UKC

This story appeared today on the beeb, talking about kids waiting years to get dental work done abd being in pain while they wait. 

https://www.bbc.co.uk/news/health-66095984

This is clearly awful. 

However, it got me wondering why so many kids need multiple teeth removed. Surely, in this day and age, we can bring out some sort of kids cartoon which encourages tooth brushing, we can do lessons in school about it (one school in the story does make kids brush their teeth after lunch). This shouldn't be beyond us to make sure kids have good teeth?

I have never had a filling or rotten teeth removed. (I had some removed as a teenager due to overcrowding and had braces, but that has been my only ever dental work). I get that some of it will be luck with genetics, but surely this is always preventable? Even chewing gum helps, it can't be hard to encourage that, surely?? (Although, obviously chewing gum comes with the risk of litter etc, I get that it's not problem free!)

There are more reasons than decay to have teeth out/anaesthetics. Tooth pain is miserable. Fluoride in water, brushing and healthy habits can only go so far. The situation just reflects the massive lack of dental services for both children and adults. We need a societal decision in how we are going to fund our free medical services and what quality of service is wanted.

I had some primary dentitions/baby teeth extracted when I was young (once the dentist extracted the wrong tooth, due to me not being exactly which one caused the pain, so then had the correct one extracted). I brushed my teeth, but I ate sweets too. I think there may be local oral factors involved. I probably did not drink enough water, though I remember drinking Ben Shaw's lemonade to some extent, and also Tip Top diluted orange squash, all of which were sugary. Meanwhile my brother never seemed to brush his teeth, and yet never had any dental caries, or dental work.

It is terrible that children are having to wait 18 months for anaesthetic based dental work.

Bit of an aside, but for anyone who doesn't know about it already, and was trying to navigate the NHS website directly, this is too useful not to post:

https://dentalchoices.org/find-nhs-dentist/

I totally agree Steve.

Yes, completely agree that we need a radical change to all medical provision, and dentists do seem to be particularly stretched. 

I just find it really sad that we can't protect kids better from needing extractions in the first place, particularly when it is multiple milk teeth. Surely the only tooth pain that can't be avoided through brushing is broken teeth from a fall etc? When the solution is so simple, why aren't we making sure it happens? 

I wonder if the rise in sweeteners rather than sugars in drinks will help at all with tooth health? I generally think anything artificial is worse for our health, so I presume sweeteners are worse than sugar generally, but maybe better for teeth?

Drinks must attack teeth pretty badly, presumably? Due to the fact that they must touch all of your mouth and the residue will stay if you don't drink water after. 

Especially if only 14% of the population is getting it, despite it being well-accepted and highly successful in other areas since at least the 1970s.

https://en.wikipedia.org/wiki/Water_fluoridation_by_country 

Soft drinks damage teeth in two ways.  The ones with lots of sugar cause acid production by plaque bacteria, which dissolves enamel.  Fruit juices and other highly acidic carbonated drinks dissolve the enamel directly.

This is especially damaging where children have poor oral hygiene (more mature plaque and more acid production from sugar) and where their teeth are in contact with sugary/acidic drinks frequently and for longer periods.  This tends to correlate with socioeconomic class* and poor dental provision.

*Except for very health-aware individuals who drink too much fruit juice!

Because bad parenting?

Perhaps toothbrushing should be carried out in primary schools as part of the school day, particularly after lunch but also in the morning.

I remember a big news story where kids had been given ribena in bottles and it had literally rotted their toddlers teeth away.

I do worry about sports cap drinks bottles (and straws) doing similar, as you get more drink on your teeth than drinking from an open necked bottle or glass. Dread to think what energy drinks are doing to teeth!

Really? I think I get less drink on my teeth. When drinking from a glass, the liquid has to wash over my front teeth, whereas with a straw or sports cap it can bypass that part of my mouth.


 

For children, those Tommy Tipper type mugs (where you can knock them over without spilling) and all drinks with a sports drink type cap are seriously bad as they encourage a constant sipping (and hence a constant coating, doesn’t that matter whether it’s a tick or thin coating of sugary fluid). 

In my past I managed a programme of community health projects and got to know the women behind the campaign to ‘ban’ Sunny Delight as it was soooo bad for children’s dental health. Poor parenting is a major factor (not regulating sugary drinks, too many sweets, not brushing teeth). Made worse the demise of organisations that assisted parents who needed extra help. 

Important to note that's only for South of the border.

Scottish equivalent can be found here https://www.nhsinform.scot/scotlands-service-directory/dental-services 

There is a teacher in the article saying that they do get the kids to brush at lunchtime. How on earth they keep track of everyone's toothbrushes, I have no idea! Great effort there!

As someone who's daughter (8) is on this list, and has been for a while, with no confirmed date to have four teeth removed due to hypoplasticity (i.e. the enamel never formed on these teeth, nothing to do with what has happened since she was born) its a total number nightmare/deeply distressing - what she can eat is now starting to get more and more restricted due the pain which may lead to further complications down the line

https://www.webmd.com/oral-health/what-are-hypoplastic-teeth 

The lack of a functioning healthcare system in this country is a disgrace

All the dentists around me have a ~3 year waiting list for NHS patients. The system is clearly broken.

Saw a woman on the news the other day who slowly pulled all her own teeth out as she couldn't afford dental care. She ended up being crowd-funded a new set of gnashers. 

"No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means."

What have we become?

What I don't quite understand is that 3 or 4 years ago I was supplying IT services to a company that ran a chain of NHS practices - 40+ when I was involved, expanding at 2 or 3 per month. They were making money like billy-o, and because of the peculiarities of the NHS contract were practically dragging punters in off the street.

So WTF is going on?

I go to an NHS dentist. They are very good and I was lucky getting on their books when they first opened. The missus goes to the same dentist but has to go private. I asked one of the dentists about this and he told me that treatment on the NHS is highly rationed. Once they've done a certain number of procedures, they aren't paid for any more. He said he wanted to do more - but wasn't allowed. I have no insight into NHS provision, but I have no reason to disbelieve him. When I had a crown replaced, he did a mix of NHS and private (to get a good tooth replacement but procedures done on NHS) - so he wasn't scamming cash from me.

Just found this website. https://www.nhs.uk/service-search/find-a-dentist

Maybe it's thanks to having a dental teaching hospital (and being a generally nice place to live), but Sheffield apears to have NHS dentists still accepting new patients. Good job, given we still don't have flouride in the water!

Where I live the NHS dentistry service (which is still massively oversubscribed and not taking any new patients), in conjunction with the education dept have a system of “Toothbrushing Supervisors” who go into primary schools at lunchbreak and distribute the toothbrushes and check everyone knows how to brush properly.  Or at the very least has a toothbrush with some paste on it in their gob for a while after lunch is eaten.  

Kids do still have tooth rot but nothing like the scale of it when I was at school (typical 70s Scottish childhood full of sweeties, fizzy drinks and no thought to dental hygiene).

Im aware though that we are very fortunate and that this is not a common scenario.

Oh, and the toothbrushes are stored upright on a tray with holes in it - each brush had a colour and an animal on it, so the kids (including the really little ones who couldn’t read yet) knew which one was theirs.

have just asked my teenager what they did and she said it worked ok.  They were preloaded with paste before handing to kids (or you can imagine the mess and waste)

No.  Human teeth are a mess, it’s not uncommon to have one occluding another preventing proper cleaning.

More pertinently, if you have a child in constant pain *now*, it’s only preventable if you have a time machine.  We live in the now.  I’m pretty sure a back-in-time machine where the exit is within the light cone of the entrance (ie a person going back in time can influence themselves) is always going to violate conservation of energy and destroy itself the moment it’s created.

2 of my daughter's friends did dentistry at university.....both been qualified 3 years now and both work in private practice doing cosmetic stuff.

I asked one of them if she felt bad about people suffering, she said she did but given that she came out with a huge debt from her training felt no obligation to work in the NHS. Likewise a nursing friend of hers who now makes a living doing lip fillers and Botox.

Conversely, a colleague and I were talking about retiring from the NHS the other day.....we have about 65 years of experience between us and both felt that we couldn't because we were still doing our "duty" having been trained at a time where we weren't charged for it and there being very few experienced clinicians around these days.

I don't know about dentists but where I go there are very very expensive cars in the staff car park. Maybe like all health staff with huge debts from training there should be a deal of working in the NHS for a defined period and ones fee debts are removed.

We have been governed by ideology though for years ....the market knows best mentality. It's bullshit. That children and people without wealth are suffering this way is yet another  illustration of why we need to get the Tory's out and elect a govt who governs for all not just the wealthy...

Imbrication is common and makes good oral hygiene a bit more complicated but not impossible.  And, in any civilised society, it should be treated in childhood, not just for cosmetic reasons but also to ensure good periodontal health.  It shouldn’t be a luxury, done properly it would actually save the NHS money by preventing the kind of catastrophe happening right now.

Well I've got to hold my hand up here.  My eldest had to have two teeth extracted when they were 7 or so.  We did our middle-class parent muddling along as best we could with tooth-brushing but clearly didn't do well enough, although he did his teeth every night he wasn't well enough supervised.  Sprog had cavities in the teeth and was in pain when eating.  My wife blames a nightmarish flight to the US where we had a 24 hour delay in Atlanta and spent hours and hours and hours in queues for security and lollipops were used in unwise amounts.

Although we'd gone private by this point my memory is that the NHS did the surgery. The kid over the aisle in the dental hospital was having 9 out, poor fella.

One of our biggest parenting fails.

As an aside we'd been with an NHS dentist for about 10 years, last spring they wrote to us and said "Soz, can't do NHS anymore that'll be £60 a month please, we know there's a cost of living crisis but we can't afford to go on doing NHS work".

So yeah, it happens.

As a Sheffield resident, it is unfortunately not as it seems. The dentists say they are accepting new NHS patients but when you call, all you get it '3 year waiting list', '2000+ people before you', etc.

Bother, I've just sent that link to my niece  who desperately needs a dentist and can't afford to go private. 

As someone else said what we need is to incentivise newly qualified dentists to stay in the NHS - maybe some kind of payback on their tuition fees, so if they work (full time or equivalent) in the NHS for ten years their tuition fees are written off. (I'd love to see similar for other medical professionals as well)

I think one of the problems is that although the country has paid for their course, medics, vets and dentists are often in debt to the tune of £70-100K at the end. So they likely don't feel that the course was paid for as much as they have paid for it! You see the concept of students as consumers in several recent posts e.g. the marking boycott. 

Tuition fees would account for £45K of this and your idea would seem sensible. However I wonder if you even have to pay anything back if you leave the country and so going to Australia for 10 years might be even more financially worthwhile.

In the sunny uplands of South east Kent, if you miss an appointment they kick you off the NHS books immediately, happy to have you back as private patient though. Seems like they cant wait to get rid of any NHS patients asap. 

A local tory councilor often brags about his trips to Turkey for his dental treatment, in his free propaganda paper, and they still vote for him!!!!!

Maybe a little bit, but I think a bigger factor is the acidity of the drinks. For example, cola can corrode teeth because it contains phosphoric acid (whether diet or the full fat version).

That does sound awful. But if we take general dental hygiene/ education more seriously, then maybe the waiting list for people with conditions like this would be far more manageable. 

Can they not do any sort of artificial enamel or something? (I guess not, or they would presumably have done it. 🤷)

That sounds like a great system! Well done to them!

Mine were like that before I had braces, but with some care you could brush them properly. 

I have never liked fizzy drinks, so I have always drank water and milk almost all the time. Very very occasionally I would have diluting juice or hot chocolate, but it was rare. I guess this helped particularly with all my overlapping teeth, as it would be harder for food to get between them than it would be doe drinks?

Well, yes. That is true. We could definitely look to preventing this situation in the future though.

I just find the thought of kids having to have so many teeth pulled etc to be really sad. 

Sadly not - only option is removal - hopefully they get done within the next year (though who knows) as there is also a timing issue when the next set come through ref gaps vs braces and need for further treatment 

There's a strong link between dental care and cardiovascular disease. The microbes get into the bloodstream and form plaques on arteries. The impact on individuals (and as a consequence, society) is much bigger than just pain-free teeth - although that's reason enough by itself in my book.

I generally assume that anything artificial is worth too, but I've completely about faced on sugar and sweeteners.

There's a growing body of evidence that spikes in blood sugar lead to inflammation that markedly increases the risk of cardiovascular disease and other common western killers.

The consumption of sugar in our processes diets is as close to natural as snorting cocaine is to chewing on a coca leaf.

'We'- can't protect childrens' teeth. 'They' (their parents), can...

I’m reminded of one of  the ‘aunties’ in the village I grew up - as an 18th birthday present she had all of her teeth pulled out. No need for NHS dentists then!

I had a great aunt who had the same for her 21st. I had some sort of vain hope that medical care had moved on in 100 years!

Well, clearly some parents can't! So maybe we, as a society, could do a bit more instead. It sounds like some schools are starting to do it and that can only be a good thing 

Does demonstrate how far it has - the change from the 1910’s to the 1990’s in medicine (and dentistry) has been amazing.

I’ve had a fair few teeth out and the idea of a total extraction fills me with horror.

There is also a growing body of evidence to suggest that artificial sweeteners also spike insulin and do nothing to help stave off diabetes. Although I did read that some are less harmful than others. 

We could (and have many times) done dietary threads to their death, so this probably isn't the place for it. However, weaning ourselves off the addiction to sweetness would help a multitude of health problems, including tooth decay. 

There’s a link between periodontal disease and systemic inflammation, including cardiovascular problems, although the fatty ‘plaques’ of atherosclerosis are not related to bacterial dental plaque. 

My Grandmother had this as well. Very common in her day - almost a rite of passage. She was born in 1922, and I think she had it done for her 18th.

In my primary school, we didn't have toothbrushing embedded into a routine day, but we did have a yearly visit from a dentist who would hand out toothbrushes, show us some horrible photos of what happens when you don't clean your teeth, and make us do the thing with the chewy tablets that stain all your plaque a bright colour. That would have been late 80s or early 90s. It was as a direct result of those visits that I firstly stopped sucking my thumb, and secondly stopped putting sugar on breakfast cereal and in tea...

The school that my sister's elder children (9 and 6) go to, and the nursery that the younger one go to both encourage toothbrushing after lunch.

I fear it's built-in - you'd have to go back tens/hundreds of thousands of years (millions, even?) to stop folk with a fondness for sweetness breeding, which would run into the problems wintertree outlined above

Thanks for the clarification

I’ve been a primary school teacher for the last 7 yrs and have some fairly strong opinions on this. 

Honestly I struggle to understand why this should be lumped onto a teacher’s (often already excessive) workload or take up time in an already busy school day. This is definitely a job for parents. It’s not only about coordinating the toothbrushes in school but finding enough sinks, coordinating different year groups, the time taken to clean the sinks after (yuck), keeping those brushes hygienic after repeated use etc.

I once taught an 8 yr old girl who had just arrived from S Korea and they were surprised we didn’t do tooth brushing after lunch, but she explained that they had a whole set up of sinks etc. built into the school design already as it was very much a cultural practice.

I honestly feel this is a problem with the NHS shortages and with parental behaviour, and the solution shouldn’t be - ‘just tack it on to the school day’.

It is a problem with parental behaviour (not with the NHS, as bar a 6-monthly scale and polish they won't be cleaning your teeth for you), but sometimes you can't solve that other than by having someone else intervene.  See also feeding kids properly.

It's not a parental education issue - everyone knows you should brush your teeth twice a day - so it isn't easy to solve otherwise.

Having delivered a decent amount of Paediatric dental care and education in a previous life, it really really is a parental education issue, especially in areas of social deprivation. Not just brushing (have they ever been shown how to do it properly etc) but diet and other preventative measures. 

That's not to say schools and nurseries shouldn't be involved, preventative measures in these settings can have an amazing impact, but the parents and guardians need to be on board if it's going to work.

The advantage of moving it into schools is that parents don't need to be on board for basic oral care.  Some parents just won't be fixed.  It's the same justification as breakfast clubs - all parents SHOULD provide their kid with a nutritional breakfast, but many don't even manage to throw a box of Frosties and a carton of milk at them.

Yes. I was surprised to be told my nearest NHS dentist was 160 miles away in Rochester!

For real impact yes, they do, as part of an education programme at home, school and from professionals. 

It's been a couple of years since I was doing full time dentistry so I'm unsure as to how well this is going at the moment but the Scottish Governments Childsmile programme is an example of education from multiple settings and treatment from professionals. 

https://www.childsmile.nhs.scot/

Still not going to happen with a significant minority of parents.

There's a lot of idealism here - yes, parents SHOULD take proper care of their kids, but an awful lot don't and aren't going to.  So unless you're going to take all those kids into care...

Do any dentists on here seriously think that when they tell people repeatedly not to drink fizzy drinks because they rot your teeth that anyone pays any attention whatsoever rather than just saying "yes sir" like they do to the teacher?

I'm not opposed to education, it's a good idea, but there is a significant body of kids that won't be reached by it because the parents just don't give a stuff.

In short, it's like school meals.  If you provide kids with a nutritional hot meal at lunchtime at school, you know they'll have at least one nutritional hot meal that day; if you do breakfast club too you know it's two and whatever the parents do they aren't really going to go properly hungry.  If you have them brush their teeth at school on a supervised basis, then you know that's happened at least once that day (or twice if done morning and evening).

Should the parents do it?  Absolutely.  Are there plenty of parents who won't do it?  Also absolutely, so we have to make policy taking that into account.

'Re-starting', surely you can remember the community/ school dentists we used to have?             The service was decimated over decades...

And the very direct influence of the parents of the affected child very much overrides the  well meaning collective 'we'. (  My professional view ;-(   )

It is a parental education issue. ( Not 'everyone' knows that you need to brush twice a day, use 1350-1450ppm fluoride toothpaste, not rinse after brushing, use inter proximal brushes/ floss daily, only use mouth rinse at a different time to brushing and limit sugar intake up to four times daily.) The poor knowledge, habits and behaviours of the parents get passed on to the children, and therefore disease patterns- see the current parlous GA waiting lists for paediatric dental treatment. There's an inverse care law at play here, if the middle classes had this issue, they'd be bombarding their local MP with letters.

If you think that even if people did know that that 100% of parents would do it properly - or even 80% would - then you're hopelessly optimistic about the quality of parenting in the UK.

A very large minority of parents in the UK simply do not give a monkey's.

I'm in no way opposed to education, but like meals it won't get even nearly everyone.

Agreed absolutely, but how do we achieve this? A citizens' assembly set up to examine this one topic might be one way forward. I think they had something like this in Ireland to make progress on abortion.

The problem is basically that we need to pay more tax to fund an effective NHS but most people won't vote for a party that promises to raise taxes. Just saying that "we will fix the NHS by restructuring / improving efficiency etc" hasn't cut it so far and won't do so in future.

It also needs a long term strategy which our political system isn't designed to foster. We'd be much more likely to progress things that need long-term thinking under PR.

Martin

I can see why this would be disruptive, but dentists recommend brushing teeth (30 minutes) after every meal. 

If kids go home for lunch, the parents can ensure that happens, but for those that stay in school you are in loco parentis, if it's the parent's duty to ensure teeth are brushed then surely for those meals it's yours?