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TOWARDS BETTER ORAL HEALTH IN CHILDREN: ANALYSIS OF CONSULTATION RESPONSES

CHAPTER 7: PROMOTION OF ORAL HYGIENE

The consultation stated:

Dental health is a priority for a school's health education programme, and oral care is given attention throughout the curriculum from pre5 through to S6, but with the most emphasis in pre-school and primary education. All NHS boards, through their primary care trusts and their health promotion departments, have a large and varied input into dental health education. Many schools and nurseries are supported by regular visits from dental health educators. Schools and groups benefit most when programmes are collaborative and involve a range of health professionals, parents and carers.

HEBS regularly support national oral health initiatives. In 1996, the Board produced the resource, "Healthy Teeth in Healthy Mouths". The pack…was distributed free of charge to all primary schools in Scotland.

Over 100,000 pre-school children have already received free toothbrushes and free fluoride toothpaste to encourage prevention of dental disease.

NHS boards are continuing to expand nursery toothbrushing schemes.

Good oral health habits must start early. Special responsibilities devolve on parents: they themselves need to set positive examples in caring for their own teeth and must be equipped to instruct their children in the basic behavioural skills, which will stay with them throughout their lives.

Consultees views were:

In Detail:

GENERAL COMMENTS

As in the case of better diet, a large volume of responses favoured educating the public on issues of improving dental hygiene. A general view was that prevention was better than cure (indiv 708) and that advice could be fairly straightforward, such as clean teeth twice a day…. regular check ups…clean teeth last thing at night and drink only water afterwards (Biscuit, Cake, Chocolate and Confectioners Alliance). Borders LHCC, however, cautioned that educational materials should be suitable for the age, reading-age and social class of the recipient. Respondents' views were mixed on whether education was best targeted at parents (indiv 722), children (indiv 788) or both (indiv 850, Dumfries and Galloway NHS Board). Specialist advice was recommended for parents of children suffering Autism or ADHD (indiv 7). Education should be prioritised for those perceived as, " most at risk" (indivs 150, 152) and young people (indivs 246, 1201).

People needed to be reminded of the need for regular dental checkups (Torryburn-Newmills Community Council, indiv 542) and that these are free for those under 16 (GP 1207). The public should be made more aware of the 15-month dental registration period (Forth Valley LHC).

Several respondents commented on their clear preference for better promotion of oral hygiene rather than the introduction of schemes for fluoridation of water (Highland Movement against Water Fluoridation, indivs 33, 37). However, many others advocated the introduction of free or low cost fluoride toothpaste and tablet initiatives (indivs 209, 353, East Aryshire Council, Peebles and District Community Council). The promotion of sugar free gum was also suggested (indivs 110, 225, Scottish Civic Forum).

The cost of toothpaste and brushes was raised as a problem by many with calls for subsidising these or providing them free, especially in the case of low-income families (indiv 170) or for pre-schoolers (Lothian Area Dental Committee).

Some respondents recorded their general support for some form of campaign for better oral health, which needed to be "promoted vigorously" (Faculty of Public Health Medicine). Although it was recognized that this required adequate resourcing, " impoverished Scots stand to suffer the most from poor dental care due to lack of resources, information and encouragement from governments" (Royal College of Surgeons, Edinburgh).

Joined-up, multi-agency approaches were viewed as most effective in tackling poor oral hygiene (Renfrewshire and Inverclyde PCT, Greater Shawlands LHCC, Renfrewshire Council).

Interesting comments were made regarding the need for attitudinal and perceptional changes in relation to oral hygiene. Examples were:

Working with children at this level could result in the benefits of making healthy teeth a more desirable goal, with regular oral hygiene practice and dental visits vital steps en route.

Some respondents replied more specifically regarding promotion of oral health through schools, through parents, at a community level, via health professionals or promotion through advertising. These are taken in turn below.

PROMOTION THROUGH SCHOOLS

Many responses from individuals and a variety of organisations called for the strengthening and expansion of oral hygiene promotion in schools. In particular, respondents wished to see initiatives currently aimed at nurseries extended to target all primary age children.

Free toothbrush and paste schemes were widely encouraged with several commenting on the need to make existing temporary schemes permanent. Many respondents advocated use of fluoride toothpaste or drops in schools. A few called for the wider availability of fluoride mouth rinses - one idea being the introduction of a fluoride rinse vending machine (Aryshire Orthodontics).

A need was seen for a place for oral health on the school syllabus (e.g. Paisley University, indivs 471, 843, CDS Lerwick, Falkirk Council, Renfrewshire and Inverclyde PCT ) with teaching materials updated regularly and accessible across all ages (NHS Shetland).

Guidelines on oral health policy in schools would be welcomed (Aberdeen City Council, Westone/Riverside LHCCs) with the establishment of the new Government Health Promoting Schools Unit praised (S. Lanarkshire Council). Better educating of teachers on oral health was recommended by a few (indiv 21, Dental Surgeon 1297) with oral health initiatives accommodating those with special needs (Lothian Area Dental Committee).

A greater role was requested for oral health professionals within schools (indivs 195, 1012, Salsburgh County Council, Action for Sick Children (Scotland)) and not just at the request of the school authorities (Springburn Health Centre Respondents 3 and 5). Several called for dental check-ups to take place at school with the return of the school dentist (indivs 88, 235, 115, 1085, 446, 578, 875, Scottish Green Party).

A host of fun and innovative ideas were put forward for oral health promotion at school:

Many recognised the financial implications of such initiatives and proposed adequate funding be made available to support such promotion (indiv 797, 862, Scottish Community Dental service, Beechbrae Education Centre, Borders LHC).

PROMOTION THROUGH PARENTS

The main theme to emerge related to educating parents (both father and mother) to enable them to teach and properly supervise their offspring's' toothbrushing routines and dental visits. For example, one respondent recommended that parents should be given detailed information about quality toothbrushing, that they should brush their children's teeth up to the age of 11 and be given advice on the amount of fluoride toothpaste to use to avoid fluorosis (Dental Health Service Research Unit, Dundee University).

A few people went further and demanded that parents should be required to sign a dental card to confirm that regular toothbrushing was taking place (indiv 115) or should be compelled by legislation to co-operate with children's oral hygiene routines (indiv 237).

Collaborative promotional schemes involving both schools and parents were advocated (Angus Council Education, N. Aryshire Council) with more finance requested to support dental hygiene in the home (indiv 797).

PROMOTION THROUGH COMMUNITY

Respondents envisaged great potential for the promotion of oral health through various community settings. Many recognised that structures were already in place which could be utilized to deliver more powerful health messages, particularly in deprived areas (e.g. Lothian Health Council). Initiatives existing in Tayside, Glasgow and Fife were praised (Scottish Green Party, indivs 551, 971) with the Commission for Racial Equality advocating oral healthcare services that reached out to the community, rather than waiting for the community to take the initiative.

A framework for promotion in the community emerged from responses with roles carved out for:

• Family Centres/Community Centres (some focusing on young people (Falkirk Council); vulnerable groups including Gypsy/Travellers (Highland Council))

• Community Development Schemes/Approaches (one respondent citing the Possil Initiative as a good example (Greater Glasgow PCT))

• Healthy Living Centres

• New Community Schools

• Local Pharmacies

• Community Planning Systems

• Social Workers

• LHCCs

• Libraries (posters/information)

To support promotional work, a partnership approach between the Scottish Executive, Voluntary and Community sectors was called for by Voluntary Health Scotland).

PROMOTION THROUGH HEALTH PROFESSIONALS

There was general agreement that the role played by a variety of health professionals in promoting oral hygiene could be extended, strengthened and " significantly developed" (e.g. Greater Glasgow Health Council).

A common theme was the sharing of responsibility for promotion between dental, complementary practitioners and beyond. So promotion, " through primary care and the whole health team" (University of Dundee) was advocated along with " multi-disciplinary linking and support on oral heath" (NHS Shetland). Respondents saw this as requiring a change in the way health professionals were trained with the inclusion of oral health as a regular component of their education (NHS Lanarkshire, Greater Glasgow PCT, Lanarkshire Community Dental Service).

Some perceived scope for health professionals to undertake more evaluative work relating to oral health promotions (School of Nursing Midwifery and Community Health, Caledonian University) and raise the profile of oral hygiene by involvement in lecturing (Paisley University) and giving talks (indiv 788). Many respondents requested more outreach work involving professionals such as dentists and hygienists in, for example, visiting educational establishments. A call was made for more time to be earmarked for promoting dental health by dental teams (Consumers Association).

Many saw a central role for health visitors in, for example, " giving out water drinking cups, toothpaste and brushes…and playing a key role in promoting dental attendance and encouraging dental registration" (indiv 805). Other professionals singled out for promotions were PCDs, health improvement officers (a successful example was quoted in Aberdeen where the officer leads workshops and information groups with mothers (Aberdeen City Council)), the Primary Health Care Team or Oral Health Action Team, and local Pharmacists. Seen as the " ideal location to reinforce oral health promotion messages" (Scottish Specialists in Pharmaceutical Public Health), the Community Pharmacy was viewed by many as having potential to encourage dental registration, provide oral health products and advice and link in with other professionals (Area Pharmaceutical Committee, NHS Lanarkshire, Argyll and Clyde Area Pharmaceutical Committee, NHS Argyll and Bute, NHS Forth Valley Board).

Appropriate locations for the provision of advice were seen by many as health clinics including antenatal clinics. One cautionary note related to the "bounty bags" issued by hospitals to new mothers. The importance of giving clear guidance on the level of use of the fluoride toothpaste they contained was stressed (LHCC Easterhouse Health Centre, GDP 1282).

PROMOTION THROUGH ADVERTISING

Some respondents replied in general terms on what they saw as the need for concerted media oral health campaigns. A few recommended focusing on the pragmatic details of dental charges (indiv 1062) or the timings of check-ups and follow-up visits (Dental Surgeon 1288).

Some people envisaged the possibilities of grand-scale promotions focusing on attitudinal change, along the lines of previous drink-driving or anti-smoking campaigns (indiv 540, Aberfeldy Health Centre).

Opportunities were identified for involving well-known popstar and sporting celebrities and their healthy smiles in any advertising (indivs 482, 850, Paediatric Dental Specialist 214, NHS Forth Valley Board, NHS Argyll and Bute, Lothian Health Council).

Other initiative ideas were delivering positive messages via:

• Posters (including the use of oral health posters within GP surgeries)

• Leaflets

• Books for Children

• Messages on drinking cups

The need to ensure that any messages are produced in different community and other language formats was stressed (Commission for Racial Equality, British Dental Association, British Dental Association North Scotland Branch).

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