Tackling Tooth Decay: UK’s Policy Solutions for Children’s Oral Health

UK: Children’s oral health across England is facing a significant crisis, as a large number of children are affected by dental caries, the most prevalent form of dental disease. In some regions, as many as 50% of five-year-olds suffer from tooth decay, which has notable repercussions on their education and general wellbeing. For many of these children, dental problems lead to missed school days, disrupted sleep, and in severe cases, dental extractions performed under general anaesthetic in hospitals.

According to experts at The University of Manchester, addressing this issue requires targeted public health interventions that focus on preventive measures, such as improved oral hygiene and reduced sugar intake. These preventative strategies form the cornerstone of ongoing government plans, such as the Dentistry Rescue Plan, which includes the implementation of supervised tooth-brushing schemes for children aged 3-5 years in areas with the highest need.

The importance of early intervention

Tooth brushing and limiting sugar consumption are key to preventing dental decay. Educating children on the importance of these habits from a young age is vital for long-term oral health. Dr Georgios Kitsaras, one of the researchers involved in studying oral health behavior change, emphasized that “shaping positive oral hygiene habits from an early age is vital for healthy teeth.” Research has consistently shown that consistent brushing with fluoride toothpaste and reducing sugary foods and drinks can have a significant impact on reducing the incidence of dental caries.

However, the challenge lies in ensuring that these positive changes in behavior are not just temporary but sustainable. Dr Kitsaras and his colleagues suggest that to achieve lasting improvements, interventions must be designed to encourage and maintain these good habits over time, especially in children. Educational settings, where children spend a considerable amount of time, are seen as crucial to promoting consistent oral hygiene practices.

Behavior change interventions and community involvement

At The University of Manchester, several community-based interventions have been designed to address oral health inequalities. These initiatives aim to change oral health behaviors in some of the most deprived areas of Manchester. These efforts, funded by the Medical Research Council (MRC), have involved close collaboration with Manchester’s Oral Health Improvement Team (OHIT) and local communities.

The research team has employed a variety of behavior change models to guide their work. These include the COM-B model, which focuses on enhancing capability, creating opportunities for behavior change, and building motivation to engage in healthy behaviors. One example of this approach is the BRIC (Bedtime Routines Intervention for Children), where parents received text message reminders to encourage children to brush their teeth and avoid sugary snacks before bedtime. The results showed a 16% increase in tooth brushing behavior and a 24% reduction in the consumption of snacks and sugary drinks at bedtime.

School-based programs and family engagement

Another successful intervention was the Leapfrog program, a school-based oral health promotion initiative targeting primary schools in high-risk areas of Manchester. This program incorporated educational activities, provision of toothbrushes, and ongoing text message support for families to reinforce the new habits. The intervention led to an improvement in children’s tooth brushing behaviors, with more children brushing twice a day by the end of the program.

The ongoing HeRo (Healthy Routines, Healthy Teeth) project builds on previous work by combining school-based activities with broader community outreach. The program provides oral hygiene packs to families and uses behavior change techniques to help children establish lifelong healthy routines. The initiative has been designed to target both universal and specific populations, with a focus on those in the most disadvantaged areas.

Key lessons and policy recommendations

Drawing on the findings from these projects, Dr Kitsaras and his colleagues stress the importance of co-designing interventions with the target population. Interventions should be tailored to the specific needs of different communities, as a one-size-fits-all approach is unlikely to produce the desired results. “Co-development and co-design principles with target populations should be followed from the start, not as an afterthought,” they write.

Furthermore, policymakers are encouraged to employ theory-informed, evidence-based approaches to drive sustained behavior change. According to the research team, interventions should recognize that habit formation takes time and should be adequately funded to support long-term efforts. Technology, such as mobile phone apps for sending reminders, has also been found to be effective in supporting behavior change, provided it is developed in collaboration with the target audience.

In terms of school-based interventions, the research highlights the need for oral health programs that are both easy for teachers to implement and engaging for students. Integrating social aspects, such as class activities, can help make these initiatives more attractive and effective.

Conclusion

The crisis in children’s oral health in England demands urgent attention, and evidence-based interventions are key to addressing the issue. Through its ongoing research, The University of Manchester has demonstrated the positive impact that community-based, family-focused, and school-centered initiatives can have on improving children’s oral health behaviors. As policymakers take steps to tackle the root causes of dental decay, the lessons learned from this work provide a valuable foundation for shaping future public health strategies.