Health February 20, 2019
Giving children a Smile for Life

By Daniel Male - Accountable Care Journal

Over the past 40 years, national surveys show that the oral health of children in England continues to improve. Most children, but not all, enjoy a ‘Smile for Life’ but for some of the most vulnerable in our society there remains significant work to be done in tackling tooth decay.

Tooth decay is largely preventable but in England, the sad statistics that 1 in 4 five-year-olds are starting school with early childhood dental caries; and 141 children per day – some only a year old - are having decayed teeth removed in hospital, often under general anaesthetic, highlights the ongoing dental health issues some children are facing. In fact, tooth extraction remains the number one reason for child hospital admission in the 5-9 years age group. This is contributing to £35 million per year cost to the taxpayer and increased pressure on already strained GPs and emergency services.

The burden of childhood dental disease is compounded by persistent inequalities in oral health and dental access, with those children experiencing socioeconomic disadvantage, social exclusion and other vulnerabilities, at greater risk. This injustice intensifies when considering the far-reaching impacts of poor oral health. In addition to pain and infection, there are impacts on child development, growth, eating, speaking, playing, sleeping, school attendance and social interactions. Similarly, poor oral health may sometimes be a marker of wider health and social care issues, for example, obesity or safeguarding concerns.

High sugar consumption is a well-established causative factor in developing tooth decay, as well as obesity/diabetes. Public Health England recently reported that children have already exceeded the maximum recommended sugar intake for an 18-year-old by their tenth birthday. Other contributing factors include poor oral hygiene, lack of fluoride and a lack of public and professional awareness around the benefits of early years dental checks.

Currently, only a third of children under 5 years of age are visiting an NHS dentist each year. This means opportunities for dental teams to provide evidence-based preventive interventions are being missed, despite free NHS dental care for all children.

The good news is that we certainly know how to improve children’s oral health. Promoting healthy dental habits; reducing dietary sugars, toothbrushing twice daily with fluoride toothpaste, and regular dental attendance - starting with a first ‘Dental Check by One’ - are all crucial. As is system-wide collaboration and oral health integration across health and social care and children’s services, so that preventive behaviours can be nurtured both inside and outside of the clinic. Moreover, this enables additional support to be provided to the most vulnerable children who may not come into contact with dental services, ensuring we really are Making Every Contact Count.

There are many encouraging local and national examples of good practice which align with these principles:

  • The Children’s Oral Health Improvement Programme Board, led by Public Health England, is made up of organisational partners from health and social care, education, government departments and the third sector, working together towards an ambition that every child grows up free of tooth decay as part of the best start in life.
  • NHS England’s Starting Well initiative promotes early-years dental access, prevention and outreach for children aged 0-5 years, with a focus on vulnerable children and 0-2s. This involves collaboration between dental teams, local commissioners and local authority partners (e.g. health visitors).
  • The majority of Local Authorities in England are commissioning oral health improvement programmes for 0-5 year-olds e.g. healthy food and drink policies, supervised toothbrushing schemes in early years settings and schools, targeted provision of toothbrushes and toothpaste.
  • North Manchester’s golden ticket initiative ensures there is a care pathway to link children attending the hospital Emergency Department with dental symptoms to primary care dental services.
  • Mini Mouth Care Matters, led by Great Ormond Street Hospital and Health Education England, is a hospital-based programme developing training and tools for the whole secondary care team, in order to provide mouth care for paediatric inpatients and improve children’s health outcomes.

With traction building around such efforts, there are promising signs of change. From 2017 to 2018, dental access rate for children aged 0-2 years increased by approximately 35,000 children per year. In the same period, NHS England saw a 7.4 per cent decrease in the number of 1-4 year-olds admitted to hospital for tooth extractions. With children’s oral health, an integral element of the recently published NHS Long Term Plan, we can focus on national and local endeavours, build on these small improvements to address health inequality.

So what more could we be doing to accelerate progress in better oral health and support every community endeavour to improve children’s general health and wellbeing?

Collaboration and consistency in messaging across the multi-disciplinary stakeholder network is key to maintaining momentum. By aligning our support and signposting we can continue to tackle the inequalities gulf that blights our pursuit of excellent oral healthcare for all:  

  • Build links between primary & secondary care, Health & Wellbeing Boards, CCGs, NHS England Local Dental Networks, Dental Public Health Consultants and Local Authority teams (e.g. health visiting, social care, children’s centres) in order to:
    • Engage with and developing local dental services and oral health initiatives e.g. Mini Mouth Care Matters,
    • Develop integrated paediatric care pathways, with signposting and bi-directional referral processes for children and,
    • Shape the case for oral health integration at Primary Care Home, STP and ICS level
  • Promote Dental Check by One – a baby’s first dental visit by their first birthday;
  • Provide additional support for high-risk or vulnerable children, including those with complex care needs, who may require referral to dental services (general, community or specialist) or local oral health programmes;
  • Offer evidence-based oral health advice to children in our care and their parents/guardians.

SMILE4LIFE Campaign Posters

National PHE guidance found at and

For further information on how you can support better oral health care, please contact the Office of the Chief Dental Officer (, and request further details.

#ACJInsight #ACJDental