An unhealthy start

06 March 2010
Volume 26 · Issue 3

Who is to blame for caries in children’s teeth, asks Apolline?

The average five-year-old in 2005/06 had 1.47 decayed, missing and filled teeth, compared with 1.43 in 1999/00. So says a recent report by the Audit Commission on the health of young children. In areas of high deprivation it was worse. In the same period it rose from 1.46 to 1.75.

Steve Bundred, chief executive of the Audit Commission, said: ‘Overall, the findings are disappointing. Children need a healthier start in life and policies are not delivering commensurate improvement and value for money.’

Opposition parties not unnaturally saw this as yet another stick with which to beat the Government, but ministers found there was much to ‘celebrate’ in the report. The Chief Dental Officer for England is always telling us that the oral health of 12-year olds is the best in Europe, but that of five-year-olds has frequently been a cause for concern. It does not cover the four years since the new contract was introduced, so we cannot blame that. Who then should we blame?

It being election year perhaps we should start with the Government; it’s always their fault no matter what colour. But no Government has ever said: ‘Let’s ignore children’s teeth’ indeed, quite the reverse. They normally say: ‘We give the highest priority to child dental health.’ No minister has ever donned a white coat and embarked on providing dental care.

So what is their role? In short, to provide the policy, provide the money and provide a framework within which dentists can deliver the service. The policy was there; the money was there. The framework was there, it was basically capitation. Bring the children in from the earliest age; register them and we, the NHS, will pay you, the dentist.

So should we blame the dentists? Blame ourselves? There is a case. We have registered the children; we were paid the money. They started off caries free, so why didn’t we practise prevention and stop them developing decay? Many said there was no money in capitation for prevention, just as they say now that UDAs do not pay for prevention.

There is some truth in that but the fact is that many children, especially from deprived areas, did not arrive with us in a caries free state. Very few were registered under the age of two and some didn’t turn up until decay was well set in and they were in pain – every dentist’s nightmare. There never was 100 per cent registration; at its best it was about 80 per cent and the missing children were mainly in the most deprived areas and most susceptible to decay.

I read recently of an article which said that whether or not children receive regular dental care is strongly associated with their parents’ history of seeking it. The lead researcher said: ‘When parents don’t see the dentist, their children are much less likely to see the dentist.’ So perhaps we are now getting to the heart of the problem. Parents with grotty teeth who don’t have regular care produce children with grotty teeth who are not taken regularly to the dentist.

So let’s blame the mother. Another interesting statistic from the Audit Commission report is that, as well as an increase in dental caries, there has been an increase in childhood obesity. Could they be related? Fat mums

have fat kids; mums who neglect their own teeth also neglect their children’s teeth. Junk food and sugary snacks have been a problem for as long as most of us can remember. So perhaps they don’t need to go to a dentist; they need to be educated in how to give their kids (and themselves) a healthy diet.

There is no doubt in most dentists’ minds that regular attendance and putting across the principles of good prevention leads to better oral health. But this does require some co-operative and well-motivated parents. Yes these will, on the whole, be those who are better off and not those suffering deprivation who, to be fair, have other more pressing problems on their hands. It does not, however, resolve the problems of inequalities or of ‘broken Britain’.

This brings us back full circle to ‘blame the Government’. What are they doing to improve the oral health of five-year-olds in deprived areas? They will no doubt point to water fluoridation where they have removed some of the legal roadblocks. But in Southampton at least it has run into massive local opposition and other areas are having cold feet. And just how many of the vulnerable kids drink water? They are more likely to be given a sugar-laden drink.

Since these figures were produced we have had the new contract and the UDA system. This has removed registration and any encouragement or incentive to attend regularly. Without regular visits the ‘prevention toolkit’ the health department produced is useless. The UDA system encourages short courses and attendance more frequently than once a year for children is discouraged by the need to meet access targets.

Even if the Government was not to blame for the 2006 figures, it certainly will be for any rise in dmft rates in children since then.