25 January 2018, The Museum of London

Join Sara Hurley, Baroness Floella Benjamin and other leading figures in dental health at this unique one-day event.

The recently published ‘State of Child Health’ report revealed that 31-41% of 5-year-old children across the UK are affected by tooth decay and this is the single most common reason why children aged five to nine are admitted to hospital. This represents a significant, but avoidable challenge to our NHS.

To tackle this problem, it is up to all professionals that work with children to spot the signs of poor oral health and take the appropriate action. In turn, we believe this will drive improvements in child oral health, leading to less hospital referrals and less complications later in life.

But, we can only achieve this by working together, with dental professionals, like you.

‘Insights: Why Children’s Oral Health is Everybody’s Business’ is a new event from the Royal College of Paediatrics and Child Health organised in partnership with the Office of the Chief Dental Officer and the British Society of Paediatric Dentistry. The event aims to bring together those who work with children including paediatricians and teachers, as well as dental professionals, to share best practice, compare experiences and hear insightful talks from leading voices.

Speakers confirmed for the main event will form a prestigious line-up, including Baroness Floella Benjamin OBE, Sara Hurley, Dr Jenny Godson and many more.

Here’s what Sara Hurley, Chief Dental Officer England, had to say about the summit:

“This event is a vital response to the call for multi-agency collaboration to tackle the complex interplay of factors that cause childhood diseases. A real opportunity to understand why childhood dental decay is everyone's business, the nature and extent of childhood oral health issues and how it impacts on general health and well-being.  At the heart of the event is an opportunity to develop a progressive, collaborative approach and strengthen the links between the paediatric and the dental care communities to the benefit of our patients.”

Find out more about this event at www.rcpch.ac.uk/insights-oral

This month is Mouth Cancer Action Month, a charity campaign set up by the British Dental Health Foundation (BDHF) to raise public awareness of mouth cancer. The campaign has been long running; spearheaded by the late Richard Horner, founder of Scope Group and well known among the dental media and trade, in 1998. He retired in 2003 and handed over the project to the BDHF, who have done much work to raise awareness of mouth cancer;  pushing through changes in legislation in relation to the tobacco industry, including a direct marketing ban and the smoking ban.

Over the last year concerns over the Nation’s oral health have hit the headlines; from concerns over children’s oral hygiene, the effect of sugar and proposals for a ‘sugar tax’, and more recently revelations regarding the poor state of professional footballers’ teeth. This article will consider the nations awakening interest in all things oral health, and what impact this has on the fight against mouth cancer.

Children’s Oral Hygiene

In 2013 the Health and Social Care Information Centre commissioned a survey in relation to Children’s Dental Health. This survey has taken place every 10 years since 1973 to track changes in the oral hygiene of children.  The results were published in early 2015 and found the following:

·         The nearly a half (46%) of 15 year olds and a third (34%) of 12 year olds had “obvious decay experience” in their permanent teeth. This was a reduction from 2003, when the comparable figures were 56% and 43% respectively.

·         The proportions of children with some untreated decay into dentine5 in permanent teeth have also reduced, from 32% to 21% of 15 year olds and from 29% to 19% of 12 year olds.

·         In 2013, nearly a third (31%) of 5 year olds and nearly a half (46%) of 8 year olds had obvious decay experience in their primary teeth6. Untreated decay into dentine in primary teeth was found in 28% of 5 year olds and 39% of 8 year olds.

·         In 5 year olds, the average number of primary teeth with obvious decay experience (dmft) was 0.9. Among 5 year olds with such decay, the average number of teeth affected was 3.0.

·         In 12 year olds, the mean (average) number of permanent teeth affected by obvious decay experience (DMFT) was 0.8. Among 12 year olds with any such decay, the mean number of teeth affected was 2.5.

The survey also looked at lower income families by assessing the oral health of children who had free school meals. The findings for this group were as follows:

·         A fifth (21%) of the 5 year olds who were eligible for free school meals had severe or extensive tooth decay, compared to 11% of 5 year olds who were not eligible for free school meals.

·         A quarter (26%) of the 15 year olds who were eligible for free school meals had severe or extensive tooth decay, compared to 12% of 15 year olds who were not eligible for free school meals

Around this time the Faculty of Dental Surgery at the Royal College of Surgeons of England (RCS) also published a report in relation to the state of children’s oral health. The RCS was seriously concerned about the state of oral hygiene in children and noted the regional inequalities in the results. The report confirmed that in 2013-14 approximately 46,500 children under the age of 19 were admitted to hospital with a primary diagnosis of dental caries.  The RCS estimated that 90% of dental caries are preventable.

Sugary drinks have been blamed for the poor oral hygiene in children, with many seeing sugar as the new tobacco. We reported on this in Issue 4 of our Dental Bulletin, at which time Tesco had banned sugary drinks from its shelves and Coca-Cola had funded research which down-played the effect of sugary drinks on teeth.

Since that Dental Bulletin the Government has come under increasing pressure to implement a sugar tax and for the food industry to have clearer packaging as to the amount of sugar in their products.

Jamie Oliver has been a campaigner for the sugar tax for a while, even implementing the tax in his own restaurants. He has a ‘five point sugar manifesto’, which includes the sugar tax and banning advertisements for junk food before 9pm. On 19^th October 2015 he also appeared before a committee of MPs to discuss the sugar tax, in which he asked David Cameron to ‘frankly, act like a parent’ with the food industry.

Meanwhile, Jeremy Hunt was accused of delaying Public Health England’s (PHE) report on the subject, which was meant to be published in July 2015. The report was finally published on the Government website on 22^nd October 2015; it appears his hand was forced after Dr Alison Tedstone, director of diet and obesity at PHE, went public with details of the report.

The highlights from the report are:

·         Treating obesity and its consequences alone currently costs the NHS £5.1bn every year;

·         Reducing the Nation’s sugar intake in the next 10 years to the recommended 5% (or 30g per day) could save the NHS £484m a year;

·         The influencers to buying sugary products include:

o   Advertising:

o   Food retail price promotions. Foods with higher sugar content are among the highest food retail price promotions on offer in stores:

o   Taxation on products:

·         Evidence shows lowering sugar in foods will help reduce consumption. This has a proven track record in relation to the reduction of salt in foods;

·         The report recognises that one single action will not be effective and a combination of changes will be needed to reduce the sugar intake of the Nation. Eight changes are recommended and these include:

o   A price increase of  a minimum of 10-20% on high sugar foods:

o   Reduce and rebalance price promotions;

o   Reduce opportunities to market and advertise.

What is evident from reading all the reports above is that children from lower income families are amongst the worst affected. Yet the Government is still reluctant to take action against the food industry. This is surprising as greater public awareness of the risks of sugar will surely help increase calls for change, hopefully resulting in similar action being taken against the food industry as has been achieved with the tobacco industry. 

Professional Footballers

On the opposite end of the spectrum, recent research has shown that wealthy professional footballers are amongst the worst culprits for bad oral hygiene.

Research carried out by University College London and published in the British Journal of Sports Medicine, found that nearly 4 out of 10 professional footballers have ongoing tooth decay; 57% have tooth erosion; and 8 out of 10 have gum disease, which in some cases was irreversible. Compare this with the national average, where 3 out of 10 adults suffer from tooth decay.

So why is it that professional footballers have such bad oral hygiene? Again, sugary drinks may be to blame, with the footballers drinking sports drinks during training sessions and games to help maintain energy levels. However, with appropriate oral hygiene, it has not been proven that drinking such drinks would harm teeth.

Similar research was carried out by the same study author, Professor Ian Needleman, on professional athletes during the London Olympics in 2012 and this report had similar findings in relation to the state of the athletes’ oral health.

Many people may be surprised at how oral hygiene can have an impact on one’s health and well-being in general. 7% of professional footballers and 18% of professional athletes said bad oral health had affected their training.

Dr Claudio Peru is a specialist endodontist and the principle at Chiswell Green Dental Centre.  CGDC have been working with Watford FC for the last two years, during their rise to the football Premier League. Dr Peru is responsible for the dental health for the players. His view on the importance of dental health in elite sports people is as follows:

“The importance of ensuring optimal dental health for professional athletes, including footballers, cannot be understated. By ensuring the dental health of players, they are able to train and perform during matches without being impaired by acute or chronic dental problems. There is an obvious economic advantage to the club. In particular we find that by addressing occlusal imbalances we are able to optimize neuro-muscular coordination and the postural balances. This is particularly important for the competitive performance of athletes.”

The studies did not give any conclusions as to why these professionals had such poor oral hygiene; many saying they visited a dentist regularly. With access to the best dentists and products surely there is no excuse for this.

Mouth Cancer Action Month

Mouth cancer is one of the few remaining cancers that is likely to increase in numbers in the coming years; the disease has already increased by a third in the last decade. In the UK last year 6,767 people were diagnosed with mouth cancer.

Mouth Cancer Action Month hopes to raise awareness of the symptoms of mouth cancer and the benefits of taking action early on.  The key message from this campaign is that early detection is key and it encourages the public to regularly visit their dentist.

The British Dental Association (BDA) has published an article highlighting the vital work dentists and their teams have in making the public aware of mouth cancer and early detection. It confirms that if detected early there is a 90% survival rate; compared with 50% where diagnosis is delayed. 

The BDA is also supporting HVP Action’s campaign for the HVP vaccination given to girls to be extended to adolescent boys (rather than just those between 16 and 40 who are having sex with men as recommended by the Joint Committee on Vaccination and Immunisation). It is thought that the HVP virus is likely to rival tobacco as the number one cause for mouth cancer in the coming years; the rate of mouth cancer is expected to double between 1995 and 2025.

If you want to get involved in Mouth Cancer Action Month you can visit their website here. We will be doing our part to raise awareness; look out for JFH Law’s #bluelipselfie.

Laura Pearce, Senior Solicitor

As the Association of Dental Groups (ADG) continues to promote prevention of dental health problems and delivery of quality outcomes for patients in a sustainable, high quality manner, Mouth Cancer Action Month remains of utmost importance.

“As long term supporters of the British Dental Health Foundation and Mouth Cancer Action Month, we are as pleased as ever to be able to contribute to such a worthy cause,” comments Chair of the ADG, David Worskett. “By working together we can tackle oral cancer and make a real difference to those who suffer, one campaign at a time.”

Indeed, now that Mouth Cancer Action Month is underway – as launched by the British Dental Health Foundation on the 29^th of October at the House of Commons – the ADG will once again resume its task of raising awareness on diagnosis and prevention.

Currently, statistics show that only 40% of patients who develop mouth cancer visit the dentist with concerns. [i] But as Chief Executive of the British Dental Health Foundation Dr Nigel Carter OBE explains, “if the dental and wider health profession can inform and urge patients to regularly attend dental check-ups, we can increase the chances of mouth cancer being detected at an early stage.”

If any headway is to be made, these wise words must be implemented. Indeed, with the latest figures showing that 6,767[ii] people are diagnosed with mouth cancer in the UK each year, it is important that as many people as possible get involved with Mouth Cancer Action Month.

Whether it’s the Blue Lip Selfie Campaign – where all you need to do is take a selfie of yourself and share it with the hashtag #bluelipselfie – or showing your support by wearing a blue ribbon badge, your participation is crucial to the success of the campaign.

Another useful tool available is the oral cancer CPD module available through the ADG, designed by {my}dentist. While it may not be mandatory, recapping on areas such as early symptoms, referral and treatment pathways for the disease and improving patient awareness could be the difference between saving and losing a life.

That is why the ADG is pleased to announce the return of the CPD module, and hopes that the tool will help in the battle against mouth cancer. The module is free to review, with only a small cost of £25 plus VAT – £5 of which will be donated to the British Dental Health Foundation and the Mouth Cancer Action Month campaign – for those wishing to apply for a CPD certificate.

Ultimately, the campaign needs all the help and support it can get, especially as research indicates that early detection of mouth cancer can result in a survival outcome of 90%.[iii]

For more information on Mouth Cancer Action Month, the CPD module and to find out how you can be a part of the month long November campaign, contact the ADG today.

For more information about the ADG visit www.dentalgroups.co.uk.

Recent research has revealed that only half (53%) of UK parents, with children under the age of 12, take their children to visit the dentist regularly[1]. Furthermore, just a quarter (25%) of parents believe it is important to take a baby to the dentist as soon as they develop their first baby tooth. This coincides with reported figures that suggest dental caries among children are rising[2] and that more children in England are being admitted to hospital because of tooth decay than for any other reason[3].

These worrying trends highlight the need for healthcare professionals to educate parents on the importance of regular check-ups. Creating a more child-friendly practice could also help to improve the number of children visiting and encourage them to return.

Starting with the entrance and reception area, practices should be inviting and put both adult and child at ease from the moment they walk in the door. Parents should feel comfortable enough to want to bring their babies to the practice, so that the dentist can check on the development of the milk teeth and ensure any problems or signs of decay can be identified and addressed early⁴.

A small number of changes can be made within the practice to enhance a child’s experience, for example:

• Smaller chairs for children to sit on
• A specific area in the waiting room with toys, comic books and magazines
• Experienced and friendly staff who can help to build a child’s trust
• Providing stickers, sugar-free sweets or healthy snacks for children at the end of their treatment.

It is essential to gain a patient’s confidence within the operatory room, and despite including some of the above changes, the dental chair can remain a particularly daunting place. Climbing into an intimidating chair and letting a masked, gloved stranger poke around in their mouth can be a big deal for some young patients[4]. It is important that all patients feel safe and relaxed, and a dental unit that looks and feels comfortable will help achieve this.

A modern stylish dental unit, such as the innovative Skema 8, will reassure patients that they are going to be well looked after and help keep stress to a minimum. Developed by leading manufacturer Castellini, the Skema 8 is designed to optimise the workspace while improving patient comfort. Dentists can work easily without leaning over the patient, and by not intruding so much on a child’s space this may reduce worries and ensure a quick and efficient appointment.

Maximise comfort and provide a professional service to all your patients with the Skema 8 – contact the experienced team at Castellini to find out more.

If you want more information on how to receive Castellini Technical Accreditation, please call 08000 933975 and speak to Castellini UK Ltd directly for assistance.

The pubic perception of dentistry is not a flattering one. Recent new stories in the national press only serve to highlight this. The problem is that we don’t tell people what we do.

We don’t inform and educate the public around the benefits to their general health of taking care of their oral health. All too often they think that all we do is fix holes and extract teeth and apply expensive crowns; but of course we do much more and we should be shouting about it.

A perfect example of this is in the relationship between diabetes and periodontitis. There are clear, established links that reveal how the treatment of one can positively affect the other, but when was the last time you took the time to share this with a diabetic patient?

Recently, I met Dr Leticia Casanova, a Spanish Dentist who trained as a periodontist at New York University and has a PhD in Medicine, studying the connection between diabetes and periodontal disease, so she has a particularly relevant perspective. Dr Casanova recently published an article in the BDJ entitled, Diabetes and Periodontal Disease: A Two-Way Relationship.[i] The article says that if you can control people’s periodontal disease, you can actually see a genuine reduction in their diabetic condition.   

A measure of how well a diabetic is coping is in their glycated haemoglobin levels and this is recorded as a percentage. Every drop of 1% reduces the risk of heart disease and damage considerably. The article explains that being diabetic leads to an increased risk of developing periodontitis and that having periodontitis can also affect the body’s glycaemic index (in people with or without diabetes). So if you control somebody’s periodontitis, through delivering first class periodontal treatment, and then measure their glycated haemoglobin, it is possible to see a drop of up to a half per cent and this will really make a difference to their life.

The article from Dr Casanova effectively shows the interrelationship between the two problems and explains how we can deliver dental treatment that positively affects systemic disease. This leads back to my initial point, that we don't highlight the positives that we do for our patients enough. If general dentists were seen to take a more active lead in the medical conditions of their patients, maybe this would raise the profession in the eyes of the public?

The prevalence of diabetes is phenomenal, and periodontitis is three times more likely to affect those who suffer, and a lot of diabetics become edentulous, effecting how they eat – and this is not to mention the already well established links between gum disease and heart disease. So, if through making changes in our approach we are able get a patient’s diabetes better under control, we would be performing a far greater public service.

We should therefore take every opportunity to play a bigger role in our patients’ general well being. Not just in performing oral cancer scans, which are vital and we should all already be doing, but maybe through routinely measuring blood pressure, iron and sugar levels too, so that people will begin to see us not just as people who fix holes, but as doctors that can help with a medical condition.

For further information please call EndoCare on 020 7224 0999

Or visit www.endocare.co.uk

With barbecues getting stoked up for summer, it may be a good time to help raise awareness among patients that their alcoholic drink of choice accompanying their chargrilled chicken may contribute to tooth wear.

Patients need to know that alcohol is acidic and therefore highly erosive, especially when consumed frequently, in large quantities over an extended period of time. It may also be that the high alcohol intake occasionally causes vomiting, which will exacerbate the damage to the dentition.

It’s also worth sharing with them that carbonated drinks, including sugar-free varieties, will have a similar effect on their dentition.

As well as coronal height being reduced, patients may also suffer with hypersensitivity due to the wear. In such cases, using a fluoridated mouthrinse every day at a different time to toothbrushing is an effective first line of defence. A desensitising toothpaste and/or prescription fluoride toothpaste can be helpful in alleviating sensitivity, while use of a calcium phosphate paste, applied in carriers, is an additional option if the symptoms are severe. Also, placing protective covering restorations can eliminate sensitivity and minimise further wear.

Further advice includes:

• Guiding the patient in brushing effectively yet gently with a relatively soft toothbrush and a toothpaste low in abrasivity

• Not swishing drinks around the mouth and waiting an hour after consuming an acidic drink before brushing to avoid damaging the softened enamel

• Rinsing the mouth with fluoride mouthwash or water before or after acidic drink consumption to help limit their erosive potential

• Chewing sugar-free, xylitol- or sorbitol-sweetened gum to help neutralise acid in the mouth.

The London Tooth Wear Centre^® offers an evidence-based and comprehensive approach to managing tooth wear. To request advice, make a referral or for further information on the work of the London Tooth Wear Centre^®, please visit www.toothwear.co.uk, email This email address is being protected from spambots. You need JavaScript enabled to view it. or call 020 7486 7180.