Tackling Child Tooth Decay | Expanding Sugar Tax and School Interventions

Summary:

• Report urges government to develop a national child oral health strategy

• Recommendations include expanding sugar tax to milk-based drinks

• Proposal to ban energy drink sales to under-16s

• Call for implementation of supervised tooth brushing programmes in schools

• Emphasis on reducing sugar consumption and optimising fluoride exposure

• Highlighting significant oral health inequalities, particularly in Northern England

• Suggestion to reorient dental services towards prevention for children and young people

• Estimated £40 million annual NHS cost due to childhood tooth decay crisis

Urgent Call for Radical Measures to Combat Children's Oral Health Crisis in England

In a bold move to address the escalating oral health crisis among children in England, a comprehensive report has been released urging ministers to take decisive action. The joint report, published by Child of the North and the Centre for Young Lives think tank, outlines a series of radical proposals aimed at improving children's oral health and reducing the alarming rates of tooth decay across the country.

The Current State of Children's Oral Health in England

The report paints a stark picture of the oral health landscape for children in England. With fewer than four in ten children boasting good oral health and one in ten three-year-olds already suffering from tooth decay, the situation is dire. In 2023, only half of the children in England had visited an NHS dentist within the recommended maximum period of 12 months, with the figure dropping to less than a third for under-fives.

The crisis is particularly acute in the North of England. In the North East and Yorkshire, one in five Year 6 primary school children and a third of Year 7 and Year 8 secondary school

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children have experienced tooth decay in their permanent adult teeth. These statistics underscore the urgent need for intervention and highlight the significant health inequalities that exist across different regions of the country.

The Economic Burden of Poor Oral Health

The financial implications of this crisis are substantial. The NHS is currently spending over £40 million annually to address tooth decay in youngsters. This figure not only represents a significant drain on healthcare resources but also points to the potential for long-term savings if effective preventive measures are implemented.

Key Recommendations from the Report

1. Expanding the Sugar Tax

One of the central recommendations is the expansion of the existing Soft Drinks Industry Levy, commonly known as the sugar tax. The report suggests extending this tax to include other sugar-sweetened beverages, particularly sugary milk drinks. This measure aims to reduce sugar consumption among children, a key factor in both tooth decay and childhood obesity.

2. Banning Energy Drink Sales to Under-16s

In a move to protect young people from the harmful effects of high caffeine and sugar content, the report calls for a ban on the sale of energy drinks to individuals under the age of 16. This proposal aligns with growing concerns about the impact of these beverages on children's health and behaviour.

3. Implementing Supervised Tooth Brushing Programmes

The report strongly advocates for the roll-out of supervised tooth brushing programmes in nurseries and schools. This initiative aims to instil good oral hygiene habits from an early age and ensure that children are brushing their teeth effectively. Such programmes have shown success in other parts of the UK, notably in Scotland and Wales, where they have been implemented as part of national oral health campaigns.

4. Optimising Fluoride Exposure

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Recognising the proven benefits of fluoride in preventing tooth decay, the report recommends a combination of community water fluoridation and targeted fluoride programmes. This multi-pronged approach seeks to ensure that children, particularly those in high-risk areas, receive adequate fluoride exposure to protect their teeth.

5. Reorienting Dental Services towards Prevention

A key aspect of the proposed strategy involves shifting the focus of dental services towards prevention, especially for children and young people. This includes working with the dental profession to reform the dental system, innovative commissioning led by integrated care boards (ICBs), and providing dental services within schools and nurseries.

6. Addressing Food Marketing and Advertising

The report calls for stricter regulations on food marketing, advertising, and promotions, particularly those targeting children. By limiting exposure to advertisements for high-sugar foods and beverages, the aim is to reduce the demand for these products among young people.

The Role of Local Government and Innovative Approaches

The report highlights the crucial role that local government can play in reducing sugar consumption. Many local authorities have already implemented their own strategies to reduce the consumption of foods and drinks high in fat, sugar, and salt. The report showcases successful interventions such as Sheffield's "Sweet Enough" initiative, a five-year programme aimed at educating residents about the harms of excessive sugar consumption, with a focus on the most deprived areas.

Another notable project mentioned is BRUSH, which supports the implementation of supervised tooth brushing programmes for young children in nurseries and schools. These local initiatives demonstrate the potential for targeted, community-based approaches to improve oral health outcomes.

The Importance of a National Strategy

Central to the report's recommendations is the call for the development and implementation of a national child oral health improvement strategy. This strategy would aim to improve children's oral health across the board while specifically targeting the

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reduction of social inequalities, particularly those experienced by children and young people in the North of England.

The proposed national board to oversee this strategy would include representatives from various sectors, including government departments, local government, dental organisations, specialist societies, universities, citizen representatives, and charities. This multi-stakeholder approach ensures a comprehensive and collaborative effort to tackle the oral health crisis.

Addressing Criticisms and the "Nanny State" Argument

The report explicitly calls on ministers to "ignore nanny state critics" and take bold, evidence-based action to address the oral health crisis. This stance acknowledges the potential pushback against interventionist policies but emphasises the urgent need for decisive action given the scale of the problem.

The authors argue that the long-term benefits of improved oral health – including better overall health outcomes, reduced healthcare costs, and improved quality of life for children – far outweigh concerns about government overreach.

The Broader Context of Public Health

While the report focuses primarily on oral health, its recommendations intersect with broader public health concerns, particularly childhood obesity. Many of the proposed measures, such as reducing sugar consumption and limiting marketing of unhealthy foods, align with strategies to combat the obesity epidemic.

This holistic approach to children's health underscores the interconnected nature of various health issues and the potential for interventions to have wide-ranging positive impacts.

International Comparisons and Success Stories

The report draws inspiration from successful oral health initiatives in other countries. The supervised tooth brushing programmes proposed for England have already shown significant success in Scotland and Wales. In Scotland, the ChildSmile programme has demonstrated that such interventions can be cost-effective, paying for themselves within

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three years through improvements in children's oral health and reduced need for dental treatment.

These international examples provide valuable evidence for the potential effectiveness of the proposed measures in England and offer lessons for implementation and scaling.

Challenges and Considerations

While the report presents a compelling case for action, implementing these recommendations will face several challenges:

1. Political Will: Enacting such comprehensive reforms will require strong political commitment and the ability to withstand pressure from industry lobbies and critics of interventionist policies.

2. Funding: Implementing nationwide programmes, particularly supervised tooth brushing in schools, will require significant investment. The report argues that this investment will lead to long-term savings, but securing initial funding may be challenging.

3. Logistical Challenges: Rolling out programmes across diverse communities and settings will require careful planning and coordination between various stakeholders.

4. Cultural Change: Shifting societal attitudes towards sugar consumption and oral health practices will require sustained effort and comprehensive public education campaigns.

5. Equity Considerations: Ensuring that interventions reach and benefit the most vulnerable populations, particularly in areas with the highest rates of tooth decay, will be crucial.

Conclusion

The report's call for radical action to address children's oral health in England represents a pivotal moment in public health policy. By proposing a comprehensive strategy that combines taxation, regulation, education, and direct intervention, the authors have laid out a roadmap for significant improvement in children's oral health outcomes.

The emphasis on evidence-based approaches and the recognition of the need to address social inequalities in health outcomes are particularly noteworthy. If implemented, these

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recommendations have the potential to not only improve oral health but also contribute to better overall health outcomes for children across England.

As the debate around these proposals unfolds, it will be crucial for policymakers, health professionals, educators, and the public to engage in constructive dialogue about the best ways to protect and improve children's health. The ultimate goal – a generation of children with better oral health, free from the pain and complications of tooth decay – is one that surely all can agree is worth pursuing.

FAQs

1. Q: Why is children's oral health considered a crisis in England?

A: With fewer than 4 in 10 children having good oral health and 1 in 10 three-year-olds already suffering from tooth decay, the situation is alarming. The crisis is costing the NHS over £40 million annually.

2. Q: What are the main recommendations of the report?

A: Key recommendations include expanding the sugar tax, banning energy drink sales to under-16s, implementing supervised tooth brushing programmes in schools, and developing a national child oral health strategy.

3. Q: How does the report propose to reduce sugar consumption?

  A: The report suggests expanding the sugar tax to include sugary milk drinks and implementing stricter regulations on food marketing and advertising targeting children.

4. Q: What is a supervised tooth brushing programme?

A: It's an initiative where children in nurseries and schools brush their teeth under supervision, aiming to instil good oral hygiene habits from an early age.

5. Q: Why does the report focus on the North of England?

A: The North of England, particularly the North East and Yorkshire, shows significantly higher rates of tooth decay among children, highlighting regional health inequalities.

6. Q: How does the proposed strategy address health inequalities?

A: The strategy aims to target interventions in areas of high deprivation and proposes a national approach to ensure equitable access to oral health initiatives across England.

7. Q: What role can local governments play in improving children's oral health?

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A: Local governments can implement strategies to reduce sugar consumption, support supervised tooth brushing programmes, and work with schools and communities to promote oral health.

8. Q: How might the proposed measures impact childhood obesity?

  A: Many of the recommendations, such as reducing sugar consumption and limiting unhealthy food marketing, align with strategies to combat childhood obesity.

9. Q: What challenges might be faced in implementing these recommendations?

A: Challenges include securing political will, funding, overcoming logistical hurdles, and addressing potential resistance to interventionist policies.

10. Q: Are there successful examples of similar interventions elsewhere?

A: Yes, Scotland's ChildSmile programme has shown significant success in improving children's oral health through supervised tooth brushing and other interventions.

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