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Oral health – Health visitors and school nurses supporting children, young people and families by Wendy Nicholson

Wendy Nicholson finalOver a quarter of five year olds are suffering from tooth decay - alarmingly it is one of the most common reasons why five to nine year old children are admitted to hospital, and contributes to  school absences.

However, tooth decay is almost entirely preventable. Both health visitors and school nurses are well placed to work with parents and children to develop good oral health routines.  Parents and children need clear advice and guidance; sign posting to dentists and the importance of regularly attending check-ups. Education however goes beyond tooth brushing; oral health is a serious matter with far reaching implications.

The WHO ( ) advises that oral health is integral to overall health and is essential for wellbeing. Good oral health enables individuals to eat, speak, and socialise without active disease, discomfort or embarrassment. Clearly health visitors and school nurses as leaders of public health need to be aware of the wider impact of tooth decay on health and wellbeing and why support in the early and school-aged years matters.

Children’s primary teeth are susceptible to decay when they consume sugary foods and drinks and have limited access to fluoride, often by starting brushing late or using low or no fluoride toothpaste. Brushing should start as soon as the first tooth erupts at about 6 months of age; don’t wait until all the teeth come through. Sugary drinks are also a key contributor to tooth decay and have no place in a young child’s daily diet

Tooth ache is also painful; infection can lead to difficulties with eating, speaking and sleeping. Children may require dental treatment such as extractions, which will result in time away from school and require parents to take time off work.

Evidently there are regional inequalities in terms of tooth decay, some of which can be attributed to socio-economic factors. There are also vulnerable groups who may also be more at risk for example young carers or young people in or on the edge of the justice system.

Health visitors and school nurses will know their local population and indeed individual families; they can provide both a universal and targeted offer to support good oral health.  As health professionals we need to take a 0-24 approach to oral health. This really resonated with me when I met a young man aged 17yrs, just leaving youth justice. He was a quiet young man, who never smiled; he looked away when he spoke. It transpired he had never really received information or advice about oral health; as a result he had extreme dental decay. Eventually he was put in contact with a fabulous school nurse who supported him through his dental treatment. Sadly he needed a total dental clearance having all his teeth extracted and dentures – however he was now able to eat, speak and importantly, smile.

Good oral health in childhood is essential in terms of supporting child development and achieving health and wellbeing outcomes, additionally it helps to lay the foundations for adult oral health – so prevention really does matter. Health visitors and school nurses can provide that early support as part of their routine contacts, they are professionals parents, children and young people know and trust.

We have worked with practitioners to develop an infographic to support health visitors and school nurses to be more aware of the wider impact oral health can have on general health and wellbeing. You can access here:child oral health infographic. Additionally the infographic will provide useful tips they can share with parents, children and young people. School nurses will also want to utilise the ‘healthy teeth’ digital badges – innovative learning tools for use with primary and high school pupils:

PHE has launched the Child Oral Health Improvement Programme Board (COHIPB) this week, which is Health Visiting week. The COHIPB brings together stakeholder organisations that all have key leadership roles for children and young people, including NHS England, the LGA, the British Dental Association, and the Institute of Health Visiting. For more information, visit this link.

There is also a topic on Child Health Oral Health as part of All Our Health, our 'call to action' to all health and care professional to embed and extend prevention, health protection and promotion of wellbeing and resilience into practice.

Links to other resources:


Wendy Nicholson is the Children and Young People Nursing Lead at Public Health England

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