DENTAL decay is a disease of social disadvantage. The recent shocking study which revealed the staggering number of young children who have rotten teeth proved that the poor are far more likely to need treatment.
The study showed that more than 470,000 children needed hospital admission for treatment relating to their teeth between 1997 and 2006. The most worrying rise in serious problems was among the most deprived.
There was a huge difference in the chances of being admitted to hospital to have a tooth out between children in affluent areas and those in socially disadvantaged areas. Twice as many treatments were provided to children from the poorest areas compared to those from the richest.
Is this any surprise? There is a growing gap between the health of the wealthiest and the poorest in this country.
Despite endless efforts by the Government, which says its priority is “narrowing the health gap between disadvantaged groups, communities and the rest of the country, and on improving health overall”, Britain is still divided between the healthy haves and less healthy have-nots.
Health inequalities begin in the womb, are nurtured by bad diet and poor parenting, and multiplied by bad habits such as smoking. Teeth are no exception.
In Tackling Health Inequalities: A Programme for Action, published in 2003, the Government announced some very impressive aims to: reduce smoking in
manual social groups; prevent and manage other risks for coronary heart disease and cancer such as poor diet and obesity, physical inactivity and hypertension through effective primary care and public health interventions – especially targeting the over-50s; improve housing quality by tackling cold and dampness, and reducing accidents at home and on the road; improve the quality and accessibility of antenatal care and early years support in disadvantaged areas; reduce smoking and improve nutrition in pregnancy and early years; prevent teenage pregnancy and support teenage parents; and improve housing conditions for children in disadvantaged areas.
There was no mention of oral health. However, for many years, oral health has been one of the biggest health divides and one of the worst inequalities.
One of the best ways to tackle it is water fluoridation. It is one of the few public health improvement measures that can benefit the public without people having to change their lifestyle.
Eating more healthily, cooking fresh products, abandoning ready meals, all takes time and money. Quitting smoking, taking more exercise, both take willpower.
The recently-announced NHS health checks, which will invite everyone aged between 40 and 74 for a free health assessment, are far more likely to benefit the worried well more than the deprived sick. If you have no job, live in inadequate housing and have problems finding enough money to feed your children, you are not going to turn up for a health check and follow advice on weight management and reducing your risk of heart attack.
It is the same with oral health. While the affluent may be concerned about replacing toothbrushes, buying fluoride toothpaste and finding a dentist who accepts National Health Service patients, the same cannot always be said of those living in social deprivation.
Even if they do, one of the best ways of protecting children’s teeth is a sealant put over the back teeth during the early years when they are most likely to experience tooth decay.
Sadly, this procedure is rarely available on the NHS. Nearly 15 years ago, when I paid for my daughter’s teeth to be treated in this way, it cost £10 a tooth. I dread to think what it costs today. How many people can afford that?
That is why water fluoridation is so vital. There is considerable evidence that it is the first decay that you get that sets you up for your lifetime experience. The later you get your first filling, the better your lifetime oral health.
Fluoridating water protects teeth. It has been shown to reduce the number of decayed, missing and filled teeth, particularly in children. Water fluoridation has been around since the 1960s. We can blame Margaret Thatcher initially for privatising the water companies in 1988 and causing a slowdown in the uptake.
Until recently, no real progress had taken place in implementing new water fluoridation schemes within the United Kingdom since the ownership of most water companies passed into the private sector.
Up until 2003, water companies had no obligation to fluoridate the water even when requested to do so by health authorities.
Now much of the blame lies with NHS funding. As water fluoridation is a public health measure to improve dental health, it is paid for entirely by the NHS. At local level, the strategic health authority is billed by the water company for the entire cost of fluoridating supplies.
Although they have a duty to improve the health of their local populations and reduce health inequalities, strategic health authorities also have a financial duty to keep in budget and must not spend more cash than is allocated to them.
But there are many competing demands on fixed budgets and fluoridation is often overlooked in favour of more dynamic life-saving treatments. Yet the cost to the NHS of treating avoidable dental disease would be substantially reduced by spending money on fluoridating water.
The answer surely is to ring-fence money for this purpose. It is the best way to ensure that “everybody, irrespective of means, shall have equal opportunity to benefit from the best healthcare available” – to misquote Aneurin Bevan slightly – and get rid of the scandalous inequalities in the health of children’s teeth.
