10/01/18 – “Why Children’s Oral Health is Everybody’s Business”

Speakers: Claire Stevens, Consultant in Paediatric Dentistry; Professor Michael Escudier, Dean of Dental Surgery, Royal College of Surgeons; and Sara Hurley, Chief Dental Officer for England

10th January 2018 – meeting notes

All-Party Parliamentary Group on a Fit and Healthy Childhood

Why Children’s Oral Health is Everybody’s Business

Chair: Baroness Benjamin

Chair’s Opening Remarks

Good evening everybody and welcome to this, the 31st meeting of the All-Party Parliamentary Group on a Fit and Healthy Childhood.  Tonight we are addressing one of the most shocking issues to emerge in recent years, the terrible statistics about tooth decay and dental surgery in the early years.

We welcome three of the most senior people in the sector to tell us how this can be tackled. Too often, tooth decay has been seen as a separate issue but, as we have learned in our journey as a Group, in the early years everything is interlinked.

Tooth decay and dental surgery in childhood has a powerful impact on a child’s physical and mental health and their future prospects. Action to reverse this appalling decline in oral health will be repaid many times over by reducing the enormous NHS expenditure.

To our speakers tonight I say thank you very much for sparing some of your valuable time tonight. The Chief Dental Officer, Sara Hurley, spoke to the Group in November 2016. She told us of her determination to roll out a campaign on this issue and her struggle to secure resources. I am sure she will be able to tell us what she has managed to achieve so far.

Our other speakers are Claire Stevens, a Consultant in Paediatric Dentistry from the University Dental Hospital of Manchester, and Professor Michael Escudier, the Dean of Dental Surgery at the Royal College of Surgeons.

Claire Stevens, University Dental Hospital, Manchester

The most common reason for 5-9 year-old children being admitted to hospital is for removal of teeth, so there are 10s of thousands of children having this operation every year. There is a misconception that baby teeth don’t matter because they are going to fall out anyway, but they do matter, because decaying teeth cause pain, swelling and sleepless nights,  and there’s a cost to industry in lost production (on the part of the parents) as well as a financial cost to the NHS of £50.5 million p.a. And it’s almost always preventable.

The last year has seen the profession come together and between us, we’ve begun to make a real difference to children’s oral health.

A few examples: firstly, the “Dental Check by 1” campaign. This is a British Society of Paediatric Dentistry (BSPD) led campaign in partnership with the Chief Dental Officer (CDO) of England, supported by the CDOs of Scotland and Wales. Our aim is for a child to have access to a dentist as soon as their first tooth appears and before their first birthday, and we hope that this will lead to a positive life-long relationship with a dentist.

But why so early? Well, we know from Public Health England (PHE)’s survey that one in eight 3 year-olds already has signs of visible dental decay, so if we wait until children reach school age to deliver our key dental messages, it’s too late.

The handout provides more information and there’s even more on the BSPD website.

The information is really important and when a family accesses dental care they should get a consistent message regardless of where they go – to a dentist, a health visitor, a GP, or a pharmacist.

My second example is closer to home, in Greater Manchester.  I was charged with forming a managed clinical network, which has pulled together all providers of paediatric dentistry across the area. By pooling resources we’ve reduced the number of children on the waiting list for dental extractions under general anaesthesia. This year there are 600 fewer children waiting, and with only one provider exceeding a six month wait. I’d argue that that is still unacceptable, but it’s far better than a year ago when children were routinely waiting more than 14 months. We’ve also established urgent criteria for general anaesthesia, i.e. young children under 3 years who have had more than 3 courses of antibiotics are prioritised.

I have to say that this has only been achievable with high-level support. The mayor Andy Burnham included child oral health in his manifesto, and our Chief Operating Officer, John Rouse, made sure that it was included in the population health plan for Greater Manchester. So we now have, in print, our ambition that all children should have access to preventative-focussed dental care before their first birthday.

We’re now looking at a redesign for paediatric dentistry, so that we have one whole system across Greater Manchester, so that people access the same quality of care and the same outcomes regardless of where they live in the area.

Nationally, there has been great success with the Children’s Oral Health Improvement Programme Board. This is a cross-organisational group chaired by PHE’s Jenny Godson. I was delighted to see that oral health featured in a campaign launched on 2nd January this year: asking parents to look for 100 calorie snacks, 2 a day maximum. Clearly, it’s aimed at obesity but there will be wins for oral health here.  This is one of the things I would like people to take home today: the need to look more holistically, because often the risk factors for obesity are the same as for oral health.

I would also ask for support for product reformation. Led by PHE, we are looking at reformulation. There has got to be the political will to do something about this. It’s immoral that in this day and age products can be directly marketed at children when they would exceed – in one serving – half of their recommended maximum daily intake of sugar.

There has also been another success in the launch of “Starting Well” which is a campaign looking at 13 areas that have been identified as having the poorest children’s oral health, enabling the delivery of enhanced prevention to those most in need.  4 of those 13 areas are in Greater Manchester. What will this look like? For us, it’s a £1.5 million investment over three years, enabling us to deliver supervised brushing in all early years settings in priority areas, and dental packs included in the mandated health visitor checks at 6 months and 2½ years.

I hope that this scheme will be expanded under the banner of “Smile for Life” which I’m sure Sara will be talking about shortly.

Turning to the handout, please look at the picture of the finances. Prevention pays! It is far cheaper to prevent dental disease than to treat it.

Finally, I would like to mention Hull and the “1 Part per Million” campaign to look at fluoridation. It’s currently out of the consultation stage and there are partners (dentists, health care practitioners, local and national politicians) all working together to deliver fluoridation for Hull. I hope they’re successful and that other areas will follow suit.

In summary: there have been lots of wins in the past year and I’m delighted that it remains high on this group’s agenda as there’s still lots to be done.

Professor Michael Escudier, Royal College of Surgeons

I’d like to start by thanking the APPG for its continuing support in keeping the issue of children’s oral health on the political agenda.

Claire has given us a really powerful summary of why children’s oral health is such a significant public health issue, but as she says, the good news is that we are starting to see real action to tackle child tooth decay.

As well as the Dental Check by One campaign, the past year has seen the launch of the “Starting Well” programme in the 13 local authorities with the very worst outcomes for children’s oral health, which Sara will no doubt talk about in more detail.

We are also encouraged by the fact that Government has announced that NHS England is also developing a “Starting Well Core” offer for local authorities which aren’t covered by the main programme but want to do something about child tooth decay in their area.

However, it’s absolutely vital that we continue to keep the momentum going in our efforts to tackle child tooth decay – we can’t emphasise enough how important it is to keep pushing on this issue to ensure it remains high on Ministers’ agenda.

A real determination is building across parliament to do something about this problem, as evidenced by debates which took place in both the House of Commons and the House of Lords towards the end of 2017. It’s essential that we capitalise on this and make the most of the opportunity to deliver lasting improvements in our children’s oral health.

With that in mind, I’m going to speak briefly about how the Faculty thinks we can build on what has been achieved so far, and just as importantly about what people in this room can do to help.

The Faculty believes that tackling child tooth decay is a case of getting three things right – education, access and prevention.

In terms of education, Scotland’s “Childsmile” scheme is often cited as an exemplar of this kind of work, and one of the key aspects of the programme is providing supervised tooth brushing sessions for children in nurseries and primary schools.

Supervised tooth brushing is delivered as part of the “Starting Well” scheme which is great news, but the Faculty is interested in exploring whether this could be expanded more widely.

A feasibility study published by Public Health England in December 2016 found that providing supervised tooth brushing in early years settings was “easily manageable” with low cost implications – delivering these kinds of programmes widely across England could make a real difference to standards of oral health.

Equally, it’s not only important that we educate children and parents about how to maintain good oral health, but also the wider public health workforce as well so that the advice they provide is accurate and consistent.

The Faculty believes that oral health should be part of training and continuing professional development for health visitors, midwives, school nurses, pharmacists and early years professionals.

In terms of access, we know that 42% of all children and around 80% of those aged between 1 and 2 didn’t see an NHS dentist in the last year, despite the fact that treatment is completely free.

This is despite official advice stating that children should visit the dentist at least once every 12 months, and that their first check-up should take place when their first teeth come through, normally at around 6 months.

It’s vital that we get the message out as widely as possible about the need to regularly visit the dentist, and crucially that treatment is free for under-18s, as well as doing everything we can to support the Dental Check by One campaign.

Equally, oral health professionals have to uphold their end of the bargain and have a responsibility to ensure that their practices are welcoming places for parents with small children.

Lastly, prevention is absolutely vital and the most significant thing we can do is ensure that children reduce excessive sugar consumption, which is one of the biggest causes of tooth decay.

There have been steps forward in this regard with the introduction of the Soft Drinks Industry Levy, which comes into effect from April, and Public Health England’s sugar reformulation programme, but there is unquestionably a lot more we can do around this.

One proposal which is definitely getting traction is the introduction of a ban on advertising sugary food and drinks on TV before the 9pm watershed. A report published by the end of last year by the Obesity Health Alliance found that 59% of food and drink adverts shown during family programmes such as The Voice and Hollyoaks were for junk food.

In addition, the Faculty believes that there should be restrictions around the availability of high sugar products as part of supermarket price promotions, and at the point of sale, policies which we had expected to see in 2016’s Childhood Obesity Plan but which ultimately did not materialise.

As many of you will also have heard in recent days, there are also growing calls for the Government to ban to sale of energy drinks, which are high in caffeine and sugar, to under-16s.

So what, in practical terms, can the people in this room tonight, and particularly parliamentarians, do to help?

The most important thing is to make your voice heard. Debates about dentistry and oral health are now coming up with increasing regularity – for example, next week Baroness Gardner is leading a Grand Committee debate on “Ensuring children receive regular dental examinations and any necessary treatment” so we’d encourage all Peers with an interest in children’s oral health to attend this. The Faculty is more than happy to support you by drafting written questions and providing briefings.

Equally, don’t underestimate the opportunities that you have to deliver oral health messages directly to the public and your constituents – you can play a really important role in raising awareness about how to improve oral health in your communities.

And lastly, stay engaged with this debate, as it’s only by sustaining the momentum that’s been built up so far that we’ll be successful. For instance, in March the Government will be publishing its first progress report on the sugar reformulation programme, which will give an indication of whether it’s likely to hit its target of reducing the sugar content of children’s foods by 20% by 2020. Look out for this, and other opportunities to hold the Government to account on children’s oral health through 2018 and beyond.

Sara Hurley, the Chief Dental Officer for England

Children’s oral health is everyone’s business, because every child deserves the right to a smile for life. Who would deny them that? It’s true that we have seen amazing progress in the dental profession in the past year, but it’s been siloed in the profession.

The answer is sugar: it’s not fat, it’s sugar!  And it’s not just about going to see the dentist.

The impact for the child being nurtured, and their health for the future being secured, is quite phenomenal.

Let’s not deny the good work that’s been done and that we’ve made some improvements. Regular tooth-brushing with fluoride toothpaste and greater awareness of diet have both played their part, but we are not seeing equality. When we start looking at child oral heatlh, we find that there is an 8 times greater chance of dental decay in children from deprived backgrounds. The haves and the have-nots, which is what keeps me awake at night.

So, while there is some progress, not everyone has experienced it. Why? Dental professionals have been leaning in, but we can only deal with people who walk through our doors. When people walk through our door we can do something about prevention, as opposed to intervention.

The messages that need to get through are:

  • eat less sugar
  • brush at least twice a day with a fluoride toothpaste
  • visit the dentist regularly

Sometimes people can’t find a dentist, or are told that the dentist doesn’t see children until they are school age. To combat this one of the things we have worked with across the profession in the past year is to support the work of BSPD on “Dental Check By 1” with a call to dental teams – including practice managers and receptionists – that when someone walks in asking for an appointment for their small, perhaps uncooperative, child, something is done. That might only be a knee-to-knee inspection in a waiting room in some circumstances.

We’re providing dental teams with the confidence to do that, and NHS England is actively now pursuing the ability to recognise and remunerate that work. We’re saying to practices, if someone is brought in and you haven’t seen them before, don’t turn them away, even if all you manage to do is to have a conversation with mum or dad or the carer, about diet, about less sugar, etc. – fantastic. It sets up the opportunity to get them back again to continue the process. But what they mustn’t do is say it’s all too difficult.

So, we worked with NHS England and the profession to enable confidence on all sides to follow the guidance.  However, the guidance isn’t coming consistently from all sectors of doctors, pharmacists, health visitors etc.

The eyes might be the windows to the soul but the mouth is the window to a child’s health. We need to put the mouth back into the body and make sure that oral health is everybody’s business, so that in every contact with every child, the opportunity is taken to get those messages across.

A fantastic set of recommendations came out of a report last year which said that every consultant paediatrician should include an oral inspection in every consultation. That requires training and the forthcoming conference will help us take that a step forwards.

The other key interested party in this is the local government authority because it is not the dentists, or NHS England, that hold the purse strings for oral health promotion in a community setting – it’s the LGAs. There are 329 and they have been told how to access a wide range of toolkits and resources, e.g. a warehouse full of brushes and worksheets.

Where are the Local Government Authorities doing one of the 9 recommended oral health schemes they could be doing? We have the evidence to show the dividends that are available as a result of prevention, so my call this year is to follow the example of the dental profession and NHS England, and lean forward and lean in to increase the access opportunities for children under 2 to start the oral health journey early.

PHE has put toolkits in the hands of dentists and local authorities: if anyone has any influence here, please start asking the questions about where they are in terms of the 9 recommended schemes that they could, should and must be doing. If they really want to avoid 60,000 lost school days for children to have general anaesthetic for tooth decay, as well as the lost working days for the parents of those children.

So, Local Government Authorities, come and join us, as we make child oral health everybody’s business.

Questions and Comments

Georgina Puckett: Dentists in Tower Hamlets are saying that they are not seeing young children, so people are being turned away.

Sara Hurley: I hope this will change. NHS London have signed up to the initiative and things are changing. We’ve worked hard all over the London area and elsewhere. “Starting Well” is doing well in Ealing and Barking, and every NHS practice has got or will get a pack saying what practices can do to help small children, even if the child is uncooperative.

Baroness Benjamin: Is there to be a media campaign as a way of getting the message across?

Michael Escudier: We can look at terrestrial TV but online is harder to control. However, companies are keen to demonstrate their social responsibility.

Baroness Benjamin: What kind of campaign would engage people?

Sara Hurley: Alison Bowen’s “Baby Buddy” is good. We have to nudge people and put our messages amongst others. You don’t need to talk about teeth and sugar, but we do need to talk about sugar. We want to do it in partnership: we need a national campaign.

The Singing Dentist has a massive following online and is one of the most influential. More mums will listen to him but we need consistency. The art of using social media is to drip feed.

Claire Stevens: It’s true that children can pay more attention to TV characters – in my case my children would not stop running in the swimming pool until they heard Duggie (in the children’s TV programme Hey Duggie) warning the squirrels not to do it.  So they will listen to Duggie when they won’t listen to mum.

I currently have three projects with CBeebies to try to reach this audience. I started writing a blog after seeing a child who drank only Ribena and ate only custard creams, and in 24 hours it had been read by 10,000 people, so these things can have a lot of influence.

It’s about drip feeding – TV, Twitter, mother & baby magazines  all need to keep saying the same thing.

Sara Hurley: And if anyone has any contacts among soap opera scriptwriters, please let me know.

Sara Keel, Babycup: Is there a direct correlation between parents’ oral health and their childrens’? Are there any statistics about the oral health of the parents of children with poor oral health, i.e. do they tend to have parents with equally poor oral health, or are there parents who look after their own teeth who don’t give equal attention to their childrens’? And if that’s the case, perhaps we can we reach people through adult products?

Sara Hurley: Parents who look after their own teeth are usually pretty good, although there are some misconceptions, e.g. about the sugar content of some foods. But we’re less concerned about the yummie mummies in Chiswick than the single mother in Plymouth who wants to do the best for her baby but gets turned away.

Sara Keel: Do you have to go to the dentist for the first check-up? Can it be done elsewhere?

(The division bell drowned out speech at this point)

Claire Stevens: Yes. We didn’t tell our dentists how to do it, we just told them to use their imagination. Attendance doubled.

Sara Hurley: The “Dental checks by 1” campaign is good and implementation varies across the country. Health Visitors were a little reluctant at first because they have so much else to think about, but were persuaded when encouraged to think of it as a child health issue rather than a dental one. There are pockets of excellence up and down the country, e.g. in Liverpool they are taking appointments pre-natal and talking to the pregnant mum about her own oral health, and in Leicester, they’re all over it because the city council has made it a priority.

One of the problems is that “prevention” belongs to Public Health England (PHE) and the local authorities: it does not belong to NHS England. NHS England commissions dental care in clinics but it does not commission “prevention”.

Charlotte Davis, Fit2Learn: Looking at the children we work with, nearly all failing 11-year-old have a troubled, isolated and depressed mother. I think we need outreach to get to these people.

Neil Coleman, OPAL: We know from the smoking programme that this can be done. In all meetings a few things come through again and again. The first thing that strikes me is the small sums that would make a huge difference. We also talk about the holistic approach, looking at all aspects of child health and wellbeing. So let’s get these small sums of mone and get them working. Opal is working with Unilever and their “Dirt is Good” campaign, which is recognised by 2 million people. The experts are out there that can help us, so how about we get on with it – pull in Goldman Sachs, Unilevers, etc. who have CSR (corporate social responsibility) obligations. They want to help but they need us to come to them. Let’s get PHE, let’s get everybody – let’s do something. I think it’s time.

Sara Hurley: Smile for Life is professional but I would love it to be out there as a public campaign. We’ve got the ideas behind it but we don’t necessarily have is the publicly-funded desire, because we’re living with PHE focusing on what they call their Big Three (oral health isn’t one of them but may have an impact on the Big Three). Colgate, Palmolive and Proctor & Gamble are interested in working with us, but it’s a niche market as not everyone walks into a supermarket thinking about tooth-brushing. But I do think there are some opportunities there.

You’re right, small amounts of money (but huge amounts of energy) to keep us moving forward. The difficulty is that I’m dealing with 329 local authorities and 13 different NHS areas – it’s exhausting

Neil Coleman: Don’t do them all: just do the influential ones.

Sara Hurley: Regarding Charlotte’s question, outreach works. One of the key deliverables of that “Starting Well” 13 areas is that practices are being commissed to leave their surgeries and go out and find the hard-to-reach people. #form relationships and partnerships with e.g. hygienists does work to reach people and gets people into the surgeries. Of the people who come to us, 50% are the worried well: it’s the ones who don’t come we need to reach.

Neil Coleman: Let’s get the banners up then – the bathtub of fizzy drinks is a great image.

Kate Day: I work with young mums who are interested in cosmetic surgery and I’ve heard them say that there’s no need to bother about children’s teeth “because they can have them whitened later”.

Michael Escudier: It comes back to consistency. There are too many stakeholders in a crowded place so how do we get everyone co-ordinated so that, for example, we can get pharmacists asking “what’s the Calpol for?”

Matthew Roberts: I’m interested in the point about the obesity strategy

Have the underlying ideas and strategies softened a bit? Should we re-visit some of those issues, e.g. about formulation, or tackling the suppliers and manufacturers who still have a long way to go in spite of the sugar tax? I’m also interested in the example from cigarette labelling and conveying messages about how good or bad products are. If we had a picture of someone’s teeth as a result of drinking orange juice it would be very influential.

Michael Escudier: The key issue should be to align oral health should be aligned with general health. Regarding reigniting – we’ve got opportunities with the goal of 20% reduction in sugar consumption by 2020. We can talk about product reformulation and also ask the government if they are you on track to achieve that goal.

Neil Coleman: The healthy schools rating scheme was proposed a year ago and I think it should be revived and should include oral health and all aspects of child health. The ideas are out there, I think, but they often just sit on the shelf.

Claire Stevens: I’ve always argued that it would be very effective to depict the sugar content of products by showing pictures of teaspoons of sugar. And maybe we do need the shock factor – I’ve got plenty of pictures that could be used.

Sara Keel: I remember a meeting of this group a couple of years ago with the then Deputy Chief Medical Officer for England who had just had a long battle with the tobacco industry (over graphic labelling) and felt he didn’t have the energy to take on another, similar, fight. He’s preferred approach was to work with them. It was a depressing experience to listen to him, just giving in.

Sara Hurley: Sadly in the post-Lansley world they took the Chief Dental Officer out of the Dept. for Health and moved them to the top floor of NHS England, so our influence has changed. Gina Radford and I provided a lot of information and we have got the sugar levy. Granted it’s not the whole answer but it’s a step in the right direction. Kellogs have proceeded with their reformulation, and we need to continue the pressure, but we should also now be saying to Kellogs “well done for doing that!”

Sara Keel: Perhaps we should subsidise the healthy stuff. Junk food is so cheap.

Sara Hurley: We have sugar-free medicine which is more expensive than the sugared medicine. The default choice will therefore invariably be the sugared variety. Most children will have multiple issues. Let’s pick our battles. I like the idea of the can of coke with the picture of spoons of sugar.

(At this point speech was drowned out again by the Division Bell)

Phil Royal: Our February meeting is about how marketing campaigns undermine health messages.  Our report on inequalities is being written up right now and we will shortly announce a new working group to report on child mental health.

Charlotte Davies: If we’re going to put the mouth back in the body, we need to look at the impact of having diseased nerves on sound processing. From 7 years old I can see that trauma on their sound processing profile.

Sara Hurley: If you lose front teeth you lost the ability to pronounce correctly and your confidence decreases as a result. This affects children as young as the age of 10.

Catherine Lippe:  I work with early years practitioners and I would like to know if there are any resources that I can to signpost early years practitioners to? A lot of them won’t know e.g. about the “Dental Check by 1” initiative, and other things.

Claire Stevens: The BSPD have a free download called “The Practical Guide to Children’s Teeth” which is exactly for that purpose, and I will also give you my card. As a nutritionist, you might also be interested in some work I’m doing with our child health and monitoring programme in Manchester. Every child who gets measured in school will get an oral check too, and in return, every child that comes into my clinic has their height and weight  measured, their BMI is calculated which is of interest to the nutritionists. We take email addresses so that we can all communicate with the parents. Our measurements go into their profile, and we’re not working in isolation any more.

Catherine Lippe: Could practitioners go into early years settings?

Claire Stevens: Yes, that’s what we’ve done in Greater Manchester in our priority areas, and we hope to expand it. Every early years setting has a linked dental practice so that if a child comes in with problems that practice will help them.

Baroness Benjamin: I read that sparkling water is not good for teeth.

Michael Escudier: It’s acidic. And low calorie, low sugar drinks are still carbonated and can be damaging to children’s enamel.

Estelle McKay: Recently in this group we’ve been writing reports: one was on play and included a lot about energy drinks. This is a hot topic at the moment. Apparently top sports people have rotten teeth because of the volume of energy drinks they consume.

Do you have any contacts in Manchester Utd. or Manchester City football clubs to use their high profile to promote your messages? I was shocked at the amount of sugar these drinks contain. Are you making a statement about energy drinks as opposed to other high sugar drinks?

Michael Escudier: Yes, energy drinks are a problem and we have a policy statement as a group of organisations.

Jillian Pitt: It’s heartening to hear of initiatives that are starting to work. Local government authorities hold the purse strings and commission services and impact on what can be done. I share your frustration and realise that even when things get done, they don’t always reach their targets. So, what are the barriers to access?

Sara Hurley: Often it will be signposting, which can be poor. We’ve raised this. We’re also still dealing with the legacy of the PCT era, with many old contracts that need to be looked at. We understand that there are pressures elsewhere and there is no specific budget so we can get left with pennies at the bottom of the bag.

I have said to politicians: you are the ones that can make things happen by putting the expressed needs of your constituents to the Local Authority, because this is a mandated requirement. Oral health promotion was given to them to deliver.

The action is, whoever you are, put pressure on to get the message across. Heatlhwatch is very good but oral health doesn’t always get to the top. We have Smile Week coming up and also the May elections where we can raise issues.

Remember it’s the responsibility of local government authorities, not national government.

Baroness Benjamin: Is Andy Burnham the only mayor interested in this?

Claire Stevens: As far as I’m aware, but people can go knocking on doors. In the case of Andy Burnham, I went to him to raise the issue and ask for his support. Some people’s doors are half-open so you have to get in wherever you can.

Sara Hurley: Sajid Javid is the minister for local government.

Baroness Benjamin: When you put a question down in the house it’s not up to the questioner who answers it. Maybe we should send him a report after the conference (organised by the Royal College of Paediatricians and Child Health which will be attended by BB and SH) on 25th January.

Edwina Reville: A key issue is around the way drinks are offered to children. We have a high incidence of dental caries in toddlers and we see a lot of extended bottle use in our area, so we do a lot of training and education around this topic. Is that a key message for you, perhaps as part of “Dental Check by 1”?

Claire Stevens: Absolutely, the more people know that children should not have a bottle past 1 year old, the better, and the “Dental Check by 1” campaign reinforces that message. The Health Visitor should have delivered that message, but we should be reinforcing it.

Baroness Benjamin: As nutritionists, how do you get your knowledge and training about these issues?

Michael Escudier:  Do you have a single site you can go to for information? There should be a single website containing unified resources. We don’t have a single platform and we are championing this at the moment. We need to look at this.

Sara Keel: Lots of people want advice.  A closed Facebook group we created has 30,000+ followers, and parents are less afraid to ask questions in a closed group, whereas in a more public forum they might get shot down in flames by other parents.

Matthew Roberts: Perhaps revenue from the sugar tax could be a resource for this?

Sara Hurley: No, we won’t have access to that. I look with envy at the American and Canadian Dental Associations’ websites. We would love something similar. The amount of funding is miniscule and I would love to see some benefit from the sugar tax.

Baroness Benjamin: The money will go towards sport and getting children active.

Baroness Benjamin: Before we close, would our three speakers please tell us your dearest wish for the coming year.

Claire Stevens: My dearest wish is for a societal change where everyone values children’s oral health, because if we value it, we will want to do something about it. I would ask for ministerial support for the people on the coal face, so that we can implement the clear vision that we already have.

Michael Escudier: That whenever people are considering health, that they step back and say, “What’s the oral health?”

Sara Hurley: To put pressure on local government authorities to do what they’ve been mandated to do, to use the toolkits that they’ve got, to step up to the mark and deliver those nine recommended things they should be delivering.

The meeting closed at 1915.