Children in special support schools have slightly lower levels of tooth decay than children in mainstream schools but are more likely to have their teeth extracted, according to a new survey published today (24 September 2015) by Public Health England (PHE).
The first national survey of oral health in special schools – schools for children with severe special education needs and disabilities (SEND) – also show that those who experienced decay have more teeth affected and their oral hygiene is poorer. The number of children in special support schools with a substantial amount of plaque is double that of those attending mainstream schools (4% and 2% respectively for 5 year olds and 20% and 10% respectively for 12 year olds).
Tooth decay is a lifestyle disease caused by consuming sugary foods and drinks too frequently. It can be prevented by reducing sugar in the diet and brushing teeth with fluoride toothpaste twice daily.
The survey, broken down by region, shows wide variation in tooth decay prevalence and severity ranging from 10% to 33% for 5 year olds and 22% to 41% for 12 year olds. The North West region has the poorest dental health for both age groups in special support schools.
The key findings were:
- around 1 in 5 (22%) 5 year old children at special support schools has experienced tooth decay
- around 1 in 4 (29%) 12 year old children at special support schools has experienced tooth decay
- for 5 year olds, the north west has the highest level of tooth decay at 33% while those in the south west have the lowest at 10%
- for 12 year olds, the north west has the highest level of tooth decay at 41% and those in the south east have the lowest at 22%
- those children with tooth decay have an average of 4 decayed teeth at age 5 and 2 decayed permanent teeth at age 12, which is greater than those attending mainstream schools
- the number of 5 year old children at special support schools who have had one or more teeth extracted due to decay is double that of those in mainstream schools (6% and 3% respectively)
- oral hygiene is generally poorer in children attending special support schools with more children having visible plaque at both age 5 and age 12 compared to their mainstream counterparts (4% compared to 2% and 20% compared to 10% respectively)
- in both age groups, those with a behavioural, emotional or social difficulty have the highest levels of tooth decay; 28% of 5 year olds and 42% of 12 year olds
Dr Sandra White, Director of Dental Public Health at PHE, said:
Tooth decay is caused by too much sugar in the diet and children currently consume 3 times as much sugar than official recommendations . Thankfully tooth decay can be prevented by not giving children sugary foods and drinks and brushing their teeth twice a day with fluoride toothpaste as soon as the first tooth comes into the mouth. It’s also important to visit the dentist as early as possible to receive advice on good oral hygiene and to have free preventative treatment like fluoride varnish.
Despite children in special support schools having slightly lower levels of tooth decay than children in mainstream schools, they are still very high so we must not be complacent. Children in special support schools are particularly vulnerable so they require an additional package of support to prevent and treat tooth decay. Local authorities and NHS England should take it upon themselves to provide dental services with specially trained staff who can cater for the multiple complex needs of these children.
As in mainstream schools, deprivation has an impact on tooth decay levels among special support school pupils; those from the poorest households have the highest levels of tooth decay. The regional differences found in the survey were consistent between special support and mainstream schools; therefore a continued focus on tackling wider inequalities is needed.
- This is the first national survey of the oral health of children with disabilities, special needs and medical illnesses in special support schools. It involved trained and standardised teams sampling children aged 5 and 12 at special support schools.
- The survey ‘Dental public health epidemiology programme, oral health survey of children in special support schools 2014’ provides information on the prevalence and severity of dental decay (caries) in children attending state or privately funded special support schools. A total of 1,936 5 year old children and 3,459 12 year old children were examined in 149 upper tier local authorities, representing 66% of 5 year old children and 50% of 12 year old children attending special support schools across England.
- For local authorities aiming to improve oral health, please refer to: ‘Commissioning better oral health for children and young people; an evidence-informed toolkit for local authorities’. The document can be used for guidance on oral health assessments and also for strategic planning.
- Preventive actions that clinical teams can encourage should be based on ‘Delivering better oral health: an evidence based toolkit for prevention’ and include:
- breast feeding provides the best nutrition for babies
- from 6 months of age infants should be introduced to a free flow cup and from the age of 1 use of a feeding bottle discouraged
- sugar should not be added to weaning foods or drinks
- the frequency and amount of sugary food and drinks should be reduced
- avoid sugar containing foods and drinks at bedtime when saliva flow is reduced and buffering capacity lost
- as soon as teeth erupt, to maximise caries prevention, brush them twice daily with a family fluoride toothpaste (1350 to 1500 ppm fluoride), 0 to 3 year olds using a smear and 3 to 6 year olds a pea sized amount
- brush last thing at night and at least one other occasion
- spit out toothpaste and do not rinse
- brushing should be supervised by a parent or carer
- sugar free medicines should be recommended
- Children should be encouraged to eat a healthy balanced diet based on the eatwell plate with plenty of vegetables, fruit and fibre and limiting foods that are high in sugar, saturated fat and salt. The best drinks for children are lower fat milks and water. There is no place for sugary drinks in a child’s diet as they will damage their teeth, especially if given frequently, before bed time or from a bottle.
Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Follow us on Twitter: @PHE_uk and Facebook: www.facebook.com/PublicHealthEngland.