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Let’s Get Involved
There was an eye-catching headline on the BBC website this week.
“Nursery toothbrushing saves £6m in dental costs”
Many of you may not have heard of the ‘Childsmile’ project. This is the result of a big investment by the Scottish Government over the years, with the idea starting in 2001 with pilot schemes and real action nationwide by 2010. Childsmile Core is a Scotland-wide initiative to help improve the health of children's teeth, through the distribution of free dental packs and supervised tooth-brushing programmes in all nurseries and the first two years in priority primary schools. The main scheme involves nursery staff giving supervised tooth-brushing to all children with continuity into the first two years at school. In addition, a number of nurseries and schools in targeted areas also provide fluoride varnish, applied by a dedicated team of trained staff. There is an accompanying education programme concerning diet and home care.
Those nurseries and schools participating in the application of fluoride varnish are identified as establishments who's children would benefit from preventative interventions. They are selected on the basis of the proportion of children attending the establishment who live in areas of relative disadvantage. For this, Childsmile uses the definition from the Scottish Index of Multiple Deprivation (SIMD). All this costs £1.8m a year and it has been assessed that the improvement to dental health has saved more than £6m in dental costs. The evaluation, funded by the Scottish government and carried out by Glasgow University, found that fewer children needed dental extractions, fillings or general anaesthetics as a result of the programme. There was also said to be a drop in the number of children needing hospital treatment for dental problems, freeing up operating theatres. Sadly, dentists are still needing to refer pre-school children to hospital units for general anaesthetic to remove decayed teeth but this has drastically decreased thanks to the scheme and taken another risk factor away from treating children.
Do the sums and you’ll notice that this isn’t necessarily a cost reduction exercise but one that results in less toothache, less trauma, less time off work for parents and less time away from school for the kids. Dentists backed the move to provide preventative treatment to stop teeth decay. One said: "It will hopefully remove pre-conceived views that many parents have of dentists' surgeries; fears that are often relayed to the child." One benefit reported (I’ll come to this later) is that as more children were driven into practice to benefit from fluoride varnishing, their parents, grandparents and friends came too. This boosted patient numbers and increased the number of registered adults.
As the canny will also know, brushing itself will not reduce the rate of dental decay in children. The science behind this was to get fluoride onto newly erupted teeth by any means possible, whether this was daily brushing or the application of varnishes. Along with this were leaflets concerning advice on diet.
Well, the evidence is there now, this works! So when will Englandshire Department of Health invest in something similar? Hang on, I think I can see a wee small pig flying over Parliament! So let’s get involved ourselves. The Community Dental Service seems to be contracting by the day and Health Promotion for children appears to be up to individual services. If practices can become involved with schools and nurseries locally, the benefits will pay as they did in Scotland with increased demand by adults.
Last year I became involved in a project for Y2 children at a local school, with a talk about teeth, a competition for a poster and even a poetry competition later in the year. Each contact with the school was an opportunity, as leaflets went home with the kids and feedback from parents was invited. This year, I’m going to be aiming my smile at older kids in a secondary school opposite the practice. It’s surprising how supportive and keen schools are to bring in outside speakers and projects. After all, it gives the teachers a rest!
There are consent issues with what you can do with children in establishments but try working with local nurseries and schools, you can’t buy this sort of publicity especially if reports of the activities reach local papers. Simple suggested activities -
- Oral health education for children in schools and nurseries.
- Advice and information for parents to help them care for their child’s teeth.
- Free dental packs, with toothbrush and toothpaste (get sponsorship if possible – local chemist?).
Invite parents to register with their children in order to gain -
- Fluoride varnish applications to children’s teeth twice a year.
- Supervised toothbrushing programmes in the practice.
In several practices now, we have initiated Children’s Days, in which all the staff dress up in fancy dress. We had fun and scooted through UDAs without it feeling like a chore. I would strongly suggest a whole day at Christmas with the surgery done up in twinkling lights and a little pressie for each child. Let your imagination go walkabout and see where you go, it becomes difficult to create boundaries for these events, so just have fun.
I once went out to do a talk at a local school and just on a whim asked the kids ‘Who has their own toothbrush at home?’. Only two children out of thirty put their hands up! I would never go again without a bucket-full of freebies to give out. This is a priority area in which we can all make a difference to public health, which can ‘tick off’ another box at CQC central. It is a sound marketing move. It can be fun.
Dr John Shapter - QCS Expert Dental Contributor