London children’s dental disgrace

More than half of London children – nearly one million children in total – have not been seen by an NHS dentist in the past year. That’s why I was pleased to see the London Assembly unanimously passed the motion I proposed, to raise the issue with the Mayor of London, Sadiq Khan; and to call  on the Mayor to include oral health improvement measures in the London Health Inequalities Strategy. We also asked him to urge the Government to take action to reduce sugar consumption in children right across the country.


Despite dental decay being almost completely preventable, more than 10,000 children in London are admitted to hospital every year to have multiple decayed teeth removed under a general anaesthetic.


This is despite the advice in Public Health England’s new guidance “Health matters: child dental health” (published on 14th June), which points out that that targeted supervised tooth brushing programmes in nurseries and schools alone  provides a return on investment of £3.06 for every £1 spent.


Of London’s 5 year olds, 27% suffer from tooth decay, marginally higher than the 25% national average, but there are massive inequalities in oral health outcomes across the capital, which are very concerning, with just 16% of 5-year-olds suffering from decay in Bromley, whilst 39% of their peers are affected in Ealing. In my own constituency, 32% of 5 year olds in Barnet have decay, compared with 24% in Camden.


Whether Camden  will continue to register at or just below the national average remains to be seen, after the NHS recently closed the Kentish Town Dental Access Centre, a cut I vigorously opposed. This could well turn out to be a false economy on the part of the NHS, if it means yet more extractions ,both for children and adults, through hospital treatment administered under general anaesthetic, almost certainly  costing  far more in total than the NHS dentistry treatment the Access Centre used to  provide.


Overall, London has the lowest rates of dental attendance of all the  English regions. Nine out of ten of the local council areas with the lowest proportions of people attending NHS dental services are London boroughs. More than half of London children – nearly one million children in total – have not been seen by an NHS dentist in the past year, even though such check-ups are free and NICE recommends they should take place at least once a year.


Whilst such check ups and any consequent treatment dental treatment for children is free of charge on the NHS, recent research by the British Dental Association reveals that more than 70% of parents are not even aware  of that. fact, so jeopardising their children’s oral health,  possibly due to fears about affordability and cost.


This is why it is important that the Mayor acts to raise awareness of the fact that NHS dentistry is free for under 18s and encourages parents in London to take advantage of this service to help keep their children’s teeth healthy.


Of course, poor oral health impacts not just on children’s general health, but can also have a lasting impact on their school readiness, impair their nutrition, development, and ability to socialise with other children. Problems with teeth health can also significantly affect confidence and self-esteem, and even hinder a person’s long-term life chances.


The Assembly called on the Mayor to include oral health improvement measures in his development of the London Health Inequalities Strategy and to take all possible steps to improve dental attendance and oral health outcomes in the capital.


We also asked the Mayor to encourage all London boroughs to follow in the footsteps of the London Boroughs of Greenwich, Lewisham and Bexley by pledging to become ‘Sugar Smart’; and to make representations to the Government to take decisive legislative action to reduce sugar consumption in children across the country.


Sadiq Khan, the London Mayor, has give a positive response, outlining the action he is  taking to promote preventative oral health to London’s children through his Healthy Schools London programme and the emerging Healthy Early Years programme. He has committed to working  with local councils, schools and nurseries, especially in the areas of London with worst rates of tooth decay


He says he will absolutely work with boroughs, schools and nurseries to improve oral health, although it will be up to them to commission and decide which interventions work best for the needs of their own local communities. To support them to achieve this, the Mayor would encourage all these partners to continue to engage with his successful Healthy Schools London programme, which currently works with 28 of London’s 32 Boroughs and over 80% of London’s schools.


Furthermore, he is currently piloting an extension of  the Healthy Schools London initiative  to Early Years settings, ensuring we cover the full life course of London’s children and young people.


The Mayor is urging partners, in particular the London Boroughs, to  continue to choose to invest in these successful programmes, ensuring that our schools and early education settings offer the best possible environments, including oral health advice, so that our children and young people grow to be healthy and happy Londoners.


According to the British Dental Association, an average 5-year-old eats the equivalent of their own weight in sugar every year, which apart from increased obesity risks, contributes to so many  London children being admitted to hospitals every year to have multiple decayed teeth extracted under a general anaesthetic.


The Government’s Child Obesity Action Plan was a missed opportunity to show leadership and ambition in this area – and that extends to taking action on sugar reduction that matches the scale of the problem, not just for obesity but for oral health too.


The  Government needs to recognise that it is essential for more national action to reduce sugar consumption in children, and  to consider introducing local measures to help people make healthier choices in schools, workplaces, shops, restaurants and cafés. The issue is linked to deprivation and the Mayor’s proposed response to tackling child obesity will be set out both in his  forthcoming Health Inequalities Strategy and London Food Strategy.


City Hall, in partnership with its catering provider OSC, has led the way by introducing a ‘sugar tax’ on the sugary drinks it sells, a fiscal measure now due to be replicated nationally. Currently, the  Healthy Schools London, Healthy Workplace Charter and emerging Healthy Early Years London programmes help children, young people and employees to make healthier choices.


The Mayor has confirmed that his Healthy Early Years London programme will have a specific outcome measure on oral health and his Healthy Workplace Charter also encourages employers to provide accessible information to employees on healthy eating and  to offer healthier options at on site catering facilities.


It is awful to think so many children in London are suffering with such poor, yet preventable, dental health problems so severe that the only remaining option is to have their teeth removed under general anaesthetic. So it is very important that Mayor Sadiq Khan has recognised this, and is acting to address such profound inequalities in oral health outcomes in London.


However, that is not all. We all must do what we can to get  the message out to parents that a yearly dental appointment for their child, as recommended by the experts, is completely free and is there for their take up. Not only should oral health feature in the Mayor’s London Health Inequalities Strategy, he needs to press the Government to legislate to reduce sugar consumption in children.


With the impact of poor oral health stretching beyond a child’s general health, often taking its toll on their school readiness, development and self-esteem, and long term life chances, we need that action sooner rather than later.


Andrew Dismore AM

Labour London Assembly Member  for Barnet and Camden