Agenda item

Children's Dental Services


The Chairman welcomed those present to the meeting. 


Children & Young People Dental Steering Group (CYPDSG)

Ms Carol McLoughlin, Chairman of the CYPDSG, advised that the Group had been set up in 2019 with three aims:

1.    To roll out the supervised brushing programme in ten schools that had been identified in areas of deprivation where there had also been high levels of dental caries (tooth decay) in children.  This had been funded by NHS England but had stalled at the start of the pandemic.  However, the oral health promoter had continued to work with schools during this period to encourage schools’ participation once the initiative restarted.  As a result, eight schools would be implementing the scheme in September 2021;

2.    That the Brushing for Life programme be delivered by health visitors and in Early Years Centres and Children’s Centres.  This initiative had seen the distribution of toothbrush packs to those children who didn’t have toothbrushes (either because their parents could not afford them or because they did not see it as a priority).  If parents were not seeing tooth brushing as a priority, it was suggested that this might be an indicator that they were also neglecting other areas such as the intake of milk and fruit/vegetables.  The Children’s Centres had worked with parents on weaning and giving out messages; and

3.    To improve access to dental services / practices as part of the supervised brushing initiative.  It was noted that supervised brushing after meals was already undertaken in some nurseries on their own initiative and Members queried whether this could be encouraged in all nurseries.  Although Ms McLoughlin advised that this would come down to funding, it was argued that this could be part of the service that was being paid for by parents. 


The CYPDSG had brought together a range of partners to achieve these aims which had included a GP and links to Primary Care Networks (PCNs). 


Hillingdon Health and Care Partners (HHCP)

Ms Caroline Morison, Managing Director of HHCP, advised that HHCP’s interest in this issue was in relation to the prevention of ill health / disease and the integration of services.  She recognised that the good work that had been undertaken before the pandemic needed to be maximised and that this would be helped by the improvements that had been seen in working relationships, particularly in relation to children and young people’s (CYP) services. 


Members were advised that integrated working in Hillingdon had initially focussed on older people’s services.  As programmes had developed, it had become increasingly important to extend this to children and young people’s services.  To this end, more tangible discussions were being undertaken to include dental services in developments to make every contact count.  The CYP Transformation Board had also been looking at the messages that needed to be distributed through schools when the new academic year started in September 2021. 


Staying Well had been a pan-London pilot that had been funded by NHS England.  In Hillingdon, three dental practices had signed up to the pilot and had been involved with schools that had been geographically close to them.  This involvement had been focussed engagement and had included families being invited to visit the practices and check-ups being undertaken whilst there.


Ms Shikha Sharma, Consultant in Public Health at the Council, advised that dentists were usually very busy so dealing with schools as well would be a mammoth undertaking within existing resources.  However, many of them recognised that, if they did not go upstream with preventative / early action in some areas, they could be dealing with much more serious issues at a later date. 


In 2015, a project had been undertaken with five dental practices in the Borough to address the fact that Hillingdon had one of the worst rates of dental caries in children in England.  Although this did not use any of the participating practices’ UDAs, money had been provided by NHSE from unused UDAs.  


North West London Clinical Commissioning Group (NWL CCG)

Mr Richard Ellis, Joint Borough Lead Director Hillingdon at NWL CCG, advised that the health responsibility for children’s dentistry had been spread across numerous agencies so consideration needed to be given to how this could become more integrated.  NWL CCG’s interest in the issue was in relation to prevention but also in relation to surgery.  Mr Ellis noted that there had recently been a push on the waiting lists for children’s surgery.  Hillingdon Hospital had had an intensive paediatric surgery week this week as there were currently 99 children on the inpatient surgery waiting list.  Being able to tap into expertise elsewhere in London was also helpful in ensuring that local children had access to top quality services. 


The Chairman noted that there appeared to be four levels of activity which affected children’s oral health, which could be illustrated in a triangle.  Healthy living (effective brushing, diet, etc) would be situated at the wide base of the triangle, and was seen as the foundation of good oral health.  Above that were dentists who provided ongoing care and advice to patients.  Then came active interventions such as fluoride varnishing and supervised brushing and at the top of the triangle sat emergency interventions such as surgery.  Interventions aimed at the lower end of this triangle would prevent the need for the potentially more traumatic and costly interventions at the top of the triangle.  Ms Sharma noted that approximately one third of children in the Borough would fall into the top half of the triangle. 


It was queried whether expectant parents were routinely provided with information about the free dental services that were available to expectant mothers (up until the baby turned one year old) and the children or about the importance of taking up this offer.  As such, it was suggested that action be taken to include this sort of information in the red book that was provided to new parents.  A mother and baby app was also available in NWL to new mothers which provided information targeted at early years. 


Concern was expressed about the stories of residents being unable to get an appointment with a dentist for their children (or themselves).  As dentists had a public health responsibility, it was suggested that an initiative be introduced whereby dentists committed to never turning away a child of primary school age.  To support this, it was suggested that any units of dental activity (UDAs) which were unused locally be redistributed for use on other dental health interventions in the Borough such as this initiative or fluoride varnishing rather than returning to NHS England and being absorbed in general budgets. 


It was recognised that dental contracts needed to be updated as they did not currently work particularly well.  If UDAs were not used, they were lost from the provision of dental services in the Borough. As such, it was suggested that NHSE be asked to carry any unused UDAs in the Borough into the subsequent financial year and that this funding then be used to support other oral health related interventions.  Mr Ellis noted that the distribution of UDAs used to be broken down into two or three batch releases so that their use could reviewed during the year.  It was agreed that Mr Ellis and Ms McLoughlin would liaise with NHSE to progress this suggestion.  They would also establish whether consideration could be given by NHSE to specifying a split in the UDAs allocated towards adults and children’s treatment to enable monitoring to be undertaken. 


Rather than targeting schools in the areas where the highest level of dental caries existed, it was queried whether this could be refined further so that only those children in these schools who actually needed intervention were treated (as there would likely be a large number who did not need any additional support). 


It was noted that often, seemingly small rewards would entice participation in initiatives and improve public health outcomes.  As such, it was suggested that low cost incentives be introduced that might help residents on limited budgets.  Ms McLoughlin advised that the oral health promoter had been sending out tooth brushing packs in the Borough and had run a number of competitions to engage with parents and their children.  Recently there had been a competition to draw a picture of a healthy family meal with a glow in the dark toothbrush as the prize.  It was suggested that the pink disclosing tablets could also be distributed to help identify the effectiveness of a child’s brushing habits. 


A character called Aggie the Alien had been created to help children in the Borough to identify with specific issues.  Aggie had been incorporated into a video that had been produced by two trainee GPs in 2020 that was now available.  Ms Morrison noted that having messages from GPs and dentists was powerful but that consideration also needed to be given to the messages conveyed within communities and targeting these more proactively. 


Members noted that the mechanisms to convey information were already in place for other health interventions, so messages about dental health just needed to be dropped into these tracks.  Ms Morison advised that all of the different agencies wanted to set residents up for a healthy life and that the most effective approaches for information and messaging needed to be identified as a single approach would not suffice for such a huge issue. 


Ms Morison advised that the most comprehensive single source of simple information on dental services / health would be found on the NHS Choices website. 


Whatever interventions were undertaken in relation to children’s oral health, it would be important to monitor their effectiveness and to establish a focussed and sustained approach which covered the wider population.  The child population in Hillingdon increased by approximately 4,000 each year.  As such, standalone interventions would not be useful in the long term as there were always new parents and children that needed to be brought up to speed on how best to care for their teeth. 


From the discussion that had taken place so far, a number of areas for possible recommendations had arisen:

1.    That sugar tax funding be used for dental health as well as obesity/physical health;

2.    That information and brushing kits be provided for maternity patients in the “red book” / on maternity the ward;

3.    That an agreement be reached that no dentist turned away any child of primary school age or less;

4.    That any unused UDAs in the Borough be collected back in and carried forward to the next year and redistributed towards local dental action programmes / initiatives such as fluoride varnishing in schools;

5.    That additional training be available to health professionals such as health visitors, school nurses, etc, to help them promote good oral health;

6.    That action be taken now to introduce water fluoridation across London;

7.    That the Families, Health and Wellbeing Select Committee receive annual updates from Public Health on the performance of the community dental service in Hillingdon;

8.    That supervised brushing be introduced in all nurseries (as well as Children’s Centres) in Hillingdon; and

9.    That the Health and Wellbeing Board oversee a comprehensive communication and education plan and monitor the effectiveness of interventions. 


Members agreed that the monitoring aspect of any recommendations would be very important.  Mr Ellis advised that acting more collaboratively would be beneficial.  To this end, discussions had recently been undertaken regarding the opportunity to promote one initiative whilst advising residents about another (for example, encouraging the take up of cervical smear tests whilst being advised about Covid vaccinations).  Pregnant women would be targeted in the autumn to encourage them to get their flu vaccination and consideration would be given to working with key groups to include information about the dental services that were available to pregnant women and their children and emphasising that these services were free. 



1.    Mr Ellis and Ms McLoughlin liaise with NHSE to discuss the possibility of diverting unused UDAs in the Borough to alternative children’s dental health initiatives locally; and

2.    the discussion be noted. 

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