Oral Health Promotion in

the early years

Holly Owen

h.owen@nhs.net

Dental Hygienist/Therapist and Oral

Health Promoter

Oral Health Promotion and Dental

Outreach in The Borough of

Hackney and The City of London

We are carrying out a number of schemes to improve oral

health and reduce oral health inequalities in Hackney and the

City of London:

• Screening and Fluoride varnish for all reception and year

one children in school (including Charedi Jewish

independent schools)

• Supervised lunchtime brushing in SENCO schools

• Oral Health training for the wider professional workforce-

vulnerable adults and children

• Working with other professions to ensure that public health

policies are conducive to good oral health

• ‘Brushing for life’ scheme- distributing over 10,000 free

toothbrushes and toothpaste via health visitors, children’s

centre staff, family nurses etc

Aims of Session

• Explain the importance of early years workers in promoting oral

health

• Explain importance of good oral health in pregnant mothers and

0-5 year olds

• Explain the cause and implications of oral conditions

• Most importantly- Caries (decay)

• Deliver evidence based preventative advice

• Give early years staff the confidence to deliver oral health

promotion and empower parents to improve the oral health of

their families

• Explain how the oral health promotion team can support your

setting in promoting good oral health

Good Oral Health

• Good oral health can be a reality for

every child

• Dental caries (decay) is a

completely preventable condition in

the vast majority of cases

• A health mouth is:

-Clean

-Free of disease

• Retaining primary teeth aids in the

eruption of a healthy permanent

teeth

• Habits formed in the early years will

lead to a healthy, decay free adult

dentition

X ray of a two year old

Dental Caries (Decay)

Oral Health in Hackney

• According to the most recent Dental Health Survey of Five year olds

(PHE 2016)

• 27% of five year olds have decay

• This varies by ethnicity- 45% of Asian children, 32% of white children

and 23% of black children

• 9% have decayed front teeth

• 393 Hackney children had a GA in 2014-15 for extractions- £673 per

child

• Tooth extraction for decay is the most common reason for hospital

admissions in 5-9 year olds

• A small study of Charedi Jewish children in Hackney suggests that

decay is far more prevalent in this community- 58% of 5 year olds

examined were affected

Dental decay (caries) is

the gradual destruction of

a tooth caused by the

action of sugar on plaque

Tooth

Decay

Bacteria

Tooth

Time

Sugars

Dental decay is

completely preventable

It is essential that parents

are encouraged to take

responsibility for their

child’s dental health

• Brush 2x daily

• Use fluoride toothpaste

• Reduce sugar frequency

• Visit dentist regularly

Preventing Dental Caries

• As soon as teeth erupt in mouth

• 2x daily for 2 minutes

• Do not eat or drink anything after brushing at night

• For the best protection the whole family should use at least

1350ppm toothpaste- children do not necessarily need a separate

toothpaste to parents

• Use smear of toothpaste for babies and pea size for children

• Supervise brushing- children under seven cannot brush effectively

alone

• Spit and don’t rinse

Toothbrushing

Fluoride

• Fluoride is an ion that remineralises teeth and is clinically proven to be very

effective in preventing decay

• Topical fluoride is found in toothpaste, mouthwash and fluoride varnish applied

by dental professionals

• Two applications of fluoride varnish in a year proven to reduce decay by 37%

• Systemic fluoride found in some water supplies- Hackney DOES NOT have

fluoridated water (it has a naturally occuring fluoride level of 0.2mg to 0.4mg

per litre- the optimal amount for decay prevention is 1mg per litre)

• Fluoride is very safe and effective in the correct doses

• Young children should never be allowed to lick or swallow toothpaste-

excessive amounts of fluoride swallowed can cause mottling of the teeth

known as fluorosis

• Avoid sugary snacks including hidden sugars in yogurt, cereal bars, dried fruit

• Swap for crackers, fresh fruit/veg

• Sugar should not be consumed more than four times a day

• Only give water between meals

Diet

‘Early Childhood Caries’

AKA Bottle Caries

Early Childhood Caries

• Affects front surfaces of upper teeth

• Caused by prolonged contact of sugary liquids

• Seen when children are given sugary liquids in

a bottle

• Particularly when sent to bed with a bottle

Prevention

• ONLY give water or milk in a bottle

• ‘Bin the bottle’ after one year

• NEVER send to bed with a bottle

Aims of Oral Health Promotion and

Dental Outreach Schemes

Access to Dental Care

• Only 8.7% of 0-2 year olds in Hackney access dental services

compared to 13.3% in London and 19.9% in England

• Children should be taken to see a dentist as soon as teeth are

seen (from 6 months onwards)

• 55% of children living in Hackney access dental services

compared to 60% for London and 68% for England

• NHS dentistry is free for all under 18s

• The brushing for life packs include a list of local dentists

• Encourage parents to ask their dentist about fluoride varnish-

DOH recommends it is applied twice yearly to all over 3s

Oral Health in Pregnancy

• It is more important than ever to

maintain good oral health in

pregnancy- there are studies linking

periodontal (gum) disease and pre

term birth

• Pregnant women who smoke should

be warned about the links to

periodontal disease and early tooth

loss as part of smoking cessation-

smoking is the main risk factor in

periodontitis (advanced gum disease)

• Pregnant women and mothers of

babies aged under 12 months are

entitled to free NHS dental treatment

Teething

• Parents should be advised to brush teeth

twice daily with fluoride toothpaste as soon

as they erupt in the mouth

• Babies can be given a cooled (not frozen)

teething ring to chew on

• Ensure that any teething gels or painkilling

medications are sugar free

• 30-80% of children will have eruption cysts

which are usually symptomless and will

resolve on their own

• Natal or neonatal teeth may be present

which can interrupt feeding and may need to

be removed

Dummy Sucking

• Pronged dummy or

finger/thumb sucking can

lead to an open bite

• This is a particular risk in

children who maintain the

habit once they have

their permanent dentition

• Dummies should NEVER

be dipped in honey/jam

etc

Weaning

• Breastfeeding provides the

best nutrition for babies

• From six months infants

should be introduced to a free

flowing cup

• From one year feeding from a

bottle should be discouraged

• Children should only ever be

given milk or water in bottles

• Never add sugar to weaning

foods or drinks

Any Questions?

• Please feel free to email me with any queries you may

have

• h.owen@nhs.net

• Please contact me if you would like to book oral health

training for your staff or if you would like to join the

brushing for life scheme