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Institute of Dentistry - Faculty of Medicine and Dentistry

Improving the oral health of vulnerable children

A tailored oral health resource developed for foster carers

Dr Vanessa Muirhead

Clinical Senior Lecturer in Dental Public Health

Poor oral health negatively affects children’s quality of life, causing pain, problems with speech and disruptions in eating and sleeping. Research led by Dr Vanessa Muirhead has shown that there is a significant issue with the oral health of vulnerable children. She has sought ways to address the issue.

The consequences of poor oral health can be long-lasting. Children can struggle to gain weight and grow. It can also lead to them missing school and can disrupt work for their parents and carers. This problem is particularly severe among socially excluded groups such as looked-after children (LAC) and also children with significantly unmet dental needs.

Dr Muirhead’s research led to the ‘Let’s Talk about Teeth’ project, working with foster carers of looked after children.

Assessing the oral health needs of looked after children

Between 2008 and 2013, Dr Muirhead and her colleagues carried out 10 local oral health surveys in east London. They found that children from particular ethnic backgrounds were significantly more likely to have dental caries. They also learned that looked after children are consistently overlooked in oral health studies.

Looked after children (LAC) are children placed under the care of a local authority for their own protection. Approximately two-thirds of LAC in Tower Hamlets were placed in care because of physical abuse, neglect or family dysfunction. This can mean they are socially excluded and vulnerable on multiple fronts. Dr Muirhead’s research showed that these problems can include poor oral health.

Research with carers and children

In 2014-15, working with the public health team at Tower Hamlets, Dr Muirhead led the ‘Let’s Talk about Teeth’ research project to ascertain the oral health needs of LAC and to explore how well foster carers were equipped to the oral health of children in their care.

‘Let’s Talk about Teeth’ consisted of an oral health survey of LAC and a qualitative study of foster carers. The survey found that LAC had high levels of tooth decay, gum disease and unmet dental treatment needs.

A significantly higher percentage of teenage LAC (54%) had decayed, extracted and filled permanent teeth than children of the same age who were not in care.

Of 12-15-year-old girls under the care of the local authority, 37% had a tooth fracture, a high percentage in comparison to boys both in care and those who are not. This is important because previous research has shown that traumatic injuries to teeth are a potential sign of domestic violence, which can be picked up at a dental appointment.

What do the carers need?

The qualitative study of foster carers explored their attitudes and knowledge about dental health, and investigated their experiences of overseeing the oral health care management of LAC.

Foster carers said that looked-after children, especially when they first arrived in the care system, frequently had had poor oral health. Many of the children had no tooth brushing habits. They often had unhealthy diets, including high-sugar snacks, fizzy drinks and sweets.

The foster carers had often had inconsistent information from dentists and were unsure how to give clear guidance to these children. They often found that dentists were reluctant to see younger children who needed oral health care.

[Let’s Talk about Teeth] has been disseminated by the Child Oral Health Improvement Programme members through their networks and is also informing the ... vulnerable children action plan which is currently being developed.
— Dr Jenny Godson, National Lead for Child Improvement at Public Health England and Chair of the Child Oral Health Improvement Programme (COHIPB)

How has the research helped looked after children?

Dr Muirhead’s applied research has spotlighted the oral health needs of socially vulnerable children. As a result, changes have been made in local oral health improvement plans.

Her recommendations have been implemented by Public Health England and the Local Government Association. NHS England used the research to inform a new paediatric dentistry pathway for London.

Addressing the oral health needs of looked after children (LAC) through improvements in the health service

The researchers made a series of recommendations to commissioners of NHS dental services in London, including:

  • a dental check-up for LAC as part of their initial health assessment under local authority care

  • specialist support for LAC who are anxious about visiting the dentist

  • tailored oral health resources and support for foster carers

These recommendations were implemented in all 33 London boroughs in April 2017.

Developing new resources to help foster carers to support oral health

The researchers recommended that a tailored oral health resource should be developed for foster carers. This led to the co-produced booklet Ten Key Questions for Foster Carers, which was created in 2015.

The booklet was distributed by Tower Hamlets Council and is currently used by 130 foster carers caring for more than 300 LAC. The resource was also taken up by more than 10 local authorities across England, including in London, Leeds, Newcastle, Hampshire, Kent, Surrey and Sussex.

Let’s Talk about Teeth was cited in Public Health England Health Matters, a set of resources for local authorities and health professionals. This resource has been viewed more than 65,000 times online by users across the UK, Europe and USA, as well as in Indonesia, Pakistan, Singapore, and Sudan.

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