Child Oral Health -...

Child Oral Health A Mozart Estate community engagement study

July 2013 Produced for: Paddington Development Trust

Westminster City Council and West London Clinical Commissioning Group

Prepared by Collaborate & the Tri-borough Public Health Service

Penny Stothard, Director, Collaborate [email protected] Katie Wright, Senior Public Health Officer [email protected]

Collaborate

mailto:[email protected]

2 | P a g e

Contents

1. Summary of key findings and recommendations 3

2. Introduction and methodology 7 2.1 Methodology: Child Oral Health Survey……………………………………………………….......................8

2.2 Methodology: ‘Community Conversations’..……………………………………………………………………11

3. Findings: the Child Oral Health Survey 14 3.1 Brushing behaviours………………………………………………………………………………………………………..14

3.2 Going to the dentist: children………………………………………………………………………………………….18

3.3 Children’s hospital attendance for dental problems………………………………………………………..21

3.4 Parental dental attendance……………………………………………………………………………………………..22

3.5 Parental knowledge about looking after their children’s teeth………………………………………..24

4. Findings: Child Oral Health ‘Community Conversation’ Groups 25 4.1 Community conversation with children…………………………………………………………………………..25

4.2 Community conversation with parents……………………………………………………………………………31

5. Recommendations 38

6. Appendices 41 A1: Profile of residents who responded to the survey………………………………..…………………………41

A2: Profile of participants who took part in the community conversation with parents………..42

B1: Research instruments: Quantitative Survey…..………………………………………………..................43

B2: Research instruments: Topic Guide for group discussion with children…………………………..47

B3: Research instruments: Discussion guide for group with parents……………………………………..51

C: Key external data sources cited in this report……………………………………………………………………56

3 | P a g e

1. Summary of key findings and recommendations

Key findings

As part of the insight work, 54 surveys were conducted with families with children aged 8 years or

younger living on the Mozart Estate between October 2012 and March 2013. This represents around

25% of the families with children of that age group living on the estate. Although responses cannot be

seen to represent all families on the estate they provide interesting insights into how some residents

feel about oral health, oral hygiene practices in their household and how they access dental services.

This was followed up with two ‘community conversations’; one with parents, the other with children

aged.4-9 years to explore in more detail some of the themes examined in the survey.

Toothbrushing

Age start brushing - It is recommended that parents start brushing their children’s teeth as soon as

they come through (usually under 1 year old) so as to give the maximum protection to their teeth and

start good brushing behaviours from a young age. Of the parents who responded to the survey, 10

(nearly a fifth) reported that their child had been at least 2 years old when they started brushing their

teeth, an age when children tend to have many if not all of their primary teeth.

These findings were supported by the community conversations, where most children participating in

the discussion were not aware that children’s teeth should start to be brushed as soon as they

emerge.

Frequency of toothbrushing - Positively, four-fifths of parents in the survey reported that their children

brush their teeth twice a day (the recommended frequency). Many of the remaining parents (9)

reported that their children brush their teeth only once a day or less often.

Supervision of toothbrushing - Of the parents sampled, only a quarter felt that they should help with

their child’s brushing until the recommended age (7 years). Many felt children only need help with

brushing until the age of 3 years. It is important that parents stay with their child to ensure that they

brush their teeth properly (reaching all their teeth and brushing for a sufficient length of time). In

practice 32 of the parents sampled stay with their child while they brush their teeth. The survey

showed that parents whose eldest child was under 5 years were more likely to stay with their child

when they brush, highlighting that the age of the child can be a significant factor in oral health

behaviours.

These findings were supported by the community conversations, where many of the children who

took part admitted that their parents were not supervising their brushing until the recommended age.

Some parents joining the discussion also reported that they felt that 2-3 years was an appropriate age

to stop supervising their children’s brushing.

4 | P a g e

Toothpaste type - Children aged 3 years and over can use adult toothpaste: they do not have to use a

make of toothpaste particularly marketed for children, although they may prefer the taste. What is

important in selecting toothpaste for children is that it contains the appropriate amount of fluoride to

keep their teeth healthy. When asked in the survey what toothpaste parents used for their child,

many parents were able to recall the brand used and/or whether it was a children’s toothpaste. Very

few could name the toothpaste. The question included in the survey around toothpaste was an

experiment and in practice did not deliver the information that was intended. Even so, from the

answers received it was clear that parents are not aware of the Department of Health’s

recommendations around the fluoride content of toothpastes and may not question whether the

toothpaste they use contains fluoride and the appropriate level of fluoride.

Visiting the dentist

Age start taking children to the dentist - A quarter of parents responding to the survey had not yet

taken their child to the dentist (the children were of various ages). Around a quarter of parents who

had taken their child to the dentist had taken them for the first time after they started school. This

was also an age when a similar proportion of parents felt it was appropriate to take their child to the

dentist for the first time. It is recommended that parents take their child to the dentist at a young age

(from the age of around 1 year) so that they get used to seeing the dentist and so that parents have an

opportunity to get advice about their child’s teeth. In general parents felt that their child should be

taken to the dentist at a younger age than they actually took their child for the first time.

Frequency of dental attendance - A fifth of parents reported only taking their child to the dentist when

they had trouble with their teeth (when they are symptomatic). The survey did not explore any

reasons for this. It is important when working with families to highlight the importance of visiting the

dentist on a regular basis for check-ups to allow early identification of any problems. In addition,

whereas we know that cost can be a barrier for some adults attending the dentist for regular check-

ups, NHS dentistry is free for children.

Attending the hospital for dental reasons - One fifth of parents reported having taken their eldest child

to hospital because of problems with their teeth. We know that dental caries are responsible for a

large proportion of childhood hospital admissions across the borough and these survey findings reflect

this. The findings further highlight the need for oral health promotion activities around diet and

toothbrushing at home, as well as stressing the importance of using the dentist for prevention (not

just going when there is already a problem).

Parents’ attendance - We know that at this young age parents have a lot of control over their

children’s oral health behaviours and dental attendance. Although national surveys have repeatedly

shown the influence a mother’s own dental attendance can have on their child’s dental attendance,

we know there are exceptions. In our survey we found that although some parents may themselves

only go to the dentist rarely/when they have trouble with their teeth, some still take their child for

regular or occasional check-ups. Cost and fear are frequently cited by adults as barriers in attending

the dentist, something also reflected in the results of the recent Mozart Baseline Health Survey. It is

5 | P a g e

important, however, that these do not translate into children’s perceptions about going to the dentist

and that families are aware that NHS dentistry is free for children.

The two community conversations explored feelings about going to the dentist in more detail. In

these discussions, it is interesting to note that although the children were quite positive about visiting

the dentist, citing reasons such as being given stickers/other rewards, having cleaner teeth, and that

the dentist is your friend and ‘does not hurt you’, the parents’ reflections were more negative saying

that they felt dentists needed to be more child friendly, that attending the dentist is time-consuming

and that children and adults are frightened of the dentist. As indicated above it is important children

remain positive about going to the dentist and that parents continue to take their children to the

dentist regularly even if they themselves do not attend/ are frightened.

Diet

The survey did not ask parents about diet. This was a subject, however, which was explored in more

detail with children and parents as part of the community conversations. The community

conversation with parents highlighted that although consumption of healthier drinks and snacks such

as milk, water, bananas and carrot sticks was high, several children were also being given chocolate

and sweets as snacks on a regular basis, and sweet drinks such as Ribena and Fruitshoots were

similarly popular.

Knowledge about child oral health

A significant percentage of respondents (around a quarter) in the survey felt that they did not know

enough about how to look after their children’s teeth, as well as oral health in general. Although diet

was not explored within the survey it came out as one of the specific areas that parents wanted more

information about in terms of looking after their children’s teeth.

Recommendations

Reinforce all the evidence-based consistent messages around child oral health (covering diet,

toothbrushing and visiting the dentist) – particularly the gaps in terms of parent’s knowledge

which emerged from the survey.

Highlight the importance of valuing children’s first teeth as well as their second, adult teeth.

Continue to work with the local community to explore further gaps in the information parents

currently receive and what other information they would like and in what format.

Provide information to parents about which toothpastes contain the correct level of fluoride for

different age groups and what to consider when choosing a child’s toothpaste.

6 | P a g e

Deliver promotional activities to encourage greater access to dental services such as:

o Taking children to the dentist for prevention

o Dentistry is free for children from NHS dental practices

o It is recommended that every child over 3 years has fluoride varnish applied to their teeth

at least every 6 months.

Deliver health promotion activities to young children.

Work with GPs to explore how they could help to improve the oral health and dental access of

their patients.

Considerations for future surveys and insight work around child oral health:

Explore parents’ understanding about what toothpaste to buy for their children, including fluoride

content.

In order to better understand parents’ perception of when to take children to the dentist for the

first time versus the reality of the age their child was first taken to the dentist it would be helpful if

the age ranges in both questions were the same.

Use the survey to make a link with the Healthy Child Programme to ask whether parents received

oral health advice and a Brushing for Life (toothbrush and toothpaste) pack from their Health

Visitor at their child’s development review.

7 | P a g e

2. Introduction and methodology

Children’s oral health has been improving over the past 30 years in the UK. In spite of this, national

surveys consistently highlight persistent inequalities in oral health, which are strongly associated with

deprivation and social background.1 Improvements in the oral health of 5 year olds have not been as

great as in 12 and 15 year old children.

Locally, the oral health of 5 year old children is an important public health problem. High proportions

of children suffer from dental decay and there is a wide variation in the levels of decay across local

primary schools, highlighting inequalities in oral health. Severe tooth decay remains a problem among

young children in disadvantaged communities, with the associated dental problems of toothache,

abscesses and extractions. Some young children require multiple teeth extractions under general

anaesthesia, with all its risks. Given that dental caries is a preventable disease, this is unacceptable.

National survey data shows that in Westminster around 38% of 5 year olds attending state primary

schools have experience of decay, the 6th highest in London. Those children have on average 4

decayed, missing or filled teeth.2 Dental caries remains the top cause of hospital admissions for

children aged 1-18 years in the borough, accounting for 7% of hospital admissions. The greatest

proportion of these admissions is for 5-8 year olds, where dental caries are responsible for 21% of

hospital admissions for children in this age group (2010-11).3

Paddington Development Trust had identified from local anecdotal evidence that poor child oral

health is an issue in the Mozart estate area and wanted to explore the size of the problem locally and

some of the barriers to oral health among families with young children.

In order to harness ideas from local communities about how we can work with them to improve

children’s oral health locally it was decided to conduct a sample survey of families living on the Mozart

Estate and to run two informal discussion groups, ‘community conversations’, one with children

attending a local primary school, and another with a group of parents.

There are clear synergies between this Child Oral Health research project and the activities of the local

Neighbourhood Community Budget Pilot for future interventions. The Queen’s Park area is one of 13

areas in the country to be piloting the Neighbourhood Community Budget4 (NCB) from 2012 – 2014,

which seeks to involve local people to help improve outcomes for children by enhancing more

coordinated local Early Years Services.

Residents and service providers will co-design and co-produce Early Years Services that respond better

to local need and ensure that the quality and efficiency of these services do not suffer at a time of

shrinking budgets. It is envisaged that the Community Champions will play an important role in

promoting the enhanced Children’s Centre service offer within the community – particularly among

1 Department of Health, Choosing Better Oral Health: An Oral Health Plan for England, 2005

2 NHS National Dental Epidemiology Survey of 5 Year Olds, 2007-08

3 NHS Secondary Uses Services, Hospital Admissions Data for Westminster, 2010-11

4 See http://www.local.gov.uk/web/guest/community-budgets

http://www.local.gov.uk/web/guest/community-budgets

8 | P a g e

those who have not used the service to date. They will also help to promote other community

projects and services such as the Tell It Parents Action Group, Queen’s Park Community Mums Drop-

in, community led parenting programmes, the Children’s Centre Parent’s Forum and free peer support

networks for expectant and new parents.

Champions with a specific interest in antenatal and postnatal support will be trained as Maternity

Champions to support this initiative.

Recommendations from the Child Oral Health Study will be considered as part of the developments

and mechanisms set up to deliver the enhanced Early Years Services and joint-working to implement

oral health promotion will be pursued at every possible opportunity.

In parallel with the Child Oral Health Survey, the Mozart Community Champions also conducted a

Baseline Health Survey on the Mozart Estate. The broad objective of this Baseline Health Study was to

better understand health attitudes and behaviours amongst adults living on the estate to help shape

the future work programme of the Community Champions hub over the next few years.

The survey was conducted with 150 Mozart residents in early 2013 using door-to-door methodology.

Key findings relevant to dental health were that one-third of the residents interviewed were not

registered or could not remember the name of their dentist and patient satisfaction levels were

slightly lower for dentists compared to GPs and the local hospital. That being so, responses were still

much more positive than the equivalent figures for London and England.

Three work strands have been recommended as a result of the Baseline Health Study:

Healthy eating

Physical activity

Parenting.

Both the healthy eating and parenting strands will address themes linked to both adult and child oral

health, something the child oral health insight work will help inform. Synergies will be pursued to

guarantee the delivery of a seamless programme of support and advice to local people around the

topic of oral health via the Community Champions network and its work strands plus the NCB Early

Years activities.

2.1 Methodology: Child Oral Health Survey

In order to provide some quantitative information about child oral health on the Mozart Estate a

parental survey was designed to capture information about oral hygiene practices in the home, and

child and adult dental service use. Questions were designed to cover both knowledge about oral

health and actual behaviour. Where possible validated questions were used in order to allow

comparison with data from national child and adult dental health surveys.

In conducting the survey it was decided to target families with children under 8 years of age on the

estate, rather than all families with children. The reason for this is that we know from national survey

9 | P a g e

data that improvements in oral health over the past few decades have not been as great amongst

young children compared to older children.5 We also know that younger children are less likely to be

taken to the dentist6 and anecdotally that some families do not place as high a value on their

children’s first teeth as much as their second (permanent) teeth. In addition, published evidence

highlights the importance of the early years in setting up good health behaviours, and that good oral

health, diet, and oral hygiene practices developed in early childhood have an important impact on

health in later life.7 As such, the 0-7 year old population is the main focus for oral health programmes

currently within the borough, as reflected in the local Child Oral Health Improvement Strategy.8

There are estimated to be around 220 families with children aged less than 8 years living on the

Mozart Estate. Within the timeframe we had to conduct the survey it was decided to aim for 25%

coverage of this population. This was achieved with 54 valid survey responses being returned. As

shown in Appendix A, the majority of respondents (85%) were female and 89% were from Black or

Minority Ethnic (BME) Groups (37% Asian or Asian British and 43% from ‘other ethnicities’, the

majority of whom come from North African/Middle Eastern countries). Compared with the overall

population living in this part of Westminster (from 2011 Census data), parents from Asian and ‘Other’

ethnic groups may be slightly over represented in the survey responses and parents of a White

ethnicity slightly underrepresented (refer to Appendix A1 for more detail).

The survey was launched at a Community Champions’ Family Fun Day event held on 30 October 2012

at the Beethoven Community Centre. The theme of the event was ‘Healthy Smiles’. The Oral Health

Promotion Team hosted a stand and provided parents and children with literature and advice on good

oral health. They also signposted parents to Community Champions present who were conducting the

Oral Health Survey during the event.

The research fieldwork period lasted 18 weeks drawing to a close on 8 March 2013. The survey was

not designed to be a random sample of the local households. Instead it was a purposive sample with

surveys conducted in a combination of different locations:

Parents were targeted at community events and drop-ins (21 interviews) – such as the Healthy

Smiles event and other events at Wilberforce Primary School, Rainbow Family Centre, Queen’s

Park Library, and the Butterfly Saturday School

On the street (3 interviews) e.g. at the school gates

In households, approached, for example through knocking on residents’ doors (28 interviews).

Some households with young families were identified when the Community Champions conducted

their baseline survey and the Champions returned to these households to conduct the Child Oral

Health Survey.

5 Department of Health, Choosing Better Oral Health: An Oral Health Plan for England, 2005; NHS National

Dental Epidemiology Surveys of 5 and 12 year olds 6 Harker, R. Morris, J. (2004) Children’s Dental Health in England 2003. National Statistics

7 Holt R. Weaning and Dental Health. Proceedings of the Nutrition Society. 1997:56; 131-138; Waldfogel J. Social

Mobility, Life Chances and the Early Years, CASE Paper 88. London: London School of Economics, 2004; Fair Society, Healthy Lives: The Marmot Review of Health Inequalities in England post-2010, 2010 8 NHS North West London, Child Oral Health Improvement Strategy, 2011

10 | P a g e

Since the survey was a purposive sample rather than a random selection of local families the results

cannot be taken to be truly representative of the oral health behaviours of all the families with young

children living on the Mozart Estate. For instance the parents who were willing to complete the

survey may be biased towards those individuals whose children have good oral health and who take

their children to the dentist. Instead the results will be used to provide an indication of what some

families within the local community feel and do about oral health in their household and how they

access dental services.

The surveys were completed by a total of six Community Champions, all of whom had received oral

health training prior to carrying out the surveys. At the end of each survey, depending on the

response, the Champions gave advice to the interviewee on how to promote good oral hygiene and

strong teeth. The response from parents was very positive and people were generally happy to take

part. There were a few occasions when parents were approached but declined to take part because of

lack of time and being too busy looking after their children.

The survey was incentivised in two ways – firstly parents who completed the survey were thanked

with a goodie bag containing a toothbrush and toothpaste appropriate for the age of their child/ren, a

sticker chart to encourage brushing, information on healthy snacks and the amount of sugar contained

in common food items, information on fluoride varnishing and a listing of all local dental practices.

If consent was given the names of interviewees were also added into a free prize draw for the chance

to win an iPad mini. Interviewers felt this incentive helped to promote the survey as a more attractive

offer to local people. Everyone who completed either the oral health or baseline (general) health

survey and left contact details were entered into the prize draw and the winner was drawn using a

random number generator in March.

The interaction between Community Researcher and interviewee also presented the opportunity for

the Champions to provide residents with appropriate targeted oral health information in response to

the answers provided by the individual interviewee. On average it took 30 minutes to complete each

survey with the Champions focussing on providing advice and re-enforcing key messages to promote

good oral health. So as to not influence the interviewees’ responses this advice was offered following

completion of the survey. Information given included advice on good brushing practice, appropriate

toothpaste, diet, fluoride varnishing and finding a dentist locally. Data was collected regarding how

useful parents found this intervention.

Interviewers noted at the end of their questionnaires that:

Signposting activity took place at the end of most interviews (51 out of 53). In 33 cases, both

oral health leaflets were provided and discussion took place. In 14 cases just leaflets were

distributed;

42 residents said that as a result of this signposting they felt better informed about looking

after their children’s teeth and 35 felt better informed about local services.

The data collected from the questionnaire has been analysed for each question. Since a few questions

were left blank in a few of the returned questionnaires, the valid total displayed for each question may

vary. Furthermore, some questions around dental attendance were only asked to a subgroup of

11 | P a g e

parents, depending on the parents’ answers to preceding questions and, as such, the base for these

questions is much lower. Although the sample data represents around 25% of the local population (of

adults with young children), a total of 54 surveys is still a limited sample. As such the results have been

presented as numbers rather than proportions of respondents. Due to these small numbers it has not

been possible to analyse the results by population sub-groups.

Parents with more than one child aged 8 years old or younger were asked to respond about their

eldest child within this age bracket and the data analysis reported here reflects this (the ages of the

respondents’ eldest child is reported in Appendix A1). It should be borne in mind when interpreting

the results for questions which asked about children’s behaviour at a young age (such as when did you

first brush your child’s teeth), that the older the child, the less accurate parents responses may be due

to recall bias, which is not possible to quantify. In addition we know that when responding about

behaviour individuals can sometimes report the ‘ideal’ picture as opposed to their real experiences.

These issues are not unique to this study but are worthy of note when interpreting the findings.

2.2 Methodology: ‘Community Conversations’

In order to provide some qualitative insight into oral hygiene practices in the home and better

understand some of the factors which may influence behaviours, two ‘community conversations’9

were held, one with children and one with parents living on the Mozart Estate.

Group with children

The group with children took place on 19 February 2013 at the Beethoven Community Centre in the

heart of the Mozart Estate and ran for 45 minutes. The group was facilitated by a Mozart Community

Champion project worker who, at the time, was also employed at local primary school, Queen’s Park

Primary, as an early years educator.

Recruitment to the group was undertaken by the Community Champions team, predominately by the

project worker and early years educator who was able to utilise her position within the school to

notify parents of the children’s group by letter and through face-to-face contact.

The session followed a discussion guide which is reproduced in Appendix B, and included fun,

interactive elements. The group was digitally recorded for analytical purposes. The guide was

prepared by the Community Champion facilitator following discussions with Collaborate.

The group was attended by 10 children between the ages of 4 and 9 years old. Five participants were

boys and five were girls. Their spread of ages were:

9 Informal group with a small number of pre-invited residents held in a comfortable setting. The term

‘community conversations’ has been used as the groups were led by staff on the ground rather than qualitative moderators.

12 | P a g e

The session was very interactive and encouraged all participants to speak, however, due to the

children’s range of ages the older children were more vocal. The facilitator encouraged full

participation by asking each child individually as well as asking children to raise their hands before

giving an answer. The session discussed general health, looking after teeth, brushing and going to the

dentist.

The interactive activity asked children to select a healthy lunch from a range of healthy and unhealthy

foods and drinks available. We observed as the children processed the task and selected their choice.

The facilitator then discussed each child’s selection with the group and any unhealthy foods were

highlighted and the child was asked to replace with a healthy alternative. The children were then

allowed to eat their lunch as part of the session.

Following lunch, the children were asked to brush their teeth (they were given their own free

toothbrush and toothpaste by the group facilitators) for two minutes aided by a 2-minute timer. The

children were then given a disclosing tablet to highlight how well each child had brushed. (Disclosing

tablets are chewable tablets which make plaque visible on teeth by staining it red). Parents had

arrived by this time and therefore supported this exercise and were able to take note of the results.

Conversation with parents

The group session with parents of children under 8 years old took place on 21 February 2013 at the

Beethoven Community Centre. The group was joint-facilitated by the Mozart Community Champions

project manager and project worker and lasted 1 ½ hours.

Recruitment to the session was undertaken by the Community Champions via a question at the end of

the quantitative survey, which asked interviewees whether they would be interested in attending a

group session to discuss child oral health. The community champions used the data collected from the

survey to contact and invite parents who had expressed an interest in participating in a group.

Recruitment to the group was therefore lead by parental interest. Attendance was also incentivised

with a £10 incentive voucher. One participant refused to accept the incentive stating she was simply

happy to be involved in the project.

The Community Champions project worker performed two call-backs to parents reminding them of

the session – one a week before the session, and the second on the morning of the session.

1 child

1 child

3 children

1 child

3 children

1 child

4 yrs 5 yrs 6 yrs 8 yrs 7 yrs 9 yrs

13 | P a g e

Nine parents attended the group in total and had 20 children between them. (See Appendix A2 for

demographics of participants.)

The session followed a discussion guide, which is reproduced in Appendix B, and included interactive

elements and group work. The session was digitally recorded for analytical purposes. The guide was

amended and finalised by the Community Champions facilitators modelled on a guide produced for a

similar study into child oral health on the White City Estate, Hammersmith and Fulham.

The informal nature of Community Conversations means that the outputs cannot be analysed in the

same robust, systematic way that we might expect from other qualitative methods. The insights

derived from the Community Conversations have been formulated by basic content analysis based on

the group recordings and notes that were taken. The insight is presented separately from the

quantitative data in Section 4.2.

14 | P a g e

3. Findings: the Child Oral Health Survey

The results of the survey are presented throughout this section by theme. Where possible, results

from the Mozart Estate survey have been compared with national data sets (see Appendix C for

details).

3.1 Brushing behaviours

The first set of questions in the survey asked parents about oral hygiene practices in the home. It is

recommended that children start having their teeth brushed as soon as their first tooth comes

through (under 1 year of age)10. On being asked how old their eldest child was when they started

having their teeth brushed, nearly two-fifths of parents responded ‘under 1 year’ of age (Fig. 1). A

further two-fifths of parents reported that their eldest child started to brush their teeth between the

ages of 1-2 years. 10 parents said that their child started brushing when aged 2 years or over.

Figure 1: Age of eldest child when they first started having their teeth brushed (Q1) Valid base: 53

Note: The child whose teeth are not brushed is aged less than 1 year. As such the reason for this may be that

the child does not have any teeth yet.

It is recommended that all children and adults brush their teeth twice a day (last thing at night and on

one other occasion).1 In the survey, parents were asked about the frequency of their eldest child’s

toothbrushing (Fig.2). Around four-fifths of responding parents said that their eldest child brushes

10

Department of Health (2009) Delivering Better Oral Health: An Evidence-based Toolkit for Prevention, 2nd

Edition

Under 1 year, 20

1-2 years, 22

2-3 years, 9

3 years or over, 1Teeth are not

brushed, 1

15 | P a g e

their teeth twice a day. Nine parents indicated that their children are having their teeth brushed less

frequently than recommended. This is not dissimilar to results in the national Children’s Dental Health

Survey (2003), which found that around three quarters of children in all their sampled age groups

brushed their teeth at least twice a day11.

Figure 2: Frequency of children’s brushing or supervised brushing (Q2) Valid base: 54

Note: one of the children whose teeth are brushed less than once a day is the same child as Fig. 1 whose teeth are not

brushed (as they are aged under 1 year old and may not have any teeth yet.)

It is recommended that children are supervised when they brush their teeth until at least the age of

seven12 . Depending on the age of the child and their manual dexterity, children may require different

levels of support with brushing: parents may be required to brush their child’s teeth for them, help

them with their brushing, or merely watch over them to ensure that they brush their teeth properly

and for a sufficient length of time.

In the survey, parents were asked both up to what age they think children need help with brushing

their teeth (knowledge), and whether an adult usually stays with their child when they brush their

teeth (behaviour). It should be noted that in the response to these questions, different people may

interpret the term ‘helping’ their child brush their teeth in different ways – for some this may mean

11

Harker, R. Morris, J. (2004) Children’s Dental Health in England 2003. National Statistics 12


Edition

2

7

44

1

0

0 5 10 15 20 25 30 35 40 45 50

Less than once a day

Once a day

Twice a day

3 times a day

More than 3 times a day

16 | P a g e

physically brushing their child’s teeth, as opposed to staying with their child and supervising their

brushing, in which case they may respond with a younger age than the recommended age (7 years).

Fig 3 illustrates that only one quarter of parents surveyed felt that children should receive help with

brushing their teeth up to the recommended age (at least 7 years). Many parents (around two-fifths)

felt that children only need help up to 3 years of age.

Figure 3: Up to what age should children receive help with brushing from an adult? (Q5) Base: 50

Given that parents were responding about their eldest child under 8 years of age, we would expect

the majority of parents to respond ‘yes’ to the question as to whether they or another adult stays with

their child when they brush their teeth, if they were supervising their children until the recommended

age. As Fig. 4 illustrates, however, only three-fifths of the parents consulted report staying with their

child when they are brushing. Although the numbers are small statistically, the results indicate a

general trend that parents are more likely to stay with their child while they brush when the child is

younger (particularly those aged 5 and under).

4

4

9

13

16

4

0 2 4 6 8 10 12 14 16 18

Other

Up to 9 years

Up to 7 years

Up to 5 years

Up to 3 years

Up to 1 year old

17 | P a g e

Figure 4: Does an adult stay with your child when they brush their teeth (Q3) Overall base: 54

As a final question about brushing habits, parents were asked which brand/type of toothpaste their

child usually uses. This question was intended to discover whether the toothpaste being used in

households contains the appropriate level of fluoride to keep children’s teeth healthy, without directly

enquiring about fluoride content.

The Department of Health recommends that children under 3 years use toothpaste containing at least

1,000 parts per million (ppm) fluoride. Children aged 3 years and over (and adults) should use a

toothpaste containing at least 1,350 ppm fluoride13. Information about the fluoride content14 of

toothpaste can be found on the back the toothpaste tube and box. Some toothpastes which are

marketed as baby toothpastes (under 3 years), children’s toothpastes or as adult/family toothpastes,

do not contain the appropriate level of fluoride for those age groups. In addition, we know that many

customers are unaware of the recommended levels of fluoride in the toothpaste they should be

purchasing.

The inclusion of this question was an experiment. The results show a lack of clarity from parents

around the toothpaste they buy for their child and how much information they know about it. Many

parents recalled just the brand of toothpaste they use (28 of the 54 respondents) and others only the

fact that they use a generic children’s toothpaste (3). Only 11 parents named a specific type of

toothpaste, from which it would be possible to gauge whether it contained the appropriate level of

fluoride for their child’s age. None of the respondents mentioned the word fluoride.

Due to the small numbers, further analysis of this data is not possible since it is unknown which

particular type of toothpaste (as opposed to which brand) the majority of families use for their

children. In future it may be worth having pictures of common children’s and adult’s toothpastes as a

13


Edition 14

This might refer to Sodium Monofluorophosphate and/or Sodium Fluoride

Yes, do supervise, 32

No, do not supervise, 22

18 | P a g e

prompt for this question or asking parents different questions, such as whether they know about the

recommended levels of fluoride in toothpaste and about how they select toothpaste for their children.

3.2 Going to the dentist: children

The next section of the survey asked parents about their child’s dental attendance. Around three-

quarters of parents confirmed that their eldest child has been seen by a dentist for treatment, a check

up or just to get used to the experience at some point (Fig. 5). This therefore means that nearly one-

quarter of the parents reported that their child has not yet visited the dentist. Further analysis of the

data reveals that the ages of those who have yet been to the dentist are distributed widely across the

age spectrum (from less than 1 year to 8 years old).

As a comparison, the national Children’s Dental Health Survey (2003) found that 7% of 5 year olds and

2% of 8 year olds in England had never been to the dentist15. These figures were lower than in

previous surveys, which may indicate changing patterns of parental attitudes to visiting the dentist.

When analysed for the UK as a whole, the results for 5 year olds attendance were found to vary by

social class of household, with the proportion of 5 year olds who had not been to the dentist rising to

13% in social classes IV and V (manual), compared with only 2% in social classes I, II, III (non manual)16.

Figure 5: Has eldest child ever been to the dentist (Q6a) Valid base: 54

15


Morris, J. Pendry, L. Harker, R. (2004) Patterns of Care and Service Use: Children’s Dental Health in the United Kingdom 2003. National Statistics.

Yes, has been to the dentist, 39

No, has not been to dentist, 13

Don't know, 2

19 | P a g e

It is recommended that children attend the dentist at least once a year (or more regularly depending

on clinical need, as recommended by their dentist)17. It is also advised that parents should start to take

their child to the dentist around 1 year of age, so that they get used to the experience. As well as

finding out whether children had ever visited the dentist, we were keen to find out at what age

children were first taken to the dentist.

As Fig. 6 shows, nearly one quarter of children were first taken to the dentist after they started school.

We know this to be a common behaviour: dental health surveys regularly report a significant

proportion of children being first taken to the dentist when they are at least five years old.18 Similarly,

dental access figures show attendance rates for children increasing steadily with age of child up to the

age of 8/9 (when they plateau), with a much higher proportion of children of school age attending the

dentist than pre-school children.19 Only three children in the Mozart Estate consultation were taken

to the dentist before they were aged 1 year. No parents participating in the study reported taking

their children to the dentist for the first time because they had toothache.

17

National Institute for Health and Care Excellence (NICE) Clinical Guidance CG19, Dental Recall: Recall interval between routine dental examinations, 2004. 18


Report showing proportion of children in England accessing a dentist in the 24 months prior to March 2013, requested from NHS Business Services Authority, Dental Services, April 2013

2

9

6

10

7

3

0 5 10 15

Don't know

After they started school

3-4 years

2-3 years

1-2 years

Up to 1 year

Fig. 6 Age that child was first taken to the dentist (Q6b)(Base: 37)

4

1

13

17

11

8

0 5 10 15 20

Don't know

When they have a start toothache

When they start school

2-3 years

1-2 years

Under 1 year

Fig. 7 At what age do you think children should start going to the dentist? (Q10) (Base: 54)

20 | P a g e

A similar question was asked in the national Children’s Dental Health (CDH) Survey (2003). This survey

found that, amongst 5 year olds nationally, 28% of children had visited the dentist before the age of 2

years and 50% had visited before the age of 3 years. Although they cannot be compared directly these

figures are broadly similar to our survey results. These figures were higher than previous CDH surveys,

indicating an increasing trend to start taking children to the dentist at an earlier age. As reflected in

the Mozart study, however, the CDH survey (2003) also found that between 19% and 29% of the

sample of 8, 12 and 15 year olds had been aged 5 years or older when they were first taken to the

dentist (after they started school)20.

The Mozart Estate consultation asked parents about their perceptions of when children should be

taken to the dentist for the first time. This question was asked to all parents, irrespective of whether

their child had ever been to the dentist21. As Fig. 7 illustrates, there is a similar pattern with around

one quarter of parents who consider that children should be first taken to the dentist only after they

start school. When only the responses from parents whose child has already been to the dentist are

analysed and compared with the responses to Q6b (Fig. 6), it would appear that, in general, parents

think that children should first be taken to the dentist at a younger age than the age at which they

actually first took their own child.

Figure 8: Children's dental attendance pattern (Q6c) Valid base: 35 (those who have been to the

dentist)

Parents who had taken their eldest child to the dentist were probed further around the frequency of

their child’s attendance. Over half of the parents who took part in the survey reported that their child

attends the dentist for a check up on a regular basis and a further one quarter said that their

20


The reader should note that the answer categories are slightly different for Q6b (age first visited dentist) and perception of when children should first visit (Q10)

A regular check up, 19

Occassional check up, 9

Only attends when in trouble, 7

21 | P a g e

attendance is occasional (Fig. 8). The remaining one fifth of parents will take their child only if they

are in pain or if there is an emergency, indicating that they are not using the dentist for prevention.

Similar analysis was done on the results of the most recent Children’s Dental Health Survey (2003).

The report showed that in England, 82% of 5 year olds attend the dentist for a regular check up, 14%

for an occasional check up and just 4% attend only when they have trouble with their teeth. The

pattern reported for 8 year olds was broadly similar22.

3.3 Children’s hospital attendance for dental problems

A question was included in the survey asking whether parents had ever needed to take their eldest

child to hospital because of a problem with their teeth. Dental caries are responsible for 11% of

hospital admissions amongst 1-8 year olds in Westminster, a figure which rises to 21% in 5-8 year olds,

with many children attending to have their teeth extracted under general anaesthetic.23

The Mozart Estate survey showed that one fifth of parents surveyed have been to hospital with their

children because of dental problems, which is a high proportion of the cohort of respondents (Figure

9). This may reflect parents not using general dental services for prevention (only when children are

already symptomatic), something highlighted in Fig. 8 above, as well as poor oral health behaviours in

the home (around diet and oral hygiene).

Figure 9: Parents responding whether their eldest child has ever needed to go to hospital because of

problem with teeth (Q7) Valid base: 53

22


NHS Secondary Uses Services, Hospital Admissions Data for Westminster, 2010-11

Yes, has been to hospital, 11

No, has not been to hospital, 41

Don't know, 1

22 | P a g e

3.4 Parental dental attendance

Parents were asked about their own dental attendance: both the frequency and the reason they

normally attend. Two-fifths of parents surveyed consider themselves to be regular attendees for a

check-up and a further fifth are occasional users (Fig. 10). This proportion of parents attending for

check-ups (as opposed to when they have trouble with their teeth) is slightly lower than the picture

that emerged for child attendance (Fig. 8).

As a comparison, the national Adult Dental Health Survey in 2009 found that 61% dentate adults

(adults with teeth remaining) usually attend the dentist for a check up, with a further 10% attending

occasionally. 27% report attending only when they have trouble with teeth. Patterns of dental

attendance were shown to vary by region and by social class: London was found to have the lowest

proportion (44%) of adults attending the dentist on a regular basis and the highest proportion only

attending when they have trouble with their teeth; and adults from professional and managerial

households were more likely to attend for regular check-ups, compared to routine and manual

households24.

Figure 10: Parental visits to the dentist (Q8) Valid base: 53

The Children’s Dental Health Surveys have repeatedly shown an association between mothers’ and

children’s dental attendance patterns, suggesting that maternal attitudes to oral health and dental

services are important influences on children’s attendance. For example, in the 2003 survey nearly all

24

Morris, J. Chenery, V. Douglas, G. Treasure, E. (2011) Service considerations – a report from the Adult Dental Health Survey 2009. The Health and Social Care Information Centre.

A regular check up, 22

Occassional check up, 11

Only attends when in trouble, 19

Never been to dentist, 1

23 | P a g e

children aged 5 years whose mother regularly visited the dentist had been taken by the age of 5 years,

compared with around one half of children of mothers who only attended when they had symptoms25.

Although the numbers are very small and not controlled for the age of child (and therefore should be

interpreted with caution), of the 20 parents who have never been to the dentist or only attend when

they have trouble with their teeth, many of them (8) have not yet taken their child to the dentist. By

contrast, however, 4 parents report taking their child regularly and a further 3 occasionally to the

dentist (for prevention) despite only going themselves when they have trouble. This is positive for the

children’s oral health and may reflect the fact that the majority of NHS dental care is free for children,

whereas most adults have to pay towards their check-ups and any treatment they receive (although

there are exemptions).

When asked about the frequency of their attendance, one half of parents indicated that they had been

to the dentist ‘1-2 times’ in the past 2 years and a further one quarter had been between 3-4 times.

The remainder had not visited a dentist in the past 2 years (Fig.11). It is recommended that everyone

over the age of 18 years attends the dentist at least once every two years, or at more regular intervals

depending on their identified need (clinical risk).26 These figures are not dissimilar from the results of

the recent Adult Dental Health Survey (2009), which found that 82% of dentate adults (adults with

teeth) had been to the dentist in the past two years27.

25


National Institute for Health and Care Excellence (NICE) Clinical Guidance CG19, Dental Recall: Recall interval between routine dental examinations, 2004. 27

Morris, J. Chenery, V. Douglas, G. Treasure, E. (2011) Service considerations – a report from the Adult Dental Health Survey 2009. The Health and Social Care Information Centre

3-4 times, 15

I haven't been in the last 2 years,

11

1-2 times, 27

1

1

1

1

1

2

3

4

Other

I've had a bad experience

I havent got around to it

I haven't got the time

I can't find an NHS dentist

No need to go

I can't afford the NHS charges/fee

I am afraid of the dentist

Fig. 11 Frequency of parental visits to the dentist in past two years (Q9a) (Base: 53)

Fig. 12 Reasons for not going to dentist in the last 2 years (Q9b) (Base: 14)

24 | P a g e

Fig. 12 illustrates the reasons why some parents had not visited the dentist in the past 2 years.

Although the numbers are too small to do any detailed analysis, the main barriers appear to be around

the cost of dental services and 'fear' of the dentist, which are also factors regularly reported in the

Adult Dental Health Survey. Other significant barriers reported in the recent Adult Dental Health

Survey (2009) included not needing to go to the dentist/ having no teeth problems and not being able

to find a dentist/their existing NHS dentist turning private.

3.5 Parental knowledge about looking after their children’s teeth

At the end of the questionnaire, parents were asked whether they felt they know enough about how

to look after their child’s teeth and oral health in general. Nearly one-quarter of parents responded

that they do not know enough about how to look after their child’s teeth and general dental health.

These parents were asked to comment on what information that they might like.

The following emerged as areas that parents would like more information on (based on responses

from 8 parents):

More general information

Ideas for how to avoid sweets

More information and advice from the dentist

Reassurance and advice about doing the ‘right thing’ (for their child)

When to start flossing.

Due to the low response rate to this question, it would be useful to work with the Community

Champions further to explore any gaps in the information parents currently receive and what more

information they would like around child oral health and in what format. Elements of this were

covered in the group session with parents which took place after the survey. See section 4.2 for full

details.

Areas which parents felt they required more support on included:

How to manage toothbrushing time at home – both morning and evening brushes appear to

be a very difficult time for parents

Clarification on when it is safe for children to use mouth wash and floss and tailored advice

around particular cultural beliefs and practices around looking after children’s teeth Resources

to support with good oral health in the home – posters, pictures, charts for children to

complete.

25 | P a g e

4. Findings: Child Oral Health ‘Community Conversation’ Groups The findings of the two group discussions with children and parents are presented throughout this

section by the theme detailed in the topic guides (See Appendix B)

4.1. Community conversation with children

4.1.1 What being healthy means

The participants were asked as a group what being healthy meant to them. Children raised their hands

to share their ideas with the group. Answers were recorded on the whiteboard. Responses to this

question included:

Healthy eating – getting calcium and protein

Taking exercise

Thinking about what I should eat – what’s good for my brain, stomach and bones

Brushing my teeth

Keeping clean and keeping fit

Only eating junk food as a treat

Drinking milk as it’s good for bones

Doing sport and running around

Eating a balanced diet

4.1.2. Maintaining healthy teeth and brushing

Progressing the discussion to talking about teeth, the group leader asked participants to talk with the

person sitting next to them about the things children can do to look after their teeth. The pairs then

shared their responses as a group, which included:

Brushing teeth and gums twice a day

Not eating too many sweets

Using mouth wash

Eating 5 pieces of fruit a day

Eating Weetabix and vitamins

Not flossing too much.

26 | P a g e

Elements which were not mentioned by the group included:

Not drinking too many fizzy or sugary drinks

Using (a fluoride) toothpaste

Visiting the dentist regularly.

When asked what participants thought children their age do not do from the list above, they

highlighted:

Eating less sweets – they stated children eat lots and lots of sweets

Some children don’t brush their teeth because they are dirty or lazy.

Each child was then handed a piece of paper with blank speech bubbles. The children were asked to

close their eyes and think about brushing their teeth. When they opened them, they were asked to

express how they feel about brushing using the sheet. Responses included:

How brushing their teeth made the children feel:

“It hurts when you brush sometimes.”

“I feel happy because my teeth look white.”

“It tastes of mint.”

“When I brush my teeth tickle.”

“Brushing my teeth makes me happy.”

“The toothpaste makes the bubbles tickle my tongue.”

“When I brush my teeth it feels tickly.”

27 | P a g e

Other thoughts from the children about brushing their teeth:

The children gave the following responses to the questions:

- At what age should children start brushing their teeth?

1 child responded when first get teeth

1 child responded at age 1

5 children responded at age 2




- At what age should children brush their teeth without the help of an adult?

2 participants responded at age 4

1 participant responded at age 8

1 participant responded at age 11.

One participant confirmed that they stopped receiving help from an adult aged 3.

Only two children in the group stated they still receive help from their parents with brushing their

teeth.

“When you brush your teeth turn white.”

“When you eat sugar your teeth turn rotten.”

“If you have lots of black you have to go to the dentist.”

“We need to cut sweets.” “Do not eat too much fat.”

“It makes my teeth clean.” “We can’t eat sweets a lot.”

“It’s good when you brush your teeth because it’s healthy.”

“The food in my spit makes me want to vomit.”

“If I eat fruit it keeps my teeth nice and clean.”

28 | P a g e

4.1.3. Going to the dentist

The discussion moved on to talking about going to the dentist.

All of the participants stated they had been to the dentist. Two children, aged 6 and 8 years old, stated

they had had fillings.

Each child was then given a piece of paper with cartoon characters of a dentist and a smiley tooth and

three faces, each with a happy, ambivalent and unhappy expression. The participants were asked to

think about going to the dentist. They were asked to describe in the text box how going to the dentist

makes them feel and to circle the face, which best describes how going to the dentist makes them feel

(happy, ambivalent or unhappy). The results are presented below:

7 children 2 children 1 child

Overall, the responses were positive with 7 out of 10 children circling the happy face. The majority of

the statements given by children describe positive experiences of going to the dentist and references

of having fun or joking with the dentist and receiving stickers or other giveaways.

“I like the dentist because he sometimes gives us stickers, toothbrush and

toothpaste.”

“The dentist makes me laugh. They give me stickers.”

“I love the dentist because he gives me a prize. He usually

does but now he gives us a sticker. It’s fun in the dentist.”

“I like the dentist. I am not sure.”

“He told me jokes while I am getting my teeth cleaned.”

“When I go to the dentist I am always

happy because they are friendly and gentle.”

When I firstwent to the dentist I felt frightened but

after I realised there was nothing to worry about and that

the dentist is my teeth’s friend.”

29 | P a g e

“I like the dentist because he fixes my teeth and

give me stickers if I am brave.”

There were, however, a couple of more negative views shared by two of the children:

“I don’t like it because of their torch. They put some stuff on

my teeth. It hurts.”

“If my teeth are hurting, I don’t talk about it and it goes away.”

The children were then asked to state good things about going to the dentists. Responses included:

Getting stickers

Receiving surprises

They don’t hurt you

They clean your teeth for you really well

They sometime give you a prize – like a pen

The scratch ‘n’ sniff stickers are fun

You are nervous to start with but then you realise the dentist is your friend

When asked how dentists could tell more people about the good things they do, the children

suggested:

Put posters up around school

Have TV adverts about going to the dentist

Write on the front of their door what they do.

4.1.4. Choosing lunch

The interactive activity before lunch involved the children selecting their own food from a range of

possible choices (both healthy and unhealthy). The children were observed as they selected their food

and then returned to the group to discuss the contents of their plates.

The food on offer included:

Sandwiches Snacks Fruit Sweets Drinks

Pitta bread Celery sticks Melon slices Chocolate

biscuits Orange juice

White sliced bread with margarine

Carrot sticks

Strawberries

Various brands of sherbet

(fizzy powder sweet, sprays)

Apple juice

30 | P a g e

Sandwiches Snacks Fruit Sweets Drinks

Brown sliced bread with margarine

Cucumber sticks

Mango slices Water

Slices of cheese

Crisps Apples Coke

Lettuce Rice cake crisps Bananas

Chocolate spread

Grapes

Strawberry jam

Cheese spread

Observation of the children revealed most of the children selecting healthy foods to start with.

However, nine of the ten children eventually returned to the table or appeared to ‘give in to

temptation’ and selected an unhealthy option for their ‘healthy lunch’.

Other observations included:

7 out of 9 children opted to drink cola

all of the very unhealthy sherbet powder/spray sweets had been selected.

The group leader discussed each child’s plate with the rest of the group and asked participants to pick

out any unhealthy choices, which were on the plate. The group was able to pick out the unhealthy

food successfully and describe why they were unhealthy. This included selecting brown bread over

white bread and rice cake crisps over crisps.

When prompted on why children had selected the sherbet powder/spray sweets, responses included:

“It looks so exciting!”

“I love the colour.” (bright pink)

“I see these sweets in the local shop but my mum won’t let me have them so I wanted to try it here.”

“I see other children eating these sweets. I’ve never tried them and want to.”

“They look really tasty.”

As part of the exercise, the children were asked to return the unhealthy foods or drinks and replace

them with a healthy alternative. Some of the children did this reluctantly. The children were allowed

to select one less healthy choice such as crisps, chocolate biscuit, or chocolate spread on white bread.

31 | P a g e

4.1.5. Disclosing tablet test

The group leader wanted to include an educational element to the group session and performed the

disclosing tablet test with children after they had brushed their teeth for two minutes. With the aid of

a timer, children brushed their teeth with toothbrushes and toothpaste provided by the Community

Champions’ team.

Following brushing, each child was given a disclosing tablet. The children were asked not to swallow

the pill but to bite the tablet and spread the liquid around all of their teeth. They were then able to

rinse their mouth out with water and to look in a handheld mirror.

The facilitator or member of the community champions team then looked in the mirror with each child

and discussed what we could see, pointing out where the child needs to give more attention to

brushing. Parents had arrived by this time and therefore supported this exercise and were able to

take note of the results

4.2. ‘Community Conversation’ group with parents

4.2.1 Understanding and awareness of oral health

The participants were asked to think about behaviours which we can do to look after our teeth, mouth

and gums, thinking firstly about adults. Participants called out their answers. These included:

Using mouthwash

Brushing teeth

Using floss

Using toothpaste

Visiting the dentist

Avoiding sugary foods

Eating well/healthy food.

Actions not mentioned by the participants included:

Not smoking, or chewing betal nut/tobacco

Not drinking alcohol excessively

Reducing amount of sugary/fizzy drinks

The frequency of brushing (twice a day)

The type of toothpaste – fluoride toothpaste

Brushing gums.

When asked by the group leader whether the members of the group do these things, participants

admitted to:

Smoking – 1 participant was a smoker

32 | P a g e

Eating sweets

Drinking sugary drinks.

When asked whether there are any additional things that should be considered when looking after

children’s teeth, participants mentioned:

Over brushing – we should be careful not to over brush children’s gums

Brushing generally – it can be very difficult brushing in the evenings. Most felt the morning

brush is easier however some participants found this more difficult.

4.2.2. Brushing children’s teeth

The discussion continued with the theme of brushing in more detail. Each participant was given a

sheet of paper with blank speech bubbles. They were asked to think about ‘brushing teeth time at

home’ and to write any words, emotions or thoughts down on paper.

The most common associations with children’s brushing time at home are highlighted below:

“The morning brush is easier – it’s part of the

routine”

“Parents are too tired in the evening”

“It’s a time when children fight”

“If children are asleep, we don’t brush their

teeth”

“It’s a stressful time” “The evening brush is difficult – everyone

does their own thing, everyone’s tired”

“It’s always a fraught time”

“Evening is better – the kids copy daddy in the

evening”

“If the kids don’t want to brush their teeth –

they won’t.”

When asked about how we can encourage children to brush their teeth, the following suggestions

were voiced:

Putting up pictures in the bathroom

Reminding them when it’s time to brush

Helping children with brushing at the back

Being a good role model by brushing at the same time as their children

Using mouth wash

Making brushing time fun – play games

Ensuring you use a tooth brush appropriate for the child’s age

Flossing their teeth.

33 | P a g e

One parent, however, suggested a practice that could be potentially harmful to teeth: brushing

children’s teeth once a week with salt and lemon.28 It is an important part of the insight process to

pick up community beliefs such as these to enable us to target health promotion messages

appropriately.

Participants were asked at what age we should start brushing children’s teeth. Answers varied from

“as soon as the teeth come through” to “2 years old”.

One parent stated it was important to brush baby’s gums with your finger. Another participant said

between 6 and 9 months old.

When asked about from what age children can be left alone to brush unsupervised, responses

included:

“…from between 2 – 3 years old.”

“I still supervise my 6/7 year old – otherwise he won’t brush. I have

to say – ‘that was too quick – go back and do it again.’”

It appears that robust information with tips and techniques for managing brushing time in the home

would be welcomed by parents. Parents would welcome fun and interesting resources, such as

posters, pictures or charts to put up in the bathroom for children to interact with and aid them to

brush more regularly and thoroughly.

Clarification on when it is safe and appropriate for children to use mouth wash and dental floss, and

supplying tailored advice around particular cultural beliefs and practices around looking after

children’s teeth, to breakdown myths around solutions to dental health which might be inappropriate

(such as the use of lemon and salt), may also be considered as part of wider promotional activities to

support parents.

4.2.3. Children’s diet

The discussion then moved to children’s diet and understanding more about what food, snacks and

drinks are given.

Each parent was given a sheet with a list of types of foods or drinks. This list ranged from healthy

foods, to unhealthy snacks and treats. Parents were asked to score each type of food or drink on a

scale of 0-10 to indicate how frequently they give each food type to their child (0 being never and 10

being every day). We have aggregated the scores and the results below highlight how frequently each

food is consumed – the higher the score, the more frequently the food type is eaten. The score is out

of a possible 90.

28

Lemon is very acidic and can wear away tooth enamel causing dental erosion. In addition, salt is an abrasive substance and is likely to compound the erosive effects on the teeth.

34 | P a g e

Yogurt = 77

Carrot sticks = 73

Banana = 71

Cereal bar = 41

Crisps = 41

Sweets = 34

Chocolate bar = 32

Dried fruit = 32

Chocolate spread = 23

Tinned fruit = 19

Some interesting conclusions include:

Consumption of sweets and chocolates was relatively high: 4 parents give their child/ren chocolate

more than 3 or 4 times a week and the same four parents also stated they give their children

sweets more than 3 or 4 times a week

Crisps was also a popular snack being consumed by some children 4 times a week.

Positively consumption of bananas and carrots was high, which are both healthy snacks consumed

5 – 6 times a week

Yogurt is very popular. Seven out of the nine parents give their child a yogurt every day. Whilst

natural (unsweetened) yogurt has nutrition value and is high in calcium, which is good for teeth,

many flavoured/fruit yogurts are unfortunately also high in sugar.

A similar exercise was then performed about the types of drinks parents give their child. The results

are detailed below. Again, the higher the score, the more frequently the drink is consumed. Score is

out of a possible 90.

Water = 83

Milk = 81

Fruit juice = 67

Fruitshoot = 36

Ribena = 36

Fizzy drinks = 15

Energy drinks = 1

35 | P a g e

The results were mixed. Some interesting findings include:

Water was the most frequently consumed drink – only one parent gave their child/ren water

infrequently (once to twice per week).

Milk was the next most frequently consumed drink. This is also positive since milk and water are

the healthiest drinks for teeth.

Six out of nine parents reported giving fruit juice to their child every day. Whilst fruit juice has

nutritional value, it can also have a high sugar and acid content. As such, in order to cause the

least harm to teeth, the best juice to have is pure fruit juice, consumed in small quantities, diluted

and drunk during a meal time, ideally through a straw.

In terms of the other more typically ‘sugary drinks’, consumption of Fruitshoots and Ribena was

high, with four parents offering one of the two drinks to their child/ren every day. Fizzy drink

consumption was however quite low down the list and appeared to be only offered occasionally

by a couple of parents as treats. Once again to cause the least harm, sugary and fizzy drinks

should be restricted and only consumed at mealtimes with a straw.

When discussing diet in more detail, the following themes were raised by participants:

“The children always want to snack. They are always hungry.”

“We go passed the shop and the kids always want to go in and get sweets.”

“After dinner, the kids always want to have a snack before bedtime.”

“I don’t allow fizzy drinks in the house.”

“Flavoured spring water is a favourite in our house.”

“I now only buy sweets and drinks as a treat.”

“Children see other children drinking fizzy drinks and

they want them.”

“Children see adverts on TV and want to try all of the drinks and food.”

“I try to hide vegetables in my dishes, like curries.

That way they don’t really notice they are eating them.”

“The cost of veg in local shops is really high, if you can get it that is.”

4.2.4. Fluoride varnish and visiting the dentist

The discussion then moved to fluoride varnish to ascertain knowledge of fluoride varnish amongst

participants. Fluoride varnish is a concentrated fluoride gel which is painted onto children’s teeth by a

dental professional. There is strong evidence that painting fluoride onto children’s teeth can help

36 | P a g e

reduce tooth decay. The department of Health recommends that fluoride varnish is applied at least

twice a year to children aged 3 years and over.29

2 of the participants had definitely heard about fluoride varnish and 1 was uncertain. One of the

participants familiar with fluoride varnish described it as “a coating to protect teeth.” Children of two

of the parents present had had the fluoride varnish applied at school as part of a local fluoride varnish

outreach pilot (Keep Smiling Programme).

When discussing where parents would like their children to have fluoride varnish applied, participants

commented:

“It’s easier if it’s done at school – I think that’s a good idea.”

“We don’t have to find the time to go to the dentist. We’re always so busy.”

“It’s difficult to see a dentist after school – it’s always too late.”

“The children listen to the dentist or nurse at school.

They teach it and make it more of a subject with

pictures and information. It’s better for the

child – better than a visit to the dentist.”30

When the discussion moved to talking about visiting the dentist, it appeared to generate more

negative comments than positive comments. Interestingly, this was in contrast to the children’s group

discussion, which was overwhelmingly positive regarding dentist attendance. The following themes

emerged from parents when thinking about going to the dentist:

Lack of time

Fear of going to the dentist

The need for dentists to be more child-friendly

Participants stated:

“I really struggle to find the time to go to the dentist. And when you do

go they are always running late and you have to wait for ages.”

“Adults are petrified to go to the dentist. I think this fear is

portrayed onto our children. They must pick up on this.”

“The dentist needs to be more child-friendly. Young people

are scared and afraid to go to the dentist so dentists should be more friendly and chatty.”

29


Edition 30

The Keep Smiling Programme is a targeted pilot programme rather than a universal rolling programme provided in all primary schools in the borough. As such there is currently no provision for children to receive fluoride varnish on a six-monthly basis at school. A key component of the Programme is to sign post families to local dentists to receive subsequent fluoride varnish applications. This is important not just to receive fluoride varnish but to encourage families to use the dentist for prevention, taking their children for a check up on a regular basis (rather than only attending when the children are in pain/requiring treatment).

37 | P a g e

One participant revealed she has changed her dentist 3-4 times because she was unhappy with the

service. She stated she had been told by her local dentist that her child was too young to come to the

dentist at 3 years old and she should bring her back in six months’ time. She also feels dentists should

take the time to gain the trust of the children before going straight to their mouths. She continued:

“The dentist should explain what he’s going to do first so the child

knows what to expect. They need to be more caring and talk in a more

caring way.”

The two positive comments included:

“We try and go as a family so it’s like a bit of an outing!”

“My daughter likes the dentist. She gets a sticker from the dentist

and comes out happy!”

When asked about when children should start to attend the dentist, participants felt between 2 and 3

- 3 ½ years old is the best time.

4.2.5. Community and dental health messages

Before the discussion drew to a close, the participants were asked for ideas about the best ways of

telling people about some of the themes covered in the group session. Parents suggested the

following ways of communicating with other parents:

Leaflets through doors

Letters from dentist addressed directly to the child

Events at the Beethoven Centre – Eid/Christmas events where there is a focus on oral health. Keep

the children busy and then hold a seminar or provide information for the parents

Get the schools to send out letters in the children’s school bags

Work closely with nurseries – get the dentist to visit the nurseries and hold talks. Provide children

with a toothbrush and have diagrams or pictures/posters which parents can put up in the

bathroom at home

Facilitate a meeting with parents in school to talk together about looking after teeth and tips or

ideas for what they can do to help with things at home

Organise a puppet show at an event or school

Local people really like Queen’s Park Voice publication – put oral health information inside

Get local people, like the Community Champions, to talk with local people about our health and

children’s health: “It’s nice to know someone’s volunteering and cares about the area. I would

listen to them.”

38 | P a g e

5. Recommendations

Recommendations for work around oral health

Re-inforce all the evidence-based consistent messages around child oral health (covering diet,

toothbrushing and visiting the dentist) – particularly the following gaps in terms of parent’s

knowledge which emerged from the survey and the community conversations:

o Age to stop supervising children to brush their teeth

o Recommended fluoride contents of toothpaste

o Tips and techniques for home toothbrushing and encouraging children to brush twice a

day

o Diet – particularly how to avoid sugary foods, and clarification on what to look for in

certain foods where there is ambiguity as to what is healthy

o Oral hygiene practices – particularly around flossing

Within oral health promotion activities it is important to highlight the importance of valuing

children’s first teeth as well as their second adult teeth.

Work with the local community to explore further any gaps in the information parents currently

receive and what more information they would like and in what format, and to explore if

information sharing leads to behaviour change. Initial ideas generated within the community

conversation held with parents included:

o Information or tips on how to get children brushing at home twice a day

o Fun resources for the home to encourage children to brush their teeth properly

o Clarification on when it is safe and appropriate for children to use mouthwash and dental

floss

o Tailored advice around particular cultural beliefs and practices around looking after

children’s teeth.

o Working more closely with schools and nurseries to promote oral health and dental access

e.g. organising for dental talks and resources for children to take home around oral health

o Use Queen’s Park Voice publication to promote information around dental health

o Organise local events focussing on oral health for parents

o Use the Community Champions to talk to local people about keeping teeth healthy.

Provide information to parents about which toothpastes contain the correct level of fluoride for

different age groups and what factors they should consider when choosing a toothpaste for

children. This would help to address some of the misinformation about ‘appropriate’ toothpastes

for children

Deliver promotional activities around dental access for children highlighting that:

o Taking children to the dentist for prevention, that it’s good for children to go to the dentist

for advice early on before there are any problems (even if parents do not attend)

39 | P a g e

o Dentistry is free for children from NHS dental practices

o It is recommended that every child over 3 years has fluoride varnish applied to their teeth

at least every 6 months. Fluoride varnish is evidence-based prevention for reducing tooth

decay and is available free from NHS dental practices.

Deliver health promotion activities to young children to help prevent future oral problems and to

instil good oral health behaviours from a young age.

Work with GPs to help improve the oral health and dental access of their patients.

o Ask GPs and Practice Nurses to recommend/remind parents who are visiting their surgery

with children to take their child/ren to a dentist for a regular check up and promote

fluoride varnish. A collaborative drive between GPs and dentists would help to reduce

costly use of A&E and hospital admissions. This would also contribute to achieving the out

of hospital strategy. Explore possibility of giving/collecting information from parents by

Practice Nurses about oral health messages and their children visiting a dentist at their

childhood immunisation visits.

o Ensure that GPs and Practice Nurses are part of the local child oral health pathway and

that they are clear how to identify children who would benefit from being referred to the

Community Dental Service for specialist dental support, rather than a general dental

practice

o This approach could also be widened to other local partners working with children

including the Children’s Centre and local nurseries. Explore how Health Visitors and the

newly developed Maternity Champions may be able to support with such activities.

Considerations for future surveys and insight work around child oral health

Explore parents’ understanding about what toothpaste to buy for their children, including the

fluoride content. In place of the question used in this survey about toothpaste brands, maybe in

future surveys the following alternatives could be considered:

o Include a list or photos of common brands of children’s and adults’ toothpastes to

accompany the survey for parents to identify the toothpaste they use for their children

o Ask parents about how they select their child’s toothpaste

o Ask parents directly whether they know the recommended level of fluoride for toothpaste

or whether they are aware that such a recommendation exists.

In order to better understand parents’ perception of when to take children to the dentist for the

first time versus the reality of the age their child was first taken to the dentist it would be helpful if

the age ranges in both questions were the same (in this survey they were slightly different as the

questions were taken from two different validated surveys).

40 | P a g e

Use the survey to make a link with the Healthy Child Programme to ask whether parents received

oral health advice and a Brushing for Life (toothbrush and toothpaste) pack from their Health

Visitor at their child’s development review.

41 | P a g e

6. Appendices

Appendix A1: Profile of residents who responded to the survey

Ethnicity of achieved sample and Census profile

1 Based on the Westminster 004E Lower Super Output Area (total resident population, including children), Census 2011

Number Percentage (%)

Male 8 15

Female 46 85

1-2 children living in household 32 59

3 or more children living in household 22 41

One parent living with a child/children 10 19

Couple living with a child/children 42 78

Other living arrangement with children present 2 4

Age of eldest child (< 1 year) 1 2

Age of eldest child (2 years) 5 10







White British/Irish/European/Other 6 11

Black/Black British 5 9

Asian/Asian British 20 37

Mixed/Dual Heritage - -

Other ethnicities 23 43

Number achieved

Percentage Actual percentage1

(Census 2011)

White British/Irish/European/Other 6 11% 28%

Black/Black British 5 9% 25%

Asian/Asian British 20 37% 21%

Mixed/Dual Heritage - - 8%

Other ethnicity 23 43% 18%

42 | P a g e

Appendix A2: Profile of participants who took part in the community

conversation with parents

Number

Male 1

Female 8

One parent living with a child/children 1

Couple living with a child/children 7

Other living arrangement with children present 1

Age of children < 4 year 6

Age of children 5 – 8 years 6

Age of children 9 -12 years 8

White British/Irish/European/Other 1

Black/Black British 2

Asian/Asian British 3

Mixed/Dual Heritage -

Other ethnicities 3

43 | P a g e

Appendix B. Research instruments

B1. Quantitative survey

44 | P a g e

45 | P a g e

46 | P a g e

47 | P a g e

B2. Topic guide for group discussion with children

Hi every one great to see you

This is called a focus group, in our focus group we are going to do;

Lots of talking

A little writing

Some eating (mention we need to be quickish to get to eat)

And something you might not have done before, its quite fun.

You probably all know me as I work in QPS, but I also work with the

whole of qp community. I do lots of different things in the community,

but all of those things are based on improving people’s lives.

Today we are going to be discussing health. Penny will be listening to

all the things we talk about, she might write down some of the things

you say. The things we talk about today will help us to

understand what local families want when it comes to their health.

To start I would like you to talk to the person next to you about

‘what being healthy might mean’. (adult can write answers on

board –optional)

Next we will be thinking about healthy teeth.

I would now like you to

Talk to the person sitting next to you about things we can do

to look after our teeth, gums and mouth.

I have listed some ways we can look after our teeth gums and

mouth.

48 | P a g e

Can you guess what they might be, maybe you will have some

new ideas that I haven’t thought of.

LIST –go through their list and compare with mine

Do you think that children your age actually do these things? Which

ones the most ? which ones the least ?

I would now like us to think and talk a bit about brushing teeth

(give out blank speech bubbles) I would like you to close your

eyes and think about brushing your teeth then open them and

write down any words that you think of that are to do with

brushing your teeth, don’t worry if you can’t spell them just

put your hand up and I will write them on the board instead.

You could also write about how brushing your teeth makes you

feel.

(adult write up what kids have said, then discuss negative feelings

towards tooth brushing)

I would like to ask you some questions about brushing your

teeth, you can put your hand up to answer.

Do you think adults should help children to brush there

teeth?

Why ?

What could happen if parents don’t help children with tooth

brushing ?

At what age should you start brushing your teeth?

What age should you be brushing your teeth without any help

from an adult.

Do you think adults help children brush there teeth?

49 | P a g e

I found out that some adults don’t help there children brush

there teeth, why do you think they don’t help them?

I would now like us to talk about dentists.

Some people go to the dentist regularly (lots of times) and some

people have never been.

I have given you all a picture of a dentist. I want you to let us

know how you feel about going to the dentist, if you really enjoy

it put a circle round the happy face, if its ok put a circle around

the straight smile and if you don’t like it put a circle around the

sad face. You could you also write down how you feel when you

think of going to the dentist. If you find it hard to write please

put your hand up and I could help you.

Put your hand up if you would like to tell me something good

about going to the dentist.

Some people don’t know much about going to the dentist, how

could dentists let more people know about all the good things

they could do for them?

If you were in charge of dentists would you tell them to do

anything different that you think would make them better at

there job ?

The food is coming out now but before we eat it I want you to all

choose some food that you think is healthy and put it on your plate

but don’t eat it yet!.

Ted gets junk

Now lets all look at each others plate and see what healthy or

unhealthy things we can find.

-swap healthy with unhealthy

50 | P a g e

-look at Teds plate and discuss maybe share out.

Now we have had our lunch, will brush our teeth, we will use a 2

minute timer as we should always brush our teeth for at least 2

minutes. (adult hands out toothbrushes)

We discuss

How it feels

Do you enjoy or not enjoy it

Does timer help, does it feel to long short

What’s is it like to brush your teeth at home?

When do you brush your teeth

How many times a day do you brush your teeth?

We will now use a plaque pill this will show how good you are at

brushing your teeth.

You should NOT swallow the tablet, it will stain your plaque red

(Plaque is a sticky, slimy substance made up mostly of the germs that

cause tooth decay. That's why it's important to brush your teeth.

Bite the tablet, spread the liquid round all your teeth, then

rinse your mouth with water, then lets pass the mirror around

and have a look to see if you have brushed really well or need to

brush again.

51 | P a g e

B3. Discussion guide for group with parents

Discussion guide – group with parents to explore child dental health

Beethoven Centre

Date – 21st February 2013, 1pm – 2.30pm

Introduction

Thank you all for coming today. We are going to have a discussion around a number of topics and in

particular how we look after our children’s teeth. Please respect people’s answers and allow everyone

the opportunity to speak.

There are no right or wrong answers – please be honest and open. All information is confidential. We

will try and make the session as fun and informal as possible for you but please tell me what you really

think about the questions I ask you. We will finish by 2.30pm.

Introduction/ Icebreaker (10 mins)

Briefly! So, to start with and to get to know each other a bit....can you ask the person on your left their

name, how many children they have, their ages and their favourite thing about being a parent.

Now we will go round– please introduce the person on your left to the group.

Thank you. That was great. So, let’s make a start....

Understanding and awareness of oral health (5-10 mins)

Can anyone think of things we can do to look after our teeth, gums and mouth? Think about adults

first. .

Write down anything that comes up and cross check with below

- Brush your teeth twice a day

- Brush your teeth before bedtime and on one other occasion (morning)

- Making sure you brush all parts of the teeth and gums that you can

- Reducing amount of sugary food/sweets

-Reducing amount of sugary drinks/pop

-Eating healthy food – fruit and vegetables

-Using a fluoride toothpaste

- Going to the dentist for a regular check up

52 | P a g e

- Not smoking

- Not chewing tobacco, betal nut

- Not drinking alcohol excessively

Do you think we actually do these things? Which ones the most? Which ones the least?

And what about children...are there any additional things we need to consider for looking after our

children’s teeth – or anything in particular we need to pay attention to?

Again, do you think we actually do these things? Which ones the most? Which ones the least?

Brushing teeth (10 mins)

Let’s talk a bit more about brushing teeth. You may have different experiences of this.

Circulate ‘think bubbles’ sheets.

Please write down 2 or 3 words that spring into your mind when I say ‘brushing teeth time at home’.

Give each participant a few minutes for this and support anyone who might need help with spelling

tricky words

We are now going to talk about how we can help our children brush their teeth.

How does brushing fit into your domestic routine?

Are there fixed times of the day that this happens in your house?

And how do you find this time at home?

Is it fun, difficult, stressful, do you want it over with quickly?

Probe deeper – if it’s stressful why, what are you struggling with? Can anyone share anything they find

that helps?

Can tell me whether (if you have more than one child) if your children brush their teeth together or

help each other in some way? And do you brush your teeth with them at the same time? Why?

What sorts of things can children need help with when it comes to brushing their teeth? What

about very young children?

What age should children start brushing their teeth? What age should they be doing this on their

own?

53 | P a g e

Children’s diet (20 mins)

I now want us to think specifically about what foods, snacks and drinks you give your children.

I have some samples of children’s foods, snacks and drinks here. I also have a piece of paper for you

each to take. Circulate food sheets.

Please write a number in the first two boxes next to the picture of each food/snack/drink a number

from 0 – 10 to show how often your children has these items (0 being never and 10 being every day)

and, whether you think they are good or bad for your children, or if you are unsure about them (1 –

being very bad and 10 being very good).

Give each participant a few minutes for this and support anyone who might need help the exercise

I would also like us to think about the times of day that children are generally consuming food and

drink. By this I mean meals and snacks – either sitting down, or on the go.

Here is a basic timeline of the day, a bit like a diary. Thinking of standard school day start at the

beginning of the day, when you children get out of bed, and go through the day in your head and

write down all the times that you children will eat or drink something. Write down whether it is a

snack or a meal next to the time slot please.

Give each participant a few minutes for this and support anyone who might need help the exercise

OK, so we have now covered what our children consume and when they do it. Lets have some

discussion around snacks and drinks.

Snacks –

Look at snacks consumed frequently. Have a discussion around the points:

Are there any other snacks we have missed out? Look back at your timelines, when do your children

have these snacks? (probe if not spontaneous, breakfast, on way to school and back home after

school, school gate, at home). How often would you say your child has these kinds of snacks? –

regularly, as a treat, when they’ve been good, at mealtimes, when hungry, when they are upset etc?

Why do you give your children these snacks? Do you think your children have too many of these

snacks, or the right amount?

Drinks –

Looking at drinks consumed frequently. Have a discussion around the points:

Are there any other drinks which we have missed out? Look back at your timelines, when do your

children drink these? (probe if not spontaneous: for breakfast, on the way to school, on way home,

as a treat, with their meals, before going to bed. Why? How did you score these drinks in terms of

good or bad? Do you think your children have the right amount of these drinks or too many?

Are there any other types of food that are eaten in your household that I have missed out? Would you

say these are particularly good or bad for you?

54 | P a g e

Overall, do you feel your children eat a balanced diet? Do they eat enough fruit and veg? Do you

think they get their recommended 5 portions of fruit and veg a day? Do you find it difficult to try

and achieve this? Why? Explore barriers if not already mentioned above

Fluoride varnishing (5 mins)

Has anyone here heard of fluoride varnishing?

Show of hands

Can anyone describe what it is? Has anyone had it done? Where?

Show of hands

Did you know you can ask your dentist to provide this service for your child?

Try to think about what would make it easiest for you to have this done regularly (ie twice a year).

Where would you like to have it done? At school? At the dentist?

Dentists (15 mins)

This brings us on to talking about dentists! This might be something that you do regularly or perhaps

you haven’t done yet. In either case, it doesn’t matter – remember there are no right or wrong

answers here!

What words or emotions come into your mind when you think about taking your children to the

dentist? Shout out them out! Discussion around the responses.

When do people think you should take your child to the dentist?

Probe: To see if it is prior or after a problem with the teeth

Let’s talk about the good things about going to the dentist.

How could dentists, or other people such as community champions or local schools tell people more

about these good things? What would be the best way of communicating this so that people took

notice?

Let’s talk about the not so good things about going to the dentist. What could dentists do to improve

this? What would you do if you were their boss?

Probe factors here – systematic - costs, appointments, location, accessibility,

Behavioural – fear, cultural, male dentist, time poor, juggling busy life, staff attitudes,

Try and differentiate between systemic and behavioural factors.

Community and dental health messages (15 mins):

So, to finish with, I want ask a few questions about what would best help you and others in the

community look after your children’s teeth.

55 | P a g e

We have talked today about the best way to look after children’s teeth and you can see there are

some simple tips that make a huge difference and make sure teeth are strong and last a lifetime.

It is important we find out the best way of getting this information out to people to make sure our

children’s teeth are strong and healthy

So, thinking about what we have been talking about today – ie brushing teeth, snacks and drinks

and having a good diet, fluoride varnishing and regularly visiting the dentist what do you think is the

best way to tell people about these messages and make sure they adopt them?

Write down any suggestions. Probe

Here we have some ideas please can you say which you think would be the best or make other

suggestions - discussion

- At schools – coffee mornings, parents evenings,

- Dentist?

- Leaflets and posters?

- Online - Do you use social networking sites such as Facebook or local websites?

- Face to face on the doorstep or on the street

- Word of mouth/ friends and family

- Fun community events, stalls,

- Other ...

Do you think Community Champions could help encourage more parents to take their children to

the dentist, or promote healthy eating and good brushing at home? How?

Are there any ways you think are particularly successful at reaching people in your communities?

Summarising:

We have now discussed all of the questions I had. Is there anything else that you think is important

that you have not managed to say yet?

Finally we are always looking for new people to get involved ... so if anyone is interested in becoming a

Community Champion, has any questions or wants to find out more please speak to Emma

Before you go we need everyone to answer a short questionnaire – again it is important you answer

honestly – there really is no right or wrong answer here.

56 | P a g e

Appendix C: Key external data sources cited in this report Children’s Dental Health Survey – A national survey of children’s dental health has been carried out every ten years since 1973 in England and Wales, and since 1983 in the whole of the UK. The survey provides information about the dental health of children, as well as their experiences of dental care and treatment and their oral hygiene. The survey is based on a representative sample of children aged 5, 8, 12 and 15 years of age attending government maintained and independent schools. The data is collected both through a dental examination of the children and a parental survey, sent to a sub-group of the sampled children. Adult Dental Health Survey – A national survey of adult’s dental health has been carried out every ten years since 1968. The main purpose of these surveys, which include a questionnaire based interview and clinical examination, is to get a picture of the dental health of the adult population and service use (including examining the condition of adult’s natural teeth and supporting tissues, as well as denture use, and investigating dental experiences, knowledge about and attitudes towards dental care and oral hygiene), and to monitor changes in dental health over time.

Child Oral Health -...

Documents

Transcript of Child Oral Health -...