introducing supervised tooth-brushing sessions in all nurseries, as they do in Scotland, to improve oral health education for all our children?

The noble Baroness is right to highlight this important issue. Twice as many five to nine year-olds are admitted to hospital with tooth decay as are admitted with broken arms—that is how bad the problem is. It has improved in recent years: 75% of all five year-olds have no sign of physical decay, up from 69% in 2008. Supervised tooth-brushing is part of the “Starting Well” programme, but Public Health England and local authorities are responsible for commissioning and will look at the results to see whether it can be rolled out into general dentistry practice.

My Lords, does the Minister appreciate that in Australia and the United States there is widespread community fluoridation? Fluoride has been established as one way of preventing dental decay. I went on to Google today and found an article that states:

“With 60 Years of Data and 3000 Studies, Australia Declares Fluoride ‘Completely Safe’”.

That is supported by community water fluoridation, which means that your water authority cannot only see that the right amount is put in but will take out any oversupply above the optimum rate. The noble Baroness said that she thinks that oral health is important for children from an early age; I took my treatment antenatally for my children, who have very good teeth.

My noble friend is quite right that fluoridation is effective. The 2012 Act allows local areas to choose to introduce it—with local legitimacy, which is important because this issue still stirs passions. We encourage any local area considering this—I believe that Greater Manchester is one—to look at the study my noble friend mentioned in order to see its effectiveness.

My Lords, I am delighted that my noble friend mentioned the dental contract because the current target-driven contract was introduced in 2006. The Government committed to reforming it in their 2010 manifesto, but progress has been very slow. The latest reports speak of a national rollout no earlier than 2021. We urgently need a new contract that rewards prevention. Does my noble friend not agree that patients and dentists should not have to wait so long?

Yes, I agree with my noble friend. Preventive care is important. Pilot schemes have been going on in 75 practices to look at incentivising preventive care and population care. I understand that an evaluation report of that first full year of prototyping is due to be published in the new year.

My Lords, regarding fluoride and dental decay in children, can the Minister provide figures for the incidence of dental decay in areas that fluoridate their water compared with those that do not?

I do not have that exact comparison in front of me. I understand that areas that fluoridate have much better oral health than others, which is why, as I said to my noble friend, we encourage all local areas to look at the evidence and make decisions accordingly.

My Lords, does the Minister realise that, in order to get children to be seen by a dentist, their parents have to take them, and many parents are not happy themselves about going to the dentist? How can that be overcome?

Probably not by giving out lollies to say well done for coming. The noble Countess makes an important point, but some 7 million under-18s were seen by a dentist in the last year for which data is available, which is an increase on previous years, so I think that things are improving.

Will the Minister consider asking manufacturers of sugary cereals to include in the packet a free toothbrush, which would cost them very little?

That is one idea that I will certainly take away. Some of the impact that we are having is on reformulation, which is perhaps even more preventive than putting toothbrushes in cereals. There is a plan to reduce sugar in key foods by 20% by 2020, specifically for the benefit of children.

Does not part of the answer to this problem lie in that attractive four-letter word “milk”? Does not research evidence show that milk helps to protect the teeth of young children, as well as combating obesity?

I am sure that milk does have those benefits. I should also point out that one of the best things one can do for all bone health is to have vitamin D and calcium supplements, which are recommended for young children.

My Lords, I am sure that we are all grateful to the Minister for his wisdom in advising us on such important matters. I declare an interest as president of the British Fluoridation Society. To return to the point that I have raised with many Ministers over the past few years, the Minister says that it is down to local decision-making. The problem is that the hurdles that have been put in place make it almost impossible for local authorities to get fluoride into their water supplies. Will he look again at the rules and the law and agree that this is a strategic decision that needs to be made by government?

I am certainly happy to look again at that issue because we know the benefits of fluoridation. That is one reason why more children are having fluoride varnishes, for example.