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Welcome to the Smile4Life Launch
Wednesday 27th October 2010
Helen DentonExecutive Director for Children and Young People
and Chair of Lancashire Children’s Trust
Collaborative Working
The Children and Young People's Plan
Julie GuestPolicy Development Officer for Health
Lancashire County Council
Eric RooneyConsultant in Dental Public Health NHS
Cumbria and Lancashire
What is Smile4Life?
Background
• Local Area Agreement (LAA) identified children’s oral health as a local priority• Lead for Lancashire County Council
identified• Children and Young People’s Oral Health
Strategy developed and approved by the LA/NHS partnership “Be Healthy Theme Group”
Julie Guest, LAA Lead for Oral Health
Melanie Smith, Dental Public Health Project Manager
Mel Catleugh, Consultant Dental Public Health
Eric Rooney, Consultants Dental Public Health
The Project Team
Developing the Programme
• Consultation events:– Children & Young People– Children & Young People Workforce– NHS Oral Health Teams
• The aim of the consultations were to find out:– What was already happening in Lancashire– What the gaps were– How the gaps could be addressed
The findings were developed into the
Smile4Life Programme
What is Smile4Life?
• A programme that supports co-ordinated activity with the aim of:– Reducing dental caries (tooth decay) in
children and laying solid foundations for good oral health throughout life
• Focussed on 4 key areas
Smile4Life Award Scheme
Enables Early Years Foundation Stage settings to demonstrate and be recognised for their oral health
improvement activity through the
• NHS Oral Health Improvement team to act as experts and advisors
• Local Children’s Centres to identify Oral Health Champion
• Dental practice staff to link with local settings
Implementation of the Smile4Life Programme
NHS Support for Oral Health Champions
Support the Oral Health Champion, using a standardised training and support package, to:
• Promote a Smile4Life environment by focussing on the four key oral health changes
• Work through the Programme Workbook
The Smile4Life Workbook
Programme Workbook
Programme Workbook
• Supports the implementation of the
Smile4Life Programme
• Helps them understand their current approach to oral health improvement
• Helps settings plan their activities• Helps them evidence their approach• Prepares them to achieve
the Smile4Life Award
Step 1 Work through the workbook and develop a plan
Step 3 Submit the evidence
Step 2 Implement the plan using the resources and collect supporting evidence
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Additional Resources
Additional resources have been developed to support the programme which include: • Leaflets• Poster• Standardised Displays• Website (hosted by LCC)
Evaluation Design• Process Evaluation
– Monitor the numbers of settings taking up the programme
– Review of the materials and support• Outcome Evaluation
– Monitor the achievement of the Smile4Life Award
– Monitor the oral health of the children
Percentage of 5-year-old children with decay experience (deciduous teeth) inLancashire Local Authorities including 95% confidence limits, 2007/08
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Monitoring Oral Health
Smile4Lifein the Early YearsDot SmithInterim Lead for Sure Start, Early Years and Childcare ServiceLancashire County Council
• Shared commitment to improve oral
health in the early years
• Strong partnerships and shared vision
• Building on existing good practice in Lancashire's Children’s Centres
• Early intervention and prevention
• Ante-natal sessions for mothers-to-be delivered in Children’s Centres including oral health messages
• Continued support with oral health in the post-natal period
Maggi MorrisChair of Lancashire Directors of Public Health
Director of Public Health, Central LancashireChair of Be Healthy Theme Group
Integrating Oral Health within the Public Health Agenda
Lord HoweParliamentary Under Secretary of State
(Department of Health)
Official Launch of the Smile4Life Programme
Group A – those with on your packs
Please help yourself to coffee in the foyer for the next
ten minutes and then return to the Oak Room
Group B – those without
Please stay to browse the displays for the next ten
minutes and then go to the foyer and help yourself to
coffee.
Both groups to reconvene at 11.20
Coffee and Displays
Sue GregoryDeputy Chief Dental Officer for England
Overview and National Direction for Oral Health Improvement
Launch of the Smile4Life Programme
Sue Gregory
Deputy Chief Dental Officer
27th October 2010Woodlands Conference Centre, Chorley
Decayed, missing or filled teeth (DMFT) at age 12 in the EU
http://www.euro.who.int/hfadb
Comparison of mean dmft/ DMFT for 5, 12 and 14-year-olds England and Wales, from 2000 to 2006
AGE YEAR MEAN dmft/DMFT
MEAN dmft/DMFT for chidren with caries experience
% CHILDREN CARIES FREE
5
2005/06 1.51 3.88 61%
2003/04 1.55 3.9 60%
2001/02 1.52 3.83 60%
11/122004/05 0.66 2.12 69%
2000/01 0.89 2.35 62%
14 2002/03 1.48 3.03 51%
Inequalities
Choice
Choosing Better Oral Health:An Oral Health Plan for England
Common Risk Factor Approach and Oral Health
Fits well with ‘Choosing Health’
Poor quality diet Inappropriate infant
feeding practices Poor oral hygiene Smoking Excessive alcohol
consumption
Prevention in practice
Simple messages Concise advice Evidence based with
strength of evidence Practical and easy to use Good reference for sugar
free medicines and fluoride concentration in toothpaste
Links with healthy eating
Studies that have been carried out by universities and commercial units were assessed by members of the working group.
Where a systematic review had been completed this highest level of evidence was accepted.
Items of evidence were pieced together to allow consistent messages to be produced.
Understanding the Evidence Behind the Messages in the Prevention Toolkit
Windsor Dental Practice, Salford
Hygienist
Smoking cessation adviser
Extended duties dental nurse
Therapists
Parents should brush or supervise brushing twice daily as soon as teeth erupt
Use only a smear of toothpaste containing no less than 1,000ppm fluoride
Do not allow children to lick or eat toothpaste from the tube
Children up to 3 years
Children 3–6 years Brush last thing at night and on one other occasion
Brushing should be supervised by an adult
Use a pea-sized amount of toothpaste containing1,350-1,500ppm fluoride
Do not allow children to lick or eat toothpaste from the tube
Spit out after brushing and do not rinse
Fluoride toothpastes are effective in reducing caries
in the deciduous dentition
1 study involving 2008 children
37%
reduction in caries in the deciduous dentition
Marinho et al. 2003
Evidence: Type 1
Fluoride toothpastes are effective in reducing caries
in the permanent dentition
74 studies involving 42,300 children
70 contributed to meta-analysis
24%
reduction in caries in the permanent dentition
Marinho et al. 2003
Evidence: Type 1
Frequency
Concentration
Rinsing
Amount
Factors affecting effectiveness of fluoride toothpaste
Brushing twice a day is more effective than once a dayEvidence: Type 1
Brushing twice a day reduces caries by a further 14% when compared with once a day
Marinho et al. 2003
Summary of clinical trials
1
3
5
7
9
0 500 1000 1500 2000 2500
Fluoride level (ppm)
DM
FS
incr
emen
t
Koch (1982)
Mitropoulos (1984)
Triol (1987)
Stephen (1988)
Conti (1988)
Fogels (1988)
Winter (1989)
Marks (1992)
O'Mullane (1997)
The benefits of fluoride toothpaste are concentration dependent
For every increase in concentration of 1000 ppm F there is a further 8% reduction in caries and vice versa
Evidence: Type 1
Marinho et al. 2003
Rinsing Method DMFS Incr
Use beaker (large vol) 6.9
Use brush 5.9
Head under tap 5.8
Use hand (small vol) 5.5Chesters (1992)
Reported behaviourEvidence : Type 3
Encourage spitting out of excess
Do not rinse with a large volume of water after brushing
Evidence:Type 3
The amount of toothpaste applied is not associated with the benefits
of fluoride toothpaste
Evidence:Type 3
30/01/15
Does the amount of toothpaste influence the effectiveness of a fluoride toothpaste?
Amount N (%) Mean DMFT
23 (1%) 5.96 (5.82)
3.68 (N=547)524 (18%) 3.58 (3.92)
2,024 (70%) 3.69 (3.69)
317 (11%) 4.24 (3.79)
3.76 (N=2,341)
Increment
The impact of variables on the effectiveness of
fluoride toothpaste
OPTIMAL
Twice daily
No beaker
1450 ppm F
Sub-optimal
Once daily
Beaker
1000 ppm F
Approximately 40-50% difference
in caries prevalence
Exploring the 4 Key Oral Health Messages
Frances PearsonOral Health Improvement Lead
NHS Cumbria
Science
=
Sugar+Bacteria Acid=
Tooth Decay+ TeethAcid
Science
Every time you eat something that contains sugar, you create conditions which allow tooth decay to develop
Science
So it is VERY important to limit thenumber of times this happens
Hidden Sugars in Foods and Drinks Sugars come in many disguises, so check
labels for hidden sugars such as:
HoneySucrose Glucose Glucose SyrupDextroseFructose Maltose
LactoseMolasses Invert Sugar SyrupMaltodextrinMaltoseOligofructose Hydrolysed Starch
Did you know?
Fruit juice and dried fruit can adversely
affect teeth because of their high concentration
of sugars and are not recommended for
consumption between meals
Kerry PlaceOral Health PromoterNHS East Lancashire
The Purpose of Brushing
• To keep gums healthy
• To apply fluoride toothpaste which strengthens and protects teeth from decay
Healthy Gums
Pale pink/Flat
Tight against the teeth
Do not bleed on
brushing
Amount of Fluoride Toothpaste
Smear(up to 3 years old)
Pea-size(over 3 years old)
Role of Parents/Carers
Up to the age of 7 years, children need help with brushing:
– Manual dexterity
– Spit don’t rinse after brushing
Margaret WilliamsSenior Oral Health Promotion Officer
NHS Central Lancashire
• General Health
• Oral Health
– Gum disease
– Oral Cancer
Relevance of these messages
Relevance of these messages
Gum Disease Oral Cancer
Tobacco
Tobacco use
–Smoking
–Smokeless
Alcohol
Men should not regularly drink more than 3 – 4 units of alcohol a day
Women should not regularly drink more than 2 – 3 units of alcohol a day
Alcohol
4% Vodka, Whiskey etc.
Tequila, Sambuca etc. 13%
330ml Bottle:1.3 units
440ml Can: 1.8 units
568ml Pint :2.3 units
Small (25ml): 1 unit
Large (35ml): 1.4 units
Double (50ml): 1.9 - 2 units
Small (25ml):1 unit
Large (35ml):1.3 units
Small Glass (125ml):1.25 units
Std Glass (175ml):1.75 units
Large Glass (250ml):2.5 units
Bottle (750ml):7.5 units
Bottle (275ml): 1.4 units
Binge Drinking
Binge drinking is defined as drinking an excessive amount of alcohol in a short space of time
• For men, that’s drinking 8 units during one session
• For women, that’s drinking 6 units during one session
Cecilia JaquesOral Health Promotion Officer
NHS Central Lancashire
Reasons for visiting the dentist• Prevention rather than cure
– Forming good habits
• Dental decay rapid process in children
• Early professional intervention– Opportunity to ask for fluoride
varnish
• Bump to birth and beyond– Free treatment for children and
pregnant & nursing mothers if you are an NHS patient
If a tooth is knocked out, stay calm and get the child
to their dentist as soon as possible
If a child does not have a regular dentist, contact the
NHS Help Line or NHS Direct for Advice
Dealing with Dental Trauma
NHS Help Lines
• NHS Central Lancashire 01772 777397• NHS Blackpool 01253 655200• NHS North Lancashire 01253 306378• NHS East Lancashire 0845 533 3230• NHS Cumbria 01228 603900
Thank You!
Thank you for attending today’s launch of the Smile4Life Programme. We hope you found it useful and will support the Programme in your area of work.
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