Towards Better Oral Health in Children

The UNISON Scotland Submission To the Public Health Division of the Scottish Executive

On - "Towards Better Oral Health in Children: A Consultation Document on Children's Oral Health in Scotland"

See also updated submission Feb 2003

December 2002

Executive Summary

• UNISON Scotland welcomes the consultation paper as an important step in raising awareness of the problem of oral health in children and in highlighting the need to address this issue.
  
  
• UNISON Scotland supports the use of health promotion programmes, including the extension of the fresh fruit initiative. As well as improving oral health these programmes would have a knock on effect in improving children's health more generally
  
  
• We also support the planned shift to a more preventive approach to oral health and the use of treatments, such as fissure sealants, where they have been properly piloted and assessed.
  
  
• UNISON Scotland would support the use of increased resources to be directed to children in deprived areas to ensure that their oral health improves in line with those from more affluent areas.
  
  
• UNISON Scotland would hope that sufficient resources are allocated to ensure the full implementation of initiatives aimed at improving diet and oral hygiene including increased resources for community dental services.
  
  
• UNISON Scotland believes that the issue of water fluoridation would be best served by issuing a separate consultation exercise on this issue. There is some concern that this issue could detract from the positive initiatives highlighted in the consultation document. Where fluoride products are used in any health promotion initiative, parents should have the option of a non-fluoride alternative.

Background

This document lays out the Scottish Executive's case for improving children's oral health. It provides a depressing picture, backed up by statistics and international comparisons, as shown below;

• Over a quarter of a million (250,000) teeth are extracted from children every year,
• By the age of 5, 55% of children have dental disease,
• In comparison, 70% of 5 year olds in the Netherlands are decay free as are 71% of 5 year olds in Denmark.

The issue of inequality in child oral health with regards to social background was also raised. For instance, children from the most deprived areas are three times more likely to have experienced dental decay at the age of 5 years than children from the least deprived area.

The Scottish Executive also highlighted some of the actions currently being taken to address this issue. This includes combating the two main causes of dental problems, namely a high sugar diet and a lack of oral hygiene. Initiatives such as healthy eating programmes, health promotion events, visits to dentists and various community projects encouraging better oral hygiene are also highlighted.

The main purpose of the document though is to consult with the public and interested parties on proposed additional measures to improve the oral health of children. It is within this context that the Scottish Executive raises a number of specific issues. These are:

a) Diet and health promotion programmes, including:

- Extension of fresh fruit initiatives

b) Enhanced dental services and preventative treatments, including:

- Strengthening current links between the primary care medical team and dental services

- Encouraging greater use of professionals complimentary to dentistry in the dental care of children

c) Alternative ways of using fluoride, including:

- Expanded toothbrushing with fluoride toothpaste in nurseries and schools

- Use of fluoridated milk or salts in various settings

- Fluoridation of the largest public water supplies in Scotland

Diet and health promotion programmes

Diet is recognised by the Scottish Executive as one of the two principal causes of oral health problems. This is primarily down to the high sugar content in the typical Scottish diet. This in turn encourages acid production, which gradually erodes teeth.

There is also concern that the diet of children in deprived areas is worse than those in more affluent communities and this consequently has an impact on their oral health. The Scottish Executive report, Health in Scotland 2001 stated that, " A significant gap continues to exist between the dietary status of those from low and high income communities".

UNISON Scotland support the various initiatives that the Scottish Executive has launched to address Scotland's poor diet, including:

• The establishment of a Scottish Food and Health Co-ordinator,
• Production of a Scottish Diet Action Plan,
• Scottish Community Diet Project,
• Scottish Healthy Choices Award Scheme.

Improving the diet of children will improve not only their oral health but also their more general levels of health. This, in itself would be a positive move to encourage a more healthy diet and lifestyle. There is some need for co-ordination of all health promotion issues involving diet and the establishment of a Scottish Food and Health Co-ordinator is a positive step.

UNISON Scotland supported the recent School Meals (Scotland) Bill. We strongly believed that the bill tackled poverty and social exclusion, provided a welfare service free at the point of use, addressed poor nutrition standards in Scotland and related health problems, and a whole range of socio-economic and behavioural issues.

Given that the Bill did not receive the support of the Parliament, UNISON has supported the Scottish Executive Expert Panel Recommendations on School Meals (Please see our response to this consultation). The provision of healthy and nutritious food, along with the availability of water and milk is, for UNISON, urgently needed to address poor health, diet and oral health issues.

This issue can be further expanded by the use of schemes to supply children with free fruit at schools and nurseries. It would also be important to evaluate existing schemes before the implementation of a national scheme.

With regards to the issue of deprivation, UNISON Scotland believe more resources should be directed towards those children, and their families, in order to ensure that their diets improve in line with those from more affluent areas. This should include an examination of current initiatives on how they help to raise the dietary knowledge and intake of families in deprived areas. This may include concentrating on more breakfast clubs at school and nursery level as well as an expansion of food co-operatives to ensure access to a fresh range of fruit and vegetables.

Enhanced Dental Services and Preventative Treatment

The dental professions have a vital contribution to make not only in dental treatment but also in terms of health education. In looking at enhanced dental services there should be some action to ensure that all children can access a local dental practice. There is concern over the lack of local dental practices, especially in rural areas. This will need to be addressed in order to relieve the burden placed on community dental services.

The first step is to ensure that all children are registered with a dentist. This is currently being addressed by the Scottish Executive with an expansion of registrations that include 25,000 children under 2 years old since 1996. However only 65% of children are registered, with those not registered most likely to be the ones needing help. Visiting the dentist for regular advice, check-ups and treatment can contribute to changes in behaviours and attitudes to oral health and UNISON Scotland would support plans to extend registration to all children, particularly in deprived areas.

The links between dental services and the primary care medical team could be strengthened in a number of ways, some of which were highlighted in the Diet Action Plan for Scotland. This could include the primary care team encouraging parents to register their children with dentists as well as some dental practices being located in health centres and the use of a central appointment function. Every encouragement should be given to pregnant women to attend dental services before they give birth so that they can receive free dental treatment and advice. This would also give the dental team the opportunity to advise her not only about her own dental health but also of the importance of early registration of their children with a dental practice. This would also tie in with the issue of offering dietary advice to parents and their children.

The measures outlined above, such as a better diet and better dental hygiene, will have a positive effect. Another option currently under use is enhanced payments to dental practices for preventive treatment offered to children. This includes the use of fissure sealants (where a plastic coating is applied to teeth to protect them from dental decay) which it is estimated has benefited 50,000 children so far in a trail which should be extended, dependent on final trial results. UNISON Scotland would support the extension of such preventive treatments along with more health promotion campaigns.

The role of professionals complimentary to dentistry (hygienists, therapists, etc.) can also be developed to improve child oral health. This was outlined in the consultation paper, highlighting possible plans to move these professionals into the community where they can help reinforce the oral health promotion message. This can be achieved by regular visits to schools, nurseries, playgroups etc, to ensure that all children, and their parents, are informed of the importance of oral hygiene. UNISON Scotland would hope that sufficient resources are allocated to ensure that these initiatives can be fully implemented as well as ensuring that any staff given extra duties or responsibilities in the implementation of these measures would be suitably rewarded.

Alternative ways of using fluoride

This is the section of the consultation paper that is most likely to receive both public and media attention. It will lead to a strong debate between those for and against water fluoridation.

To help provide an objective view of the situation, the UK Government commissioned the Centre for Reviews and Dissemination at York University (the York Review) to carry out an expert scientific review of fluoride and health. This review, which was published in 2000, identified 214 studies of fluoridation. However its main conclusion was that not enough high quality research has been carried out to assess whether water fluoridation will have positive or negative effects.

UNISON Scotland believes that the issue of water fluoridation would be best served by issuing a separate consultation exercise on this issue. There is concern that this issue could detract from the positive initiatives highlighted in the consultation document. Where fluoride products are used in any health promotion initiative, parents should have the option of a non-fluoride alternative.

The basis of any plan to use fluoride would be best served by allowing people to make their own choice on whether to use fluoridated products or not.

For instance, there are already toothbrushing schemes in place which have provided around 100,000 pre-school children with free toothbrushes and free fluoride toothpaste to encourage prevention of dental disease. This should be extended to cover all pre-school and primary school children to ensure that they develop good oral hygiene practice. However there should also be some consideration given to parents who do not want their children to use fluoridated products, such as handing out alternative non-fluoride toothpaste.

Another method of increasing the update of fluoride is through the use of fluoridated products such as fluoride added to milk or salts. This method would rely on suitable products being readily available while ensuring that non fluoridated products could still be accessed by those opposed to the use of fluoride. This would result in a consumer-based choice to increase fluoride intake. However if these products are used within communal settings, such as nurseries, playgroups, schools, etc., there should also be a non-fluoride alternative.

For Further Information Please Contact:

Matt Smith, Scottish Secretary
UNISONScotland
UNISON House
14, West Campbell Street,
Glasgow G2 6RX
Tel 0141-332 0006 Fax 0141 342 2835

e-mail matt.smith@unison.co.uk