Stakeholder event this autumn aims to be a watershed moment for policy

[ Words: Will Peakin ]

More than 4,700 children were admitted to hospital for tooth extractions in Northern Ireland last year. From 2017 to 2018, dentists extracted 23,035 teeth, of which 89% were baby teeth; taken out due to decay. By the age of 15 just under a fifth (19%) of children in Northern Ireland can be considered to have good oral health overall. 

While there have been headline improvements in the oral health of young people across the UK, inequalities remain “stark and persistent”, according to a briefing paper prepared by BDA Northern Ireland ahead of what representatives hope will be a “watershed” summit, to be held at Stormont on 17 October.

For some time, Northern Ireland has been at the bottom of the league table when it comes to children’s oral health outcomes in the UK, with 40% of five-year-olds showing signs of decay, compared with 25% in England. There are also distinct variations in oral health outcomes depending on socio-economic background; children from lower-income families are much more likely to have oral disease than other children of the same age.

According to the latest Children’s Dental Health Survey, more than a fifth (21%) of five-year-olds eligible for free school meals had severe or extensive tooth decay, compared with 11% of other children of the same age.

In 15-year-olds, more than a quarter (26%) of the 15-year-olds eligible for free school meals have severe or extensive decay; more than twice as many as their peers who are not eligible (12%). These figures, says the briefing paper, suggest the gap between oral health of children from richer and poorer backgrounds widens as they grow older. 

Children from lower-income families are also much more likely to have poorer diets and consume more sugary drinks; in Northern Ireland almost a quarter (24%) of children on free school meals drink sugary drinks four or more times a day, compared with just 1 in 10 (10%) of children who are not eligible for free school meals.

“Poor oral health affects not only children’s physical health, but also their overall wellbeing, confidence, mental health and development,” observed Tristen Kelso, the BDA’s Northern Ireland Director. “Problems with teeth can impact on a child’s ability to sleep, eat, speak, play and socialise with other children, as well as their school readiness. This summit is designed to not just highlight the work we need to do, but to start to come up with a new, more ambitious, positive vision for oral health in Northern Ireland – in collaboration with key stakeholders.

“Northern Ireland faces incredible challenges when it comes to oral health, particularly for our most vulnerable cohorts at both ends of the age spectrum. Tackling these challenges requires a new vision, one that is ambitious and underpinned by a policy framework that is suitably resourced.”

Last month, SDLP Health Spokesperson Mark H Durkan, expressed concerns following disclosure of 800 GP referrals for patients at high risk of developing Type 2 Diabetes between March and May of this year.

Durkan has previously pressed the Department of Health to ring-fence funds from the Soft Drink Industry Levy (SDIL) to address related health issues- including Type 2 Diabetes, obesity and improving dental hygiene.

The MLA for Foyle commented: “The NI Block Grant has benefitted from approximately £12million of Soft Drink Industry Level funding in 2019/2020. Since the introduction of the tax in 2016, I have made consistent calls for this money to be ring-fenced.

 “In the prolonged absence of Stormont, it is disappointing that the department has failed to direct the entire revenue generated by this levy toward targeting obesity, Type 2 Diabetes and dental hygiene. Funding from the plastic bag levy, brought in during my time as Environment Minister, was made specifically available to environmental projects- therefore this approach is not only doable but necessary.

 “It is axiomatic that the failure to do so has seen the North spiral into an obesity crisis in the interim and most alarmingly figures released this year show that 17% of children here are overweight. When targeted early, three-in-five cases of type 2 diabetes can be prevented or delayed yet the lack of action has undoubtedly aided the exponential rise in diagnoses.

 “The inability to invest this money in preventative healthcare costs our health service millions of pounds through needless lowering of quality of life and in some cases the rising number of related deaths. We must stop making short-sighted decisions when it comes to health.”

He continued: “I welcome assurances from the department that collaborative framework is currently underway to address these health issues. Yet it is lamentable that these crucial preventative healthcare measures have not been implemented sooner.”

Speakers at the summit include Caroline Lappin, CDS Clinical Director at the South Eastern Trust and Chair of the BDA’s Northern Ireland Council; Gerry McKenna from Queen’s University Belfast, and Chair of BDA NI’s Hospitals Group; Simon Reid, Chief Dental Officer at DoH, and Michael Donaldson, Head of Dental Services at the Health and Social Care Board.

Last December, the Chairs of BDA Northern Ireland’s three committees, wrote to the Department of Health expressing concern that the £12.3m raised from the Soft Drinks Industry Levy would not be spent on improving children’s dental health because, in the words of the Chief Medical Officer, there was “no mechanism in place to hypothecate the tax”.

Tristen Kelso added: “Few could argue that we don’t have pressing oral health needs in Northern Ireland, yet we have an Oral Health Strategy that dates back to 2007 and has never been formally evaluated.

“As a result of this policy vacuum, there is a need to recouple oral health with wider public health policy, and the important contribution dentists can make in this regard.

“With the right level of commitment and collaboration, these difficulties are not insurmountable”

Looking ahead to the Stormont event, Lappin said: “The research that points to a correlation between oral health and overall health is growing by the day. We need to pool all of our resources into addressing the massive public health challenges we face.”