The Royal Society of Edinburgh (RSE) is pleased to respond to the NHS Scotland consultation on children's oral health in Scotland. The RSE is Scotland’s premier Learned Society, comprising Fellows elected on the basis of their distinction, from the full range of academic disciplines, and from industry, commerce and the professions. This response has been compiled by the General Secretary, Professor Andrew Miller and the Research Officer, Dr Marc Rands, with the assistance of a number of Fellows with extensive experience in this area.
The oral health of children in Scotland is an important issue that requires short, medium and long-term planning. Caries is a multifactorial disease and a multi-faceted approach will be required to produce significantly reduced caries levels. While dietary changes are very important with respect to improvement in both dental and general health they will involve long-term programmes that are integrated into medical and other initiatives. Therefore, other short to medium term measures are also needed, and the evidence would suggest that these should concentrate on employing various strategies to ensure that optimum levels of fluoride are present in the oral cavity. Additionally reconfiguration of dental services for children is required to allow the dental care of this population group to be delivered in a cost- effective manner and integrated with other health care needs.
The specific points raised in the consultation document are now addressed below.
Diet and health promotion programmes
The RSE strongly supports the extension of school breakfast schemes, the provision of fruit in nurseries, playgroups and schools, and efforts to facilitate easy access to fresh fruit and vegetables by residents living in socio-economically disadvantaged areas. However some of the benefits of these initiatives will be lost unless parents and carers are encouraged and given the opportunity to develop the relevant skills in food preparation. School meals should be of high quality and of sufficient variety to encourage children and parents to choose this option. An expansion of the existing and successful school nutrition action groups (SNAGs) should take place as a matter of urgency. Overall the reduction of refined sugar in the diet should be a prime aim.
The RSE also supports the extension of community development schemes involving multi- disciplinary working, for example, the Pre-S Oral Health Gain Project and Starting Well schemes in Glasgow. Recent evaluations of the former project has shown the advantages associated with partnership working involving agencies with interests in child care provision.
More emphasis should also be placed on oral health in the undergraduate training of non-dental health professionals and others involved in the care of children, so that a consistent oral health message from all health care professionals is delivered.
Dental Services and Professionals Complementary to Dentistry
Children and their parents should have access to appropriate dental advice and care on a regular basis. Since epidemiological evidence suggests that at present many children in Scotland are not receiving optimum care, there is a need for a review of the present system of delivering childrens' dentistry. Consideration should be given to the reconfiguration of the present system to involve the salaried dental service to a greater extent, with a significant input from Professionals Complementary to Dentistry (PCDs). This would be particularly important in areas of high need. Such a system could also have the potential benefit of providing appropriate settings for the outreach training of dental and dental therapist students. Appropriate and close links must be instituted not only among the various branches of the dental services involved in childcare but also with relevant medical and social services.
Use of Fluoride
Regular twice daily brushing with an fluoridated toothpaste is a habit which should be encouraged to become a norm early in life since this type of behaviour may be easier to establish than some others e.g. those associated with dietary habits. Therefore the current Scottish Executive initiatives in community tooth brushing should be continued and evaluated.
Recent scientific reviews by the MRC and the NHSCRD of water fluoridation have again shown no evidence of risk to general health but benefit to dental caries prevention. This benefit may be complicated by the potential increased risk of mild fluorosis of the tooth.
While recent national epidemiological surveys suggest that dental fluorosis is not a public health problem it would seem reasonable to follow the MRC Report's recommendation that further research is required to quantify the current prevalence of fluorosis in fluoridated and non-fluoridated communities, and to examine the public's perception of this condition. The impact of fluoridated toothpaste and other sources of fluoride on safe and optimal levels of fluoride added to the water system have not been fully investigated. Therefore there is a need for research in relation to water fluoridation and dental caries, particularly regarding the impact of other fluoride sources, social class, quality of life and economic indices. An ideal place for such prospective epidemiological studies to be conducted would be in the central belt of Scotland.
Other methods of fluoride delivery should be fully investigated, for example, using milk and slow release devices. In Scotland clinical studies in relation to fluoridated milk and a slow release device placed on the teeth of children are in progress or planned. The results will yield valuable data about the additional benefits, if any, of these measures over and above that associated with brushing with fluoride toothpaste.