Agenda item

The Board considered a report of the Strategic Director – Children and Young People outlining the findings of the scrutiny topic on oral health of children and young people in Halton, which had been carried out following a resolution of the Board on 27^th November 2007 that oral health should provide the focus for scrutiny during 2008. This topic was in line with the Council’s Annual Performance Assessment of Services for Children and Young People in Halton where it was recommended that the Local Authority should “accelerate plans to improve oral health”.

The Oral Health Scrutiny Group had been a joint scrutiny topic comprising Members from both the Healthy Halton, and the Children and Young People, Policy and Performance Boards. The aim of the group had been to:

• receive and consider evidence presented on the state of children’s oral health in the Borough;
• consider the information in relation to statistical neighbours and national and regional benchmarks; and
• consider future strategies for securing improvement.

The Group had met on a number of occasions and considered evidence presented by Dr. K. Milsom, Consultant in Dental Public Health, regarding the state of dental health experienced by children and young people in the Borough. Members interrogated the evidence presented and a summary of the Group’s findings was outlined within the report for the Board’s consideration.

It was noted that detailed dental health data on the adult population was not readily available; however, the Decennial Adult Dental Health surveys repeatedly confirmed that the North West had the worst dental health in England, and Halton and St. Helens PCT had developed its Dental Commissioning Strategy accordingly. This strategy had been accepted by the PCT Board in March 2008 and funding had been provided to ensure that key dental health objectives identified within the strategy were addressed. In 2008-9 the PCT had elected to focus on two priority issues:

• improving child dental health and reducing dental health inequality; and
• improving access to primary dental care

and further information was outlined within the report in relation to this.

Dr Milsom attended the meeting to respond to Members’ queries and the following points were noted:

• dental decay was a disease of deprivation;
• the average child in Halton at age 5 had 2 decayed teeth;
• effective tooth brushing could reduce gum disease but had very little impact on tooth decay;
• this was the first time the PCT was actively addressing this issue;
• fluoride was a naturally occurring mineral which, providing it was consumed at an appropriate level, could reduce tooth decay – the PCT was looking at a number of strategies to use fluoride to reduce children’s tooth decay in the area;
• there was evidence that painting the biting surfaces of teeth with fluoride varnish twice/three times per year could result in a reduction of 30%-40% in prevalence of tooth decay;
• the PCT was purchasing the varnish and paying dentists to carry out the work in their surgeries and the impact of this would be measured over the next three years;
• there was a trial currently ongoing in Lancashire where this work was being done in the school setting. If this was successful, a similar proposal would be a priority for Halton in order to reach all children as 30% of children in Halton did not attend a dentist regularly – results were expected early in the year;
• in the meantime, fluoride toothpaste was to be issued to all children aged three and over in the area;
• research had shown that excessive use of fluoride could cause white spots on teeth, although this would not happen if used after the age of three as, by this time, the front teeth had calcified;
• once a dentist had made a prescription for the varnish, the painting of teeth could be carried out by a therapist or a dental nurse and so was extremely cost effective;
• the Government was looking at amending the Dental Act in order that dentists could make a class decision in this respect, eg the decision could be made collectively for the whole of Halton;
• the World Health Organisation made it clear that any dental professional who saw neglect had a duty of care to refer the matter to the appropriate services and so dentists who viewed a child with very bad teeth would draw this to the attention of the school and subsequently to the parent;
• the PCT was committed to spending money to increase the number of dentists in the area;
• all dentists were to be invited to work hours to suit the needs of patients;
• it was intended that, by the end of the year, there would be a substantial increase in the number of dentists in the area reducing any access problem to zero;
• recommendation 2.4 within the report was intended to assist homeless young people;
• simple pain relief and care could be obtained from the dental access centre at Halton Lea;
• the centre had been the subject of an extensive review and there was work ongoing looking at its role – developments arising from this work were expected within the next six months; and
• the Strategic Health Authority was looking at the fluoridisation of water, which had been successful elsewhere in the country, although this could only be implemented following a comprehensive consultation process.

The Chairman thanked Dr Milsom for attending the meeting.

RESOLVED: That

(1)       the draft Topic Report be endorsed;

(2) the Executive Board be requested to approve the recommendations contained in 3 to 5 below and report back to the March meeting of the Policy and Performance Board on its conclusion;

(3)       Halton and St. Helens PCT should, subject to parental consent and outcomes of the “Lancashire Trial”, support the administering of fluoride varnish to children, to take place in school settings;

(4)       Halton and St. Helens PCT should take steps to support the take-up of dental services by vulnerable young people who may not have regular access to dental services or be registered with a dentist; and

(5)       the Children and Young People’s Policy and Performance Board should keep under review the implementation of the Oral Health Strategy.