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For a disease that is eminently preventable, the focus of childhood dental decay has tended to be treatment orientated and siloed as the responsibility of the dental profession. While contemporary evidence continues to support the effectiveness of prevention and early intervention, dental attendance before the age of 2 years is uncommon. However, contact with other health professionals during a child’s first 2 years of life is high. With this in mind, this editorial introduces a series of articles that outlines why childhood dental decay is everyone’s business, the nature and extent of childhood oral health issues and how we could be addressing the complex aetiology of early childhood caries through a progressive, collaborative approach. Our aim is to highlight the range of contemporary clinical interventions and innovations in prevention. In raising awareness and stimulating discussion, we see many opportunities to strengthen the link between the paediatric and the dental care communities to the benefit of our patients.
The impact of poor oral health is not limited to the mouth, and the repercussions are not limited to childhood. In preschool children, dental caries has been shown to affect body weight, growth and quality of life, such that comprehensive treatment has bearing on psychological, social and educational spheres.1 2 The development of phonics and reading skills requires teeth to tongue contact, a confident smile relies on an intact dentition and quality of nutrition demands masticatory capacity. Moreover, with risk factors common to a number of other non-communicable conditions, childhood dental caries is now recognised as a marker of wider health and social care issues2 3 and may signal safeguarding issues.4
Appreciating that oral health impacts on health, and well-being must act as a driver to instigate key alliances across the health and social care spectrum. Many will recognise the call for multiagency collaboration to tackle the complex interplay of factors that cause childhood diseases. Applying this principle to the oral health agenda is no different. With the requisite traction across the broader health and social care domains, the opportunity for synergy and focus on prevention and behaviour change in tackling common risk factors (eg, diet and lifestyle) are significant.5 In setting the context for our call to action, our first contributor, Jenny Godson6 will present evidence of the enduring inequality in oral health and outline the case for concerted collective action.
While the reality of a generation of caries-free children is still some way off, the prospect of a generation of cavity-free children is possible. The requirement for operative intervention will remain, but in their contribution to this series of articles, ‘Recent advances in the management of childhood dental caries’, Nicola Innes and Mark Robson describe new techniques and the shift towards a less invasive, more child-friendly caries management process. This adoption of a ‘physician approach’ to the management of caries provides an opportunity to work with parents in maintaining the oral health of their children. Success is predicated on concurrent preventive programmes involving diet investigation/management and reorientation of lifestyle factors negatively affecting oral health.
The basic prevention and caries management tools are tooth brushing and controlling the frequency of dietary sugars, supported by a risk-based dental recall schedule. Mouth care should commence before teeth erupt; every child should have their initial dental check ideally when their first teeth appear in the mouth, but certainly no later than their first birthday. There remains widespread misunderstanding about when routine check-ups with the dentist should commence. In the 12 months leading up to 31 March 2017, less than 12% of children in England under 2 years visited a National Health Service dentist. In the same period, almost 60% of children aged 1–4 did not have a dental check-up.7
There is evidence of a social gradient in the experience of childhood dental caries. With children in deprived communities less likely to be taken to dental care providers,8 opportunities to implement preventive programmes such as fluoride varnish, fissure sealants or manage disease in its early stages are lost. Sadly, this same disadvantaged cohort forms the majority of children under five who are admitted to hospital for the removal of severely decayed teeth. Many of the children that find themselves in a General Anaesthetic suite awaiting dental extractions are already known to other health and social care professionals.
While dental attendance in the UK before the age of 2 years remains low, those health professionals in regular contact with children are the vital conduit for oral health advice. Building on this intent to make every contact count and realising the impact of interdisciplinary relationships is described by Jasmine Murphy in her article, ‘Maximising paediatricians’ roles in improving children’s oral health—lessons from Leicester’.9 From commissioning services and oral health improvement programmes to identifying and advising families that needed additional support, commissioners, local authorities, health professionals, education and voluntary organisations, all engaged and committed to integrating oral health into broader child healthcare services. The Leicester City initiative, Healthy Teeth Happy Smiles, engendered vital interdisciplinary connections, delivered interprofessional education and redesigns in the provision of local child services. The resulting improvement in the oral health of children, in one of England’s most ethnically diverse and deprived cities, is testament to the impact of collaborative action.
The desire for a more collaborative approach has been endorsed by the inclusion of child oral health in the January 2017 Royal College of Paediatrics and Child Health (RCPCH) report, State of child health. The report emphasised the need to tackle poor oral health in children and significantly recommended that paediatricians should include oral health in their assessment of a child’s general health. From a series of relatively simple questions about tooth brushing and dental history, through to ‘lifting the lip’ and an intraoral examination, vital indicators of an eminently preventable disease and wider dietary, health and safeguarding issues may be identified and addressed. The complex area of safeguarding and interpretation of oral findings as indicators of maltreatment will be explored by Jenny Harris in the final article in our series, ‘The mouth and maltreatment: safeguarding issues in child dental health’. The article will further consider the contribution that dental professionals can make to child protection and discuss the opportunities that exist to forge closer working relationships between dental and paediatric teams in protecting vulnerable children.
We all desire a future where the possibility of caries-free children is realised. This ambition must be driven by our common vision to deliver excellent quality care for our patients. Often marginalised groups of patients, those that are most vulnerable, present a unique challenge to our allied professions. By approaching the complex aetiology of childhood dental decay collaboratively, innovatively and by taking ownership of the moral impetus to provide the requisite solutions, we can make every contact count and improve the lives of those who need our help the most.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
Author note The article that accompanies this Editorial is the first in a series of four that will appear in subsequent editions of Archives of Disease in Childhood.
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