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Public Health Matters (2017)  Health Matters: Child dental health. Available at: https://www.gov.uk/government/publications/health-matters-child-dental-health/health-matters-child-dental-health. Last accessed: 17th December 2018.

Dental Health Foundation (2018) Learn About Your Oral Health. Available at: https://www.dentalhealth.org/ Last accessed:17th December 2018.

HM Government (2015) Working Together to Safeguard Children. Available at: https://www.gov.uk/government/publications/working-together-to-safeguard-children--2 Last Accessed: 17th December 2018.

British Dental Association (2016) Dental Neglect. Available at: https://www.bda.org/dental-neglect Last accessed: 17th December 2018.

Maslow, A. H. (1943). A Theory of Human Motivation.

Bandura, A. (1989). Human agency in social cognitive theory. American Psychologist, 44 (9), 1175-1184.

Bandura, A. (2005). The primacy of self-regulation in health promotion. Applied Psychology: An international Review 54 (2), 245-254.

Oral Health Foundation (2018). National Smile Month. Available at: http://www.nationalsmilemonth.org Lat accessed:17th December 2018.

HM Government (2016). The Eatwell Guide. Available at: https://www.gov.uk/government/publications/the-eatwell-guide Last accessed: 17th December 2018.

The National Health Service (2018). Starting Well. Available at: https://www.england.nhs.uk/commissioning/primary-care/dental/starting-well/ Last accessed 17th December 2018.

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Results of a poll done by the British Dental Health Foundation showed that nearly four million under 14s in the UK are at risk of developing serious oral health problems due to lack of tooth brushing supervision the poll found that 37 percent of parents said they stopped supervising their children’s tooth brushing before the child turned seven (Dental Health Foundation, 2016).  NHS guidelines advise that parents need to supervise their teeth brushing until seven years old at least to ensure adequate teeth brushing is taking place for an appropriate amount of time (Dental Health Foundation, 2016). The British Dental Health Foundation believes this could be a contributing aspect in the current children’s dental health issues in the UK. As well as supervising tooth brushing, parents can also play a role in preventing children’s dental issues by supervising the child’s diet, ensuring that the child consumes less sugary foods (Dental Health Foundation, 2016).

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Poor dental health can be at times an indicator to neglect or at least dental neglect. When a parent fails to ensure their child has good dental hygiene, they fail to meet their basic health needs. This can then lead to wider safeguarding issues. warning signs such missed appointments for necessary treatment and failure to complete planned treatment can be a cause for concern. The working together to safeguard children’s act suggests that anyone with concerns about a child’s welfare should make a referral to local authority children’s social care. The guidance states that ‘Early sharing of information is the key to providing effective early help where there are emerging problems’ (HM Government, 2015). A mouth examination should be part of every assessment related to child protection. Anything less should be identified as incomplete assessment. Whilst dental neglect can be an indicator of overall neglect, dental examinations can also show signs of physical abuse, sexual abuse and conditions related to emotional harm.

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For all children to obtain and maintain good dental hygiene, a wide range of partners need to support and be committed. One of the most effective ways of improving dental health is to enforce it in a wide range of children’s services.  These partners include dentists, midwives, health visitors, school nurses, pediatricians, GPs, Pharmacists and Healthy settings. All members of a dental team should have access to training including delivering better oral health. Dental teams should encourage dental attendance from when the child’s first tooth arrives. Midwives should advise parents to visit the dentist and inform them that all dental care is free during pregnancy and until the child is 1 year old. As part of the healthy child programmed, health visitors obtain an important role in providing advise and support. The aspects of this role include providing oral health and support, signposting dental services, noticing families that need extra support and encouraging dental attendance. School nurses should advise o good dental hygiene to support the child’s school readiness (Health Matters, 2017). Pediatricians and GPs play a part in providing dental health messages for parents and advocate for child oral health. Pharmacists can offer dental health advice for families and refer to dental services. Early year settings can support good dental health by having policies in place such as healthy eating. They can provide oral health training for staff through e-learning and provide supervised teeth brushing (Health Matters, 2017).

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When a child starts to include foods in their diet other than breast or formula milk, their risk of tooth decay begins to increase due to sugar content.  When foods and drinks high in free sugars are regularly consumed, it increases the risk of obesity and tooth decay. The energy consumed from free sugars should be no more than 5 percent yet children and adults across the UK are currently consuming 2 to 3 times that amount (Health Matters, 2017).  Although sugary drinks are not needed in a child’s daily diet, they account for large portion of the daily free sugars consumed by 11 to 18-year olds. Poor oral health can be caused by other medical conditions such as cardiac problems, cleft lip and palate and childhood cancers (Health Matters, 2017). Gum disease can be linked to many health issues in other parts of the body. Gum disease increase a person’s risk of stroke, diabetes and heart complications. Gum disease has also been linked with issues in pregnancy and dementia. Gum disease infects the tissues that support teeth. It is caused by a buildup of plaque. The body can over react to the bacteria and cause excessive inflammation. In some, the inflammation does not clear up correctly. It is believed that this can affect the bloodstream and slowly damage blood vessels in the heart brain (NHS, 2018).

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Poor dental health can lead to wide range of psychological issues. if a child has issues with their teeth, they are likely to have a low level of self esteem due to embarrassment of missing teeth, colour, odor and shape. The child may become anxious or even depressed. Maslow’s hierarchy of needs ay suggest that to achieve self-esteem and self-actualisation, an individual must make sure all their basic health needs are met, including dental health (Maslow, 1943).The child may lack confidence, finding it hard to socialize, making the child be or feel isolated. The child may become bullied because of their teeth, which could lead to more absence from school as well as affect their mental health through to adulthood. The psychological affects that poor dental health could have on a child can be serious and log lasting, perhaps shaping them into the adult they become. Therefore parents, carers and service providers should work in an integrated way to ensure the child can obtain and maintain adequate dental health.

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Untreated dental issues can lead to toothache, disturbed sleep difficulty eating, time off school and lack of socialization. The child maybe become at risk of bullying, repeated antibiotics, repeated exposure to morbidity due to general anesthesia and infection that can lead to life threatening illnesses (British Dental Association, 2016). Children with dental related issues such as toothache may have to have time off school which will then impact their overall education. At times, parents may then need to take time off work to look after child and take them to seek dental services. This can then result in an impact in the family’s income. Pregnant women with good dental health can be three times less likely to have a premature baby, which reduces the risk of low birth weight. Because gum disease raises the levels of chemicals that induce labour, research says that there is a one in four chance that a woman with gum disease could give birth before 35 weeks (Oral Health Foundation, 2018).

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National smile month is the longest running campaign to promote good dental health it is used to share positive messages and to educate the public in gaining and maintaining good dental health. It works together with other organisations to deliver three messages. These messages include cutting down on sugary food and drink, regularly attending dentists and teeth brushing last thing at night and on at least one other occasion using a fluoride toothpaste. National smile month takes place between the 14th of May and the 14th of June (National Smile Month, 2018). The campaign encourages all health professionals, schools, pharmacies, community groups and schools to participate in educate and motivate positive oral health messages. The dental buddy program provides a series of educational resources for early years education, key stage one and key stage two. This is provided through activity sheets, lesson plans and interactive presentations (National Smile Month, 2018). As tooth decay can be a consequence of what a child consumes, the Eatwell Guide is another good resource hen promoting good dental hygiene as it works as a guide of how much of each food group should consumed to achieve an overall healthy diet. It encourages the public to consume more fruit and vegetables, at least 5 portions a day.  It also encourages the public to consume 6 to 8 glasses of water or sugar free drinks a day (Public Health, 2018). The NHS starting well program attempts to reduce dental health equalities and improve the dental health of children under five. The programs focus is children not currently attending dentals services and children under one, yet it is available to all children under five. It is a dental practice based incentive program used to ensure patient and practice level interventions and work together to build on relationships between communities and practices (NHS, 2018).

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An article by the National Institutes of Health states that “Theories can help us understand the nature of targeted health behaviours. They can explain the dynamics of the behavior, the processes for changing the behavior, and the effects of external influences on the behavior. Theories can help us identify the most suitable targets for programs, the methods for accomplishing change, and the outcomes of evaluation. Theories and models explain behavior and suggest ways to achieve behavior change.” (Bandura, 1989). Banduras social cognitive theory suggests that the actions directed at making self-needed changes have to be self-directed in order to be successful. Bandura suggested that if individuals can change their lifestyle habits, they are able to “exercise some measure of control over the state of their health”. In relation to dental health, this would suggest that for individuals to maintain good dental health, they must want to make a conscious effort to do so (Bandura, 1989). Bandura also suggests that for the change to last, people must be able to control their own behavior and motivation (Bandura, 1989). So, for an individual to maintain good dental health they must be able to take control in keeping to a good dental routine, and be motivated in doing so. this can include, brushing teeth regularly, attending all dental appointments and sticking to a healthy diet (Bandura, 1989).

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Dental anxiety is thought to be one of the most common barriers to dental attendance. Dental anxiety in children may be a consequence of the child’s developmental stage, parental anxieties or the parents wishes to avoid distress and anxiety. Banduras social learning theory suggests that children learn through observing others (Bandura, 1989). It suggests that a child would learn through observing anther persons experience of the dentist. Bandura states that “many intractable fears arise not from personally injurious experiences, but from seeing others respond fearfully toward or be hurt by threatening objects. Similarly, evaluations of places, persons, or thigs often originate from exposure to modeled attitudes”. The social theory would suggest that if a child observes another individual reacting negatively to dental treatment, it could cause the observing child to become anxious and fearful of dental treatment (Bandura, 1989). The financial impact of dental care remains to be one of the larger barriers to adequate dental health. For working families on a low income, dental care may e seen as an unaffordable luxury rather than a priority. Language and communication barriers can lead on to dental treatment misunderstandings. The dental teams that do not appreciate the differences in cultures may inhibit rather than help their patients. People with busier lifestyles may also neglect their dental health, using emergency dental services when a problem occurs, rather than attending routine check ups to prevent. Although preventable, dental disease has a significant impact on NHS funding. In 2015-2016 extractions in children aged 0-19years old cost around 50.5 million. The vast majority of these were a result of tooth decay. For children aged 4 years old and under the cost was around 7.8 million (Health Matters, 2017). This risk of tooth decay is increased for people living in poverty. Here there is no balance in income, education, employment and the environment. A report by the Health Foundation found a significant gap between rich and poor when evaluating dental health. It is found that people from more deprived areas are twice as likely to be admitted to hospital for dental issues than those of a richer background. In 2014 to 2015, eighty three percent of five-year old’s in the richest regions of the country had good dental health, compared to 70 percent in the poorest parts. The report also stated that in 2010 to 2011, the cost of dental charges has risen by over 6 percent in two years and the NHS dentistry funding had decreased by up to 15 percent. It is argued that the NHS dental contract setting limits on patient numbers has left the most disadvantaged individuals without dental access (The Health Foundation, 2017).

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For all children to obtain and maintain good dental hygiene, a wide range of partners need to support and be committed. One of the most effective ways of improving dental health is to enforce it in a wide range of children’s services.  These partners include dentists, midwives, health visitors, school nurses, pediatricians, GPs, Pharmacists and Healthy settings. All members of a dental team should have access to training including delivering better oral health. Dental teams should encourage dental attendance from when the child’s first tooth arrives. Midwives should advise parents to visit the dentist and inform them that all dental care is free during pregnancy and until the child is 1 year old. As part of the healthy child programmed, health visitors obtain an important role in providing advise and support. The aspects of this role include providing oral health and support, signposting dental services, noticing families that need extra support and encouraging dental attendance. School nurses should advise o good dental hygiene to support the child’s school readiness (Health Matters, 2017). Pediatricians and GPs play a part in providing dental health messages for parents and advocate for child oral health. Pharmacists can offer dental health advice for families and refer to dental services. Early year settings can support good dental health by having policies in place such as healthy eating. They can provide oral health training for staff through e-learning and provide supervised teeth brushing (Health Matters, 2017).

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Although tooth decay is preventable is remains a highly serious problem. Data shows that a quarter of 5-year old’s in England experienced tooth decay in 2015 and the majority of these were untreated (White, 2017). Also, in 2015, it was found that the most common reason for hospital admission was tooth decay for children aged between 5 and 9 years. It was also the sixth most common procedure in hospital for children aged 4 and under (Health Matters, 2017). Dental Health is a key aspect in a child’s overall health and children’s readiness for school. Dental health is one of the larger health and social care issues which can lead to other serious issues such as lack of nutrition and obesity (Health Matters, 2017). In 2013 31 percent of 5-year old’s and 46 percent of 8-year old’s had decay experience in their primary teeth. Children from lower income families were more likely to have oral disease than other children of the same age. 21 percent of 5-year old’s who were eligible for free school meals had severe tooth decay where as only 11 percent of 5-year old’s who was not eligible for free school meals did (Child Dental Health Survey, 2013). Although oral health is improving, 1 in 4 children will have tooth decay when they start school (Public Health England, 2018). In 2014 to 2015 Over 63,000 children aged 0 to 19 years old were admitted to hospital for extractions.