UK Child oral health has been improving

Oral health on the agenda
7th March 2007
Chris Pedersen and Barry Cockcroft with the workshop leads at the Tower Hamlets forum
Two wide-ranging and stimulating forums were recently held in London and Huddersfield to discuss ways of improving the nation’s oral health.
The events, organised by the Department of Health and run in partnership with Colgate, were titled ‘Commissioning for Better Oral Health’ and provided an opportunity to exchange ideas and future strategies amongst those working in commissioning oral health services within Primary Care Trusts across England.
Representatives of more than 100 PCTs attended the London meeting, held at the Britannia International Hotel in the Docklands a few days after the Huddersfield conference in Kirklees.
Delegates heard from a number of high-profile speakers including Barry Cockcroft, chief dental officer for England. The benefits of the ‘Brushing for Life’ scheme were one of the themes discussed along with evidence for including fluoride in the prevention of dental decay.
Child oral health has been improving with fewer children experiencing tooth decay than 30 years ago. However, national surveys still show inequalities in dental health, especially among five-year-olds.

Stephen O’Brien, chair of Tower Hamlets PCT, the London borough where the event was held, said: ‘Tower Hamlets is in my view the most dynamic and thriving of all the boroughs in London with its mixture of deep poverty and extreme wealth. The Care Trust and the borough both feel they are making serious inroads into the area’s oral health challenges, but recognise there are still challenges ahead.’
Mr Cockcroft said: ‘This [initiative] is a two-stage process. Firstly to move from national contracting to local contracting, a process that began on 1 April 2006. The next stage is to go from local contracting to truly local commissioning.
'The main objective of our reforms of NHS dentistry was to give Primary Care Trusts a statutory responsibility to commission primary dental care services, to reflect the needs of their local populations. People can benefit as much from advice on how to prevent dental disease as from its treatment. Prevention is the theme of this event and I should like to thank Colgate for their continued partnership on this initiative.’

Tony Jenner, deputy chief dental officer, said: ‘As we come to the end of year one of the new contract arrangements, we want to see a move upstream towards a preventive focus, which was one of the key principles of why we undertook the process in the first place.

‘We want to create an environment where people feel they need to adopt healthier lifestyles. England leads the field in Europe when it comes to levels of decayed missing filled teeth but we can’t get complacent. Our regional levels mark out major inequities in the UK. There is a seven-fold variation between the best PCT marks and the worst. We are now targeting PCT commissioning managers and urging them to undertake oral assessment and gather local evidence-based data.

‘One of the major criticisms of the approach we have taken in the past is that oral health has been too narrow. I believe oral health must now be recognised as part of general health.’ He added that dentists could make a significant impact on problems such as obesity by advising patients on diet alterations.

‘Patients need to know that a visit to the dentist should be a health improvement opportunity. For instance, we want dentists to encourage the use of fluoride toothpaste, particularly amongst children in poorer areas, and also to work with PCT co-ordinators with regards to smoke cessation programmes.’

Jerry Read, project leader for the Oral Health Dental Education scheme, gave the audience an update on the Brushing for Life campaign, launched last September in conjunction with Colgate to encourage families in disadvantaged areas to brush their children’s teeth regularly with fluoride toothpaste.

He said he wanted PCTs to join the Brushing for Life scheme but advised that pre-planning in relation to storage of the toothpaste packs would need to be supervised. He also stressed: ‘Getting fluoride onto the surface of the teeth is one of the most effective oral health measures, and the most effective method of this is fluoridation of water. There may be some new schemes in relation to this before very long.’

Professor Robin Davies presented the findings of his research on the evidence of inclusion of fluoride as a means of prevention. He said that there was no doubt fluoride toothpaste had contributed significantly to improving oral health, although the amount of it used while brushing appeared to have little or no effect.

Andrew Ridley, director of primary and community care commissioning at Tower Hamlets PCT, gave an enigmatic speech on how his team was making progress towards improving oral health in the borough.

‘We are very much still learning and still trying to tackle deep-rooted problems in health investment,’ he said. ‘I act as a bridge between the specialists and the people who fit national policy into daily improvement on the ground.’

Among his ideas for future success was re-allocating unused or declined UDAs to areas of higher need, evening and weekend openings and, bearing in mind the ethnic diversity in his borough, additional services in specific languages.

‘Being bolder in terms of geographical access and sorting the inequalities of investment by re-commissioning old capacity or through growth is essential,’ he added. ‘We need to shift our thinking from UDAs to preventative UPAs. It’s too late in the day to keep debating the new contract and UDAs, we need to move on and a create a new debate – a focus on issues such as oral health needs, competitive tendering and value for money.’

Chris Pedersen, general manager at Colgate-Palmolive (UK) Ltd, said: ‘We are in the business of preventing tooth decay and have a long standing track record in promoting oral health. We’re delighted to be in these forums as they represent a unique opportunity to explore how prevention can be incorporated into commissioning NHS primary care dental services. It’s a chance to share insight and expertise, and we hope these discussions will stimulate new opportunities.’
Following the conference the attendees took part in a selection of workshops to discuss their ideas and working practices in more detail.