Children’s dental health has been hitting the headlines a lot this year, and unfortunately for all the wrong reasons.
Early in 2018, BDA Chairman Mick Armstrong described it as a ‘badge of dishonour for health ministers’ after figures revealed the number of hospital tooth extractions for under-18s in England had risen to 42,911 in 2016-17. That’s a rise of over 6,000 since 2012-13.
Organisations are trying to tackle the issue with the launch of the Dental Check by One campaign by the British Society of Paediatric Dentistry (BSPD), supported by the CDOs of England, Wales and Scotland. The campaign aims to remind parents and guardians of the importance of children seeing a dentist before their first birthday.
With this in mind, I spoke to Siobhan Barry, a consultant in paediatric dentistry at the University Hospital in Manchester, about the issues facing paediatric dentistry, the challenges dentists face in treating children and advice about seeing anxious children…
Zoe Close (ZC): What are the biggest challenges in paediatric dentistry at the moment?
Siobhan Barry (SB): Without doubt it’s the decay rate, particularly in our younger children – and it’s an almost entirely preventable problem. In Manchester we have a very high decay rate, it’s higher than the national average, and dental extractions under general anaesthetic is one of the most common reasons that young children, particularly between the ages of five and nine, are admitted to hospital.
The waiting list for children needing extractions under general anaesthetic is high, and a lot of these children are in pain so it’s very hard to manage that.
Access to general dental care and access to specialist care in the UK is inequitable because we don’t have enough specialists in paediatric dentistry. In some areas such as Leeds we have consultants and specialists in the community, and in others, such as Manchester, we have very few.
ZC: And, what are the day-to-day challenges facing general dental practitioners when it comes to treating children?
SB: I love treating children, and I’m well used to it – but I know it can be tricky for some, partly because it’s such an investment in time.
Sometimes the child can be quite anxious and it’s about their acclimatisation – getting them used to being in the practice and seeing you. You may have a child in for their first visit, for example with Dental Check by One we like to see children before the age of one when all their anterior primary teeth are in place, so the chances are they won’t have been to the dentist before and they may not agree to sit in the chair or open their mouth, etc. It’s about investing the time to see them on a regular basis and getting them used to you, so it becomes more familiar and they’re more likely to be cooperative.
“We have Dental Check by One in order to tackle the high decay rate in our young children and I think it will make a huge difference but we need our General Dental Professionals (GDPs) to buy into it.”
We have Dental Check by One in order to tackle the high decay rate in our young children and I think it will make a huge difference but we need our General Dental Professionals (GDPs) to buy into it.
ZC: What kind of things can GDPs be doing to prevent children reaching the point where they need to go to hospital?
SB: It’s very important to see children early, from six months on – and see them regularly, in order to provide intensive prevention for patients and information for parents. Often, children have high decay because of things like taking a bottle of milk to bed, which parents just don’t realise can cause decay. They think they’re doing something good for their child and by the time they find out that they’re not, it can be too late.
Even if the dentist doesn’t actually manage to look in the child’s mouth, it’s still important to see young patients early as they’re able to meet the parents, give advice about appropriate toothpastes and diet, talk about caries, and check the child’s toothbrush.
ZC: What tips do you have for managing anxious child patients and the options available to dentists treating them?
SB: A non-pharmacological option is behaviour management. This is things like ‘tell, show, do’ – tell the patient what you’re going to do, show them and then do it. There’s also modelling, where you have a sibling who behaves well and you can model the behaviour of that child. You can also count – so you tell them you’ll count to five or 10, or whatever they understand, and then give them a break.
For children who are a little more anxious, they can have inhalation sedation which is gas and air through their nose. It’s very good for children who are aged six and older because dentists need them to cooperate and buy into the idea of sedation. If they don’t want to do it then sedation isn’t going to work for them…but it’s quite good for anxious children who want to do it but just need that little extra help. They’re always awake and are back to normal before they leave.
“A non-pharmacological option is behaviour management. This is things like ‘tell, show, do’ – tell the patient what you’re going to do, show them and then do it.”
For children who are aged 12 and older, we can do IV sedation which is injected into their vein and it’s a more profound sedative, they’re not asleep but it’s good for anxious teenagers.
For a certain group of people, they’re always going to need general anaesthetic, for example pre-cooperative children aged under-three and some older children who have multiple quadrants of dentistry that you just couldn’t manage otherwise, e.g. surgical extractions, or children who present with big facial swelling that makes extraction difficult.
So, whilst I don’t think you’ll get rid of general anaesthetic for children completely, there are these other options which mean you can dramatically reduce its usage.