Agenda item

To provide an overview to the Committee on children’s oral health in Brent, including both national and local contexts and available data.

Councillor Neil Nerva (as Cabinet Member for Adult Social Care, Public Health and Leisure) introduced the report, which provided an overview of children’s oral health in Brent, including both national and local contexts and available data. The report considered what the local authority and local NHS could do in partnership to improve oral health in Brent, and he thanked the Committee for prioritising this area.

Somebi Anwunah (Principal Public Health Strategist, Brent Council) provided additional information on the report, which he advised covered data, trends and levels of dental decay in the borough as well as the interventions Brent Public Health had put in place which included; an oral health needs assessment; the oral health bus, which had been running since 2021 and had completed over 3,000 dental assessments for children in primary schools; the supervised toothbrushing programme which had been running in Brent since 2017; and the Big Brent Brushathon which was an oral health promotion programme run annually for the past two years. The report also covered the negative factors perpetuating poor oral health outcomes in Brent, such as gaps in knowledge regarding toothbrushing techniques, inadequate access to fluoridisation and poor behaviours around diet. Finally, the report detailed future planning, including a consultation on the programmes currently being delivered and the national expansion of the supervised toothbrushing programme for which Brent had received funding for. Brent Council was also looking at surveying schools to further understand children’s health and oral health needs.

The Chair thanked presenters for their introduction and invited comments and questions from those present, with the following issues raised:

The Committee recognised the importance of oral health for children, and highlighted concerns in the figures showing that 43% of children in Brent had experienced some form of dental decay by the age of 5. They noted that Brent had the highest number of people suffering from dental decay compared to other boroughs and asked why there had been no earlier interventions. Somebi Anwunah responded that, whilst the level of dental decay in Brent was high, it was trending downwards. Up until 2022, dental decay levels had been trending upwards, where the figure showed 46% of children in Brent had experienced dental decay by the age of 5, compared to 43% now. This was in comparison to the London trend, where dental decay levels appeared to be currently trending upwards. As such, whilst Brent had historically high levels of dental decay, he felt that the trend over the last two years showed it was going in the right direction, particularly compared to the rest of London. Dr Melanie Smith (Director of Public Health and Leisure, Brent Council) added that there were deep-seated, entrenched beliefs amongst Brent’s communities in relation to oral health, and Public Health found that parents who had experienced poor oral health in their own childhoods had negative attitudes towards oral health and accessing dentists as they associated it with pain and discomfort. Public Health was proactively addressing this and trying to change that mindset so that parents saw dentistry as a positive experience where they could take their children when their teeth were fine. Challenging that mindset was difficult, but she highlighted that this had been a priority area of work that Public Health had been addressing for ten years and not something only being addressed now. One of the challenges Public Health faced was intervening early enough so parents were comfortable taking their children to dentists as soon as their milk teeth appeared. She acknowledged that oral health was not where Public Health would want it to be, but confirmed it was moving in the right direction, which she felt was a direct result of the intervention programmes that had been put in place.

Considering that the trend of high dental decay levels started in 2015 and there had only been a 3% decrease since then, the Committee asked how effective the interventions had been. Dr Melanie Smith replied that, whilst the figures were not where Public Health would like them to be, they were showing a difference in Brent compared to the rest of London, which had been acknowledged by OHID and the GLA. She explained that it would likely take a generation to get to where Public Health would want to be on oral health, which was to have the same levels of oral health outcomes as the least deprived areas in the country.

The Committee asked how Public Health was reaching children to disseminate messaging and provide interventions. Dr Melanie Smith explained that the oral health bus programme undertook specifically targeted work, recognising the strong correlation between dental decay and levels of deprivation, therefore had been attending primary schools, nurseries and early years settings in those areas. The data was showing that those targeted interventions had been successful. She felt that the new supervised toothbrushing programme also represented a step change, as that offer would be universal. There would be a need to do outreach for particularly difficult partners to engage such as smaller nurseries and childminders.

Noting the comments regarding encouraging parents to get their children’s teeth checked as soon as their milk teeth appeared, the Committee asked what strategies were in place to set that good example from early years. Dr Melanie Smith advised that supervised toothbrushing started in nurseries until reception with the aim to establish very sound oral health practices early on. Most headteachers were well aware of the problems surrounding oral health as it impacted school attendance, with the most common reason for a child to have an unplanned admission to hospital being to have their teeth taken out. It was found that there was misinformation regarding oral health, for example, it was not widely known that professionals advised people not to use mouthwash after brushing as this washed the fluoride away, so there was also an emphasis on oral health education. This was done on the oral health bus, which also targeted health promotion at older children and their parents. Nigel Chapman (Corporate Director Children, Young People and Community Development, Brent Council) added that there was a close relationship between schools and Public Health on this issue and headteachers would speak to parents on an individual basis where a need was identified, in addition to the learning from the bus going into schools regularly. Schools also had a focus around healthy eating, ensuring there were very few sugary snack and drink options in schools, but it was highlighted that this could not be controlled in the home environment, so there was a need to support parents to do the right thing.

The Committee asked whether Brent was learning from other boroughs who were performing better on oral health. Somebi Anwunah confirmed that Brent participated in a community of practice in London around oral health. Many of the boroughs with poor oral health outcomes were from NWL, and there was a NWL Oral Health Network that Brent was part of to learn from there, and there was also learning from other parts of London with better outcomes to see what they were doing so that may be replicated in Brent.

The Committee felt that some of the issues that had been attributed to causing poor oral health in Brent, such as diet, systemic NHS issues and fluoridisation, were national issues, and therefore asked why it was worse in Brent. Dr Melanie Smith agreed that some of the issues were national, but there were some particularly acute issues in Brent needing to be addressed, including access to child-friendly dentistry and provision of preventative dentistry. The most significant intervention she felt would make a difference was addressing the intergenerational beliefs of communities and parents whose expectation was that their child would have poor oral health because they had it. To get the message across that poor oral health was preventable required sustained behaviour change and challenging those entrenched beliefs and behaviours, including around breastfeeding and weening.

The Committee recognised that Brent had areas of high deprivation such as Harlesden and Stonebridge, which was being linked with poor oral health, but asked what could have been done more efficiently over the last 7 years to bring oral health performance in line with similar boroughs such as Lewisham, who had very similar demographics to Brent but better oral health performance. Dr Melanie Smith explained that, historically, dentistry, and specifically child-friendly dentistry, had not been easy to access within Brent. Public Health was working with the NHS to influence the provision of dentistry to improve access in Brent. She added that, whilst the rates of dental decay were high, they were reducing, and Brent Council had been taking action for a number of years around this. The targeted interventions had been impacted by the pandemic, as it was not possible to conduct supervised toothbrushing virtually, which she felt was why the figures had begun to improve over the last 3-4 years post-pandemic. Whilst the figures in Brent were high compared to other similarly deprived boroughs, she highlighted that the rest of London was trending upwards, so she would not be surprised if those other boroughs had higher levels at the next survey. There were also differences with dietary culture practices, parental experience and access to services that needed to be factored in. Somebi Anwunah reassured members that Public Health’s strategy had been to address oral health behaviours as early as possible, but, due to the combination of factors perpetuating poor oral health, this could not be solely addressed by the local authority and needed a multi-agency approach.

The Committee asked what was being done to fix the underlying issue in Brent specifically regarding access to child-friendly dentistry. Dr Melanie Smith explained that the national NHS dentistry contract actively disincentivised dentists from providing preventative dentistry. Whilst lobbying the NHS around the contract, Public Health had, with the help of other professional bodies, found dentists who were open to working in a different way and become child-friendly. Those dentists were often newly qualified dentists who Public Health then recommended to parents when the oral health bus identified dental decay, because officers knew they would have a positive experience with those dentists.

The Committee raised concerns that the education piece needed had not reached children and parents, and asked whether there was any focus from Brent Health Matters (BHM) to provide that education. Dr Melanie Smith welcomed a wider recognition on the importance of oral health and felt it was growing but there was further recognition needed, particularly in relation to decay and problems with milk teeth in the early years. As such, educating the whole community that dental decay was preventable if addressed early enough was needed, advising the community on the powerful impact of using fluoride on teeth to prevent dental problems which should be done by a dentist as soon as milk teeth appeared and every 6 months to 1 year after that.

Noting that the Community and Wellbeing Scrutiny Committee had previously reviewed oral health before Covid-19 and made a number of recommendations, the Committee asked how those recommendations had been progressed and asked for a sense of the journey Public Health had been on from then until now. Somebi Anwunah felt that the journey could be described through better collaboration, which he felt had been the highlight of how Brent had got to where it was now. The oral health bus had grown its number of assessments year on year with organisations such as Whittington Health Trust, Library Teams, Early Years and NHSE part of these events, allowing more collaboration, including with schools. Public Health had gone from having a mobile assessment unit travelling to different areas to delivering events inside schools and libraries where information around oral health, diet and nutrition could be provided. Public Health recognised that poor oral health outcomes were multi-factorial, so was trying to address as many of those factors as possible per event and were trying to collaborate with as many parts of the system as possible to improve those outcomes.

The Committee asked how Public Health was engaging other partners to help, such as Brent Health Matters, Libraries and Family Wellbeing Centres (FWCs). They were advised that the oral health bus involved libraries staff, who were trained to make interventions themselves, and oral health education sessions were held within libraries. Dr Melanie Smith assured the Committee that Public Health was using all possible means to get messages out, but asked for suggestions from members if they had ideas.

Recognising that Public Health were trying to address the underlying beliefs surrounding oral health in the community, the Committee asked officers whether they felt they had done enough to change that underlying tone. Somebi Anwunah responded that there was still more to be done, but the Council was eager to do as much as possible. Public Health had done a lot of work with the oral health needs assessment to understand why Brent was in this position relative to other local authorities, and was looking at doing a wider health and wellbeing survey with schools to understand need, and focus promotion on nutrition for oral health and other aspects not necessarily related to dental hygiene. Dr Melanie Smith assured the Committee that Public Health would continue to prioritise oral health and would want it to be a priority for everyone.

Noting that the gap between Brent and the national picture would not change in the near future, the Committee asked whether there was a timescale in mind to reach closer to other boroughs. Dr Melanie Smith advised that she envisioned the figures being closer to the London average in 5-10 years, but nationally it would not be possible due to the issue of fluoridisation in London.

The Committee highlighted that the NHS had recently undertaken a consultation on the NHS Dentistry Contract and asked whether Brent had input into that. Dr Melanie Smith confirmed that the level at which the contract was administered locally was through NWL Integrated Care System, so Brent had worked as a collective with NWL to respond to the consultation.

The Chair then invited representatives from Brent Youth Parliament (BYP) to ask the final question in relation to this item. BYP asked what the Council was doing to support young people in Brent to become dentists locally, and, furthermore, child-friendly dentists. Dr Melanie Smith replied that Public Health had introduced young dentists in schools and community settings to make dentistry appear more accessible, and whilst the primary aim of that was not to encourage people to become dentists, she considered that when young people saw other people their age as dentists they might consider that as a career. Nigel Chapman added that dentistry was a highly skilled role with strict requirements, and was confident with the A-level performance in Brent, which was higher than the national average, that many children leaving Brent schools were well-equipped to access a dentistry place. He was less clear on the funding for dentistry places nationally, how many vacancies there were and whether there were sufficient training places available. He encouraged the Council and partners to ensure community dentistry was seen as a job of choice for young people.

As no further issues were raised the Chair thanked officers for their time and responses and invited members to make recommendations, with the following RESOLVED:

i)               To get a strong message out to Brent parents, carers and communities via tools such as the Brent Magazine, Brent Health Matters, Libraries, Hubs, Family Wellbeing Centres and schools, focusing on areas with poorer oral health outcomes, about the use of fluoride on teeth.

An information request was also made during the discussion, recorded as follows:

i)               For the Committee to be provided with the response made to the NHS Dentistry Contract consultation, and any follow-up responses made as a result of the findings of the consultation.