TOWARDS BETTER ORAL HEALTH IN CHILDREN: ANALYSIS OF CONSULTATION RESPONSES
EXECUTIVE SUMMARY
A Scottish Executive Health Department consultation on Oral Health in Children took place between 24 September 2002 and 28 February 2003. In total, 1,342 responses were received, including 5 petitions that contained a total of 6464 signatures.
This report presents an analysis of the responses to the consultation. The results of the analysis will provide further evidence to inform the development of future policy to improve children's oral health in Scotland.
Scotland has a very poor record with respect to children's oral health. A target has been set that by 2010 60% of 5-year old school entrants should have neither cavities nor filling/extractions. The Action Plan for Dental Services in Scotland, published in August 2000, has a special focus on improving the oral health of children. The document builds on the Oral Health Strategy for Scotland, published in 1995, which identified a number of key actions to improve oral health in Scotland, including action on health promotion and prevention.
Following from the Action Plan a number of initiatives have been introduced. Particular initiatives include the distribution of free toothbrushes and free fluoride toothpaste to infants and young children throughout Scotland to encourage prevention of dental disease and the introduction of a Caries Prevention Programme targeted at children aged 6-7 years.
The consultation document encouraged further debate on a number of major proposals aimed at ensuring that the national target is met.
The volume of responses was exceptionally large for such an exercise. Most responses, however, focused entirely on the single issue of fluoridation of water, presenting a skew in coverage of issues and in depth of response in terms of constructive solutions and ideas.
Respondent coverage was very broad with a wide range of organisations and individuals participating from across Scotland and beyond. Women were over-represented amongst the respondents, men were under-represented.
Some of the topics for consideration generated emotive and hard-hitting responses. Clear messages emerged for an agenda for future action. A number of overarching and more urgent recommendations were presented by respondents, along with a plethora of other suggestions for consideration. These are summarised below:
OVERARCHING AND URGENT ACTION POINTS
The huge volume and wide variety of responses contained a wealth of suggestions for future action. From these, a number of broad themes emerged as priorities for action. In general, respondents perceived the need for:
an overarching, comprehensive, children's oral health strategy
closer integration of diet within the oral health agenda
a major educational oral health campaign
further research and more consideration on the issue of fluoridation of water
the banning of fizzy drink promotion and availability in schools
much tighter controls on the advertising of sugary products to young children
In addition, an analysis of respondent type suggested that future action, subsequent to the consultation, could usefully be steered by the views of children and young people as appropriate. Despite attempts to engage with this sector for the consultation, a lack of response from this group indicated a gap in the coverage of the consultation. It is suggested that this could be addressed by their involvement at various stages of future development of policy on oral health in children.
OTHER KEY POINTS MADE
A summary of the views of respondents on key aspects of children's oral health is presented below. As stated previously, a huge volume of responses was submitted with the views below being representative of the general thrust of opinion.
On Children's Diet ( Chapter 4)
Diet plays a central role in oral health Good dietary habits can be ingrained from early years Home, school and community all constitute major influences on children's diet A wide range of measures could be implemented in schools to reduce the availability of unhealthy food and improve healthy options A major expansion in availability of free water is required in public buildings Local diet and food initiatives focused in areas of deprivation are vital
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On Promotion of Better Diet ( Chapter 5)
The public, especially parents and other carers require educating on better diet Promotional messages need to be clear, consistent and achievable Priorities are promotions aimed at parents of young children and promotions in socially deprived areas The role of schools in promotion could be boosted through better training of teachers, more dietary related curricula, help from specialist professionals, and joined up approaches with other organisations Many opportunities exist for better diet promotion in the community context and setting Health professionals need to present a greater consistency of message and greater joining up of approaches Those in the dental profession should be better versed in and contribute more to dietary advice TV advertising to young children should be banned or restricted More imaginative, interesting and informative adverts of better diets could be devised Accuracy in advertising is essential
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On Oral Hygiene ( Chapter 6)
The importance of good oral hygiene received strong support Effective oral hygiene practice should be established at a young age, supervised by carers Schools should enable and facilitate good oral hygiene practice through the day There was much support for extending free toothbrush and toothpaste schemes throughout Scottish schools
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On Promotion of Oral Hygiene ( Chapter 7)
The public should be educated in oral hygiene A vigorous, possibly very large scale campaign for better oral health is needed Well-known celebrities could be involved in promoting oral health Promotional messages should be produced in different community languages and formats Priorities for education were those most at risk of dental caries and young people Costs of toothbrushes and toothpaste should be subsidised or free for those on low income Joined-up, multi-agency approaches to tackling poor oral hygiene are most effective Partnership approaches to promoting oral hygiene are recommended Adequate funding is required to support school promotion of oral health Oral health should be a component of all health professional's training Initiatives aimed at very young children should be expanded Oral health should be on the school syllabus Guidance on oral health policy in schools is required Oral health professionals should have a greater role in schools
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On Enhanced Dental Services ( Chapter 8)
A better longer term strategy for dental services is required, underpinned by appropriate funding The current NHS fee scale is not compatible with a preventative philosophy Smarter financial incentive schemes for dentists are required More joined-up working between dental and other professionals is required A goal should be access for all to a NHS dentist Dental checks for children could be undertaken at school Rural areas face particular problems in accessing NHS dentists and this needs special attention Dentists should promote a modern and friendly image
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On the Role of Manufacturers and Retail Outlets ( Chapter 9)
Food manufacturers and retail outlets have a responsibility to contribute to good health and diets High sugar content in food aimed at children is a major problem Food labelling needs to be more accurate and meaningful for the consumer Health warnings on sugary foods are supported Opportunities exist for closer working between oral health professionals, manufacturers and retail outlets Much potential exists for the development and use of more attractive packaging of healthy foods
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On Fluoridation of Water ( Chapter 10)
Most respondents provided a clear view on their stance on possible fluoridation of the public water supply. Where a view was provided, the vast majority (97%) of responses from individual members of the public were against fluoridation of water. This contrasts with the large majority (93%) of responses from dentists and NHS Boards/Trusts/Agencies that were in favour of fluoridation of water. Of the remaining respondents, 25% were pro fluoridation of water. People presented a wide range of arguments against fluoridation of water focusing particularly on potential health risks and lack of individual choice Those in favour of fluoridation envisaged substantial and lasting effects on the improvement of oral health Further continuing objective research and a sustained fluoridation education campaign, which included social marketing, was requested by many respondents
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On Other Methods of Fluoride Delivery ( Chapter 11)
Delivering fluoride Milk, bottled water and fizzy drinks are suitable candidates for fluoridation More active promotion of fluoridated dental products is required
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On Broader Social Justice Issues ( Chapter 12)
Poor oral health is seen as a social injustice issue Poverty underlies much of the problem and needs to be tackled Campaigns need to be especially tailored for deprived areas Dental costs are a problem for those on low income Oral health initiatives and associated funding need to be more sharply targetted towards deprived areas
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Information and Research on Fluoridation of Water ( Chapter 13)
Consultees considered that improvements are required in the current evidence base for the fluoride in water debate Research is required on the longer term effects of fluoride and its effect on the wider environment Objective research is required on cost-benefit analysis of introducing fluoride to water Comparative studies are required involving fluoridated and non-fluoridated areas and cross-national experience
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