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Securing children’s dental future

Johnson & Johnson is delighted to bring you this article, with the aim of supporting the ongoing CPD needs of dental healthcare professionals in improving and maintaining the oral health of their patients.

This article is equivalent to one hour of Enhanced CPD. To provide feedback on this article, please contact dentalcpd@its.jnj.com

Learning outcomes

A,C,D

Aims and objectives

The aim of this article is to explore how dental health care professionals might best guide children and their parents to help achieve improved oral health.

On completing this CPD session, the reader will:

• Understand the prevalence and severity of dental decay in children in the UK, and that there is a north / south divide

• Understand the challenges both dental health care professionals and parents face in supporting children to improve their oral health

• Understand how parents can be helped to achieve better outcomes for their children

• Understand how DHCPs may have an impact on an individual basis, which might ultimately improve the situation nationwide.

Securing children’s dental future

This article explores how dental health care professionals might best guide children and their parents to help achieve improved oral health.

Public Health England’s 2017 report into the prevalence and severity of dental decay amongst five-year-old children revealed that 23.3% of that cohort had some obvious decay, with the average number of teeth decayed, missing or filled calculated at 3.4. The figures also indicated that nearly 17,000 children in this age group have had at least one tooth extracted.1

The most recent Children’s Dental Health Survey adds to this picture, with 46% of 15 year olds and 34% of 12 year olds having ‘obvious decay experience’* in their permanent teeth.2

In addition, the report, ‘Root causes: quality and inequality in dental health’, offered the following key point: ‘[…] dental health is better in the south and east of England, and poorer in the north of England: for example, children in Blackburn are four times more likely to have missing, decayed or filled teeth than children in South Gloucestershire.’3

The findings of these reports suggest that there remains an unmet need in relation to children’s dental care, despite dental health care professionals’ (DHCPs) best efforts. So, what might be done to improve the situation within the dental practice?

Family matters

Matsuo and colleagues (2016) suggested that interaction with a child will influence their oral health, and this is especially so when it comes to parental involvement. This idea may offer DHCPs an opportunity to support families in improving their dental health.4

Upon completion of Matsuo and colleagues’ (2016) study into the effect of parents’ oral health behaviours on children and mutual communication, they wrote: ‘Results showed that increased communication between family members positively influenced children's understanding of oral health, and it was not influenced only by parental behavior toward the child's oral health. Dental professionals should approach parents about communication between family members to improve the self-management ability of children.’4

Self-management or, as it is also referred to by Matsuo and colleagues (2016), self-efficacy is, of course, an important factor when it comes to influencing oral hygiene. It has been considered that there are four issues that affect self-efficacy:

1. One’s own experience

2. Vicarious experience

3. Social persuasion

4. Physiological factors.4

DHCPs may be able to use these four influencers to improve communication between family members, thereby enhancing the self-efficacy of a child. In relation to this, Matsuo and colleagues (2016) concluded: ‘Dental professionals should use strategies to increase communication between family members, as [a] child’s recognition was not influenced only by parent behavior toward the child's oral health.’4

Practical solutions

Although the prevention of diseases such as childhood caries rely on adopting and maintaining key health behaviours including twice-daily toothbrushing with a fluoridated toothpaste and reducing the intake of sugary food and drinks, it has been recognised that knowledge of these messages alone rarely achieves long-term change.5

Thus, as well as DHCPS understanding the issues that affect self-efficacy, they may also need to be aware of potential barriers. This may include, but is not limited to, parents’ belief that the problem is genetic and therefore outside of their control, or parents struggling to get their child to agree to brush (e.g. tantrums, tiredness) and avoiding conflict by allowing them to skip toothbrushing altogether.5

These challenges may be met in a variety of ways, which the DHCP may want to communicate to parents / guardians. For example, creating routines and structures within the family dynamic may help to manage twice-daily toothbrushing in children, perhaps adding them to the daily habits of washing and getting dressed. In addition, parents brushing their own teeth in front of their child may encourage the child to brush.5

It is also important to acknowledge that some parents may not be confident in their own levels of knowledge as to what constitutes an effective at-home oral health regimen. Some parents report confusion over detailed advice given, such as not to brush within half an hour of eating or drinking, or to be careful about a child swallowing toothpaste.5

To help overcome this, Duijster and colleagues (2015) wrote that clear oral health education is key, as is a positive approach. To that end, interventions that may of particular use include DHCPs offering support to parents’ skills in relation to oral health, such as the use of positive reinforcement, child management and the establishment of effective daily routines.5

Passing on good habits

Krupińska-Nanys and Zarzecka (2015) considered that, ‘Oral hygiene can vary in children within the same age group and depends on many factors, [some] of the most important of which are the hygiene habits of adults and the steps they take to pass on these habits to those in their care. Being aware of the need to take care of oral health is reflected in the frequency with which one brushes one’s teeth, uses toothpaste, mouthwash and dental floss.’6

To help overcome any challenges created by such factors, they offered a four-point conclusion that DHCPs may find helpful to bear in mind:

1. There is a clear improvement in children’s oral hygiene when they reach 11 years of age

2. When practising hygiene procedures, very young children should be under parental supervision

3. A relationship may exist between the failure to attend follow-up visits and a lack of desire among parents to improve the oral hygiene of their children

4. Parents need to be properly educated, and their attention drawn to the need to practice caries prevention.6

Adding to this, the government’s publication, ‘Child oral health: applying all our health’, suggests that DHCPs may have an impact on a patient-by-patient basis by:

• Ensuring all staff promote good oral health and access relevant training that is regularly updated

• Knowing the evidence-based advice and treatment that should be given. This can be found in ‘Delivering better oral health’ (available at www.gov.uk)

• Understanding how to help people change behaviour, for example, ‘Oral health promotion: general dental practice’ (NG30) (www.nice.org.uk/guidance/ng30)

• Making every contact count (MECC), which focuses on staff working with the public to offer appropriate and timely advice on health and wellbeing

• Encouraging early intervention and evidence-based advice, for example, ‘Dental Check by One’ (further information on this is available at www.bspd.co.uk).7

As stated succinctly in the Faculty of Dental Surgery’s report into the state of children’s oral health in England, ‘Education is the key to improving oral health, particularly in areas of social deprivation where rates of tooth decay are highest. Promoting good oral health in childhood will also help to ensure these lessons are continued into adulthood, thereby reducing the risk of decay in permanent adult teeth.’88

* Obvious decay experience includes untreated decay requiring fillings or tooth extraction, fillings and teeth lost because of decay, dmft for primary teeth and DMFT for permanent teeth.2

QUESTIONS: 

References

  1. National Dental Epidemiology Programme for England: oral health survey of five-year-old children 2017. A report on the inequalities found in prevalence and severity of dental decay. Public Health England 2017

  2. Children’s Dental Health Survey 2013. Health and Social Care Information Centre 2015

  3. Root causes. Quality and inequality in dental health. The Health Foundation and Nuffield Trust 2017

  4. Matsuo F et al. The effect of parents’ oral health behaviors on children and mutual communication. Pediatric Dental Journal 2016; 26(3): 122-128

  5. Duijster D et al. Establishing oral health promoting behaviours in children – parents’ views on barriers, facilitators and professional support: a qualitative study. BMC Oral Health 2015; 15:157-169

  6. Krupińska-Nanys M, Zarcecka J. An assessment of oral hygiene in 7-14-year-old children undergoing orthodontic treatment. Journal of International Oral Health 2015; 7(1):6-11

  7. Child oral health: applying all our health. Public Health England 2018

  8. The state of children’s oral health in England. Faculty of Dental Surgery, Royal College of Surgeons of England 2015