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Improving oral health - what can nurses do to help?

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Nursing Times contributor, Professor Viv Bennett CBE, looks at the impact of poor oral health. 

Public Health England has launched an edition of Health Matters focussing on child oral health. As with all editions you can access a wide range of resources, information and infographics to support you in building your knowledge and helping others.

Oral diseases can cause pain and discomfort, sleepless nights, loss of function and self-esteem and in turn disrupt family life and lead to time off work.  

“Poor oral health can also be a marker to future health concerns”

Experiencing tooth decay or having missing teeth or ill-fitting dentures can lead to an individual becoming socially isolated which may affect their confidence, mental wellbeing and employment chances.

Poor oral health can also be a marker to future health concerns or linked to general health problems such as diabetes and cardiovascular disease. As such, we cannot afford to consider this purely the domain of dentists or other specialists.

As nurses we have the responsibility and ability to identify concerns, promote good oral health and advice and support those we care for. This applies to all age groups but we can make a particular impact with the young and ensure they grow up with the minimum of oral and other health problems, but also become the oral health guardians for the next generation.

“Tooth decay was the most common reason for hospital admission for children aged 5 to 9 years in 2014-15.”

We know that tooth decay starts early, with 12% of 3 year olds in England affected. It’s the most common oral disease affecting children and young people in England, with a quarter of 5 year olds starting school with dental decay, having 3 to 4 teeth affected. Stark inequalities exist with some of the most vulnerable and disadvantaged having significant oral health problems.

Tooth decay was the most common reason for hospital admission for children aged 5 to 9 years in 2014-15 with over 26,000 admissions. Among those aged up to 18-years-old there were 63,196 admissions for extraction of teeth with an estimated cost of £52.8million.

What causes tooth decay?

What is really shocking is that tooth decay is almost entirely preventable and we know what works to improve oral health. Tooth decay happens when cariogenic bacteria in the mouth interact with dietary carbohydrates to produce acids that demineralise the teeth.

This demineralisation is reversible in the early stages, and the remineralisation is favoured in the presence of fluoride.

What can be done?

We have good evidence of what works to improve oral health in Delivering Better Oral Health: an Evidence based toolkit for prevention 3rd edition (PHE 2014) outlines the current preventive advice and treatment that improves oral health.

In addition there are summarised factsheets that list the key actions we can take to improve child and adult oral health.

“Soft drinks companies will pay a levy on those with added sugar from April 2018”

Whilst individual action and self-care is important it is also key to provide community level and national support for oral health improvement. Government action to address childhood obesity, aimed at reducing the consumption of free sugar, will also reduce tooth decay.

Soft drinks companies will pay a levy on those with added sugar from April 2018 and the reformulation programme will introduce and monitor the gradual reduction of sugar in everyday food and drink.

Community based programmes that increase access to fluorides such as fluoride varnish and supervised toothbrushing programmes have been shown to reduce tooth decay. Early years settings have reported that supervised toothbrushing schemes are ‘easily deliverable’.

In 2016 Public Health England launched the Child Oral Health Improvement Programme Board to bring together all organisations with a role to improve oral health from across health, social care, education, voluntary and community sectors who share the ambition that Every Child Grows up free of tooth decay as part of Getting the Best Start in life.

A call to action for nurses!

Nurses can help and support families, by knowing what works for oral health improvement and offering support and advice to families regarding infant feeding and weaning, a healthier diet and access to fluoride.

In 2016 we published an infographic which outlines 10 top tips to improve oral health and using the 4-5-6 model to identify contact points when health visitors and school nurses could promote good oral health.

“All nurses can make a difference to adult oral and general health by providing advice and support.”

In addition an e-learning resource is available which supports continuing professional development of nurses on this important topic and All Our Health has a topic on child oral health. And of course please check out the child dental health Health Matters resources.

For other age groups, NICE has published intervention guidelines on ‘Oral Health for adults in Care Homes’ and ‘Oral Health Improvement for Local Authorities and their Partners’, PHE’s ‘Delivering Better Oral Health’ provides evidence based advice and treatment to improve oral health for adults.

All nurses can make a difference to adult oral and general health by providing advice and support on smoking cessation, reducing alcohol consumption, improving diet or signposting to relevant information and services..

As supporters of evidence-based skills and knowledge, nurses can help all age groups to make the best choice for their oral health. 

Professor Viv Bennett is the Chief Nurse at Public Health England.


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