Only 3% of children in England visit the dentist before their first birthday and 12% visit by their second birthday, according to researchers from the University of Birmingham, the University of Edinburgh, and Public Health England.
Using the 2016/17 NHS Dental Statistics for England Annual Report, the researchers also found significant variations between local authorities in the rates of children visiting dentists, with more children in areas of deprivation visiting than those in more affluent areas.
West Berkshire showed attendance rates of less than 1% for children under the age of one, though the area was ranked low for deprivation. Yet South Tyneside, one of the most deprived local authorities in England, had the highest attendance rate at 12.3%.
“Our findings were unexpected as we had anticipated seeing higher levels of attendance in more affluent local authorities, but this was not the case,” said lead author Candy Salomon-Ibarra of the University of Birmingham.
“We explored with private dentistry providers whether children were being seen privately instead, but this does not seem to be the explanation. More studies are needed to explore the reasons for such variations in rates of dental visits, such as a lack of local initiatives to encourage attendance or difficulties accessing NHS care,” said Salomon-Ibarra.
“The fact that so few children nationally under the age of two attend the dentist, no matter where they live or their economic circumstances, shows that policy makers face enormous challenges attempting to improve this situation,” said Salomon-Ibarra.
“There is broad consensus that children should have a dental examination from a dentist as soon as the first teeth erupt, and no later than the child’s first birthday,” said John Morris, DDS, senior lecturer in dental public health at the University of Birmingham.
“Early dental visits not only provide parents with information they require to prevent early childhood oral health issues, but it is also believed that such dental visits familiarize children with the dental environment and reduce future dental anxiety,” said Morris.
“Poor oral health can cause pain and infection, which can affect eating, sleeping, socializing, and learning, yet worryingly our research suggests that there is a widespread lack of understanding of the importance of taking children to the dentist before their first birthday despite considerable investment in encouraging parents to take their child to the dentist,” Morris said.
The National Health Service spends about £3.4 billion per year on dental services, the researchers report. In the two years prior to March 2016, tooth extraction was the main reason for hospital admission for children between the ages of 5 and 9 and the sixth most common procedure in those under the age of 5.
In 2017, the British Society of Paediatric Dentistry (BSPD), in partnership with the Office of the Chief Dental Officer of England, launched the Dental Check by One campaign to promote the importance of children visiting the dentist before their first birthday. Also in 2017, NHS England launched the Starting Well program in 13 high-priority areas targeting children under the age of 5 who did not currently see a dentist.
“This study paints a worrying picture of the number of very young children attending the dentist and shows that we still have work to do to try and address it,” said Janet Clarke, chair of the West Midlands Local Dental Network at NHS England and NHS Improvement-Midlands.
“In the West Midlands, the NHS is running a public-facing campaign titled A Little Trip to the Dentist focused on encouraging more parents to start thinking about oral health early by highlighting the many benefits of checkups at a young age, even before teeth come through,” said Clarke.
“Many parents have fed back saying they simply weren’t aware of the need to take their children until they have a full set of milk teeth, so by raising awareness, we’re hopeful we might start to see the numbers increase in our region and beyond,” said Clarke.
“This latest research provides a useful baseline. Until recently, parents were told to take their child to the dentist by school age, which is clearly not soon enough,” said Claire Stevens, spokesperson for the BSPD.
“Since BSPD introduced Dental Check by One in 2017, the campaign is still in its infancy. As more practices subscribe to the Dental Check by One concept, we hope to see the numbers of babies and toddlers gaining access to a dentist increase,” said Stevens.
Meanwhile, the British Dental Association (BDA) says that low attendance among children under the age of 1 is indicative of failure from successive governments to offer a joined-up approach to the oral health of the children of England.
The BDA says it supports the idea of getting children to a dentist early to encourage good habits and embed a preventive approach. Yet it also criticizes what it calls a lack of ambition among authorities to deliver on this vision. The BDA now calls for a concerted approach involving primary schools and nurseries, general practitioners, health visitors, and other care providers.
Further, the BDA notes that wales and Scotland both have dedicated national pediatric oral health programs that operate in schools and nurseries including supervised brushing. The Starting Well program, though, only focuses on “high risk” children and has no new funding attached. It also involves only 300 of the 9,000 NHS practices in England.
“Tooth decay is the number one reason young children will end up in hospital, and it won’t be solved with token efforts. Baby teeth matter, and getting very young kids attending requires joined-up action,” said Mick Armstrong, chair of the BDA.
“Sadly, ministers have offered little more than posters to pop up in dental practices. Preaching to the converted will not cut it,” Armstrong said. “We need real engagement in schools and nurseries, and Scotland and Wales are already leading the way. Kids in England deserve better than a second-class service.”
The study, “Low Rates of Dental Attendance by the Age of One and Inequality Between Local Government Administrative Areas in England,” was published by the Community Dental Health Journal.
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