Experts identify key strategies to combat tooth decay in young children

Researchers at The University of Manchester have identified several ways for health leaders to tackle the problem of tooth decay in children in England.

In an article published by Policy@Manchester, Dr George Kitsaras, Dr Michaela Goodwin and Professor Tanya Walsh reveal that up to 50% of 5-year-olds in England suffer from pain due to untreated tooth decay – or dental caries – with many having to undergo dental extractions under general anesthetic in hospital.

However, three research projects from the University’s Dental Health Unit – in partnership with Manchester’s Oral Health Improvement Team and supported by funding from the Medical Research Council - show that making oral health a family priority, and working closely with parents of young children, can lead to changes in habits for the entire family, delivering sustained benefits for children and parents alike.

The projects include BRIC (Bedtimes Routines Intervention for Children) through which, in collaboration with parents of young children, the researchers co-designed and co-developed a text message-based intervention to promote beneficial bedtime routine activities, including oral hygiene practices and reduced sugar intake. They explain: “As a result, young children brushed their teeth more at night with a 16% increase in brushing behavior; avoided sugary snacks and drinks around bedtime, with a 24% reduction in consumption of snacks/drinks before bedtime; and generally, parents’ mood and overall family functioning was improved with less mood disturbance around bedtime.”

Also, Leapfrog, a school-based oral health promotion programme which incorporated student activities, provision of brushes and text message support for oral health behavior change for families. Kitsaras, Goodwin and Walsh write: “This work targeted six primary schools in the areas of highest disease prevalence in Manchester. It led to improvements in their brushing behavior following the intervention, with more children brushing their teeth twice a day at the end of the study.”

The third project, a community-based oral health intervention known as HeRo (Healthy Routines, Healthy Teeth), is still ongoing and involves the provision of oral hygiene packs and behavior change techniques designed to create good oral health habits for newborn children in areas of highest need.

In their article, the authors detail several key principles emerging from their research which they believe policymakers should adhere to when considering interventions to improve children’s oral health.

“First and foremost, co-development and co-design principles with target populations should be followed from the start, not as an afterthought, to ensure meaningful benefits,” they write. “Interventions should be tailored to target populations, with consideration of personal, local, and regional circumstances. A ‘one-size-fits-all’ approach will not deliver the change required.”

Second, Kitsaras, Goodwin and Walsh argue that these principles “should include theory-informed, evidence-based approaches to sustained behavior change.” They add: “There must be recognition that positive changes and habit formation can take time, with funding and other resources provided accordingly.”

Third, whilst recognizing the important role technology plays in supporting behavior change, they advocate that it must be used with a clear rationale in place including “what kind of technology will be used, for whom, how, where, and when.”

And finally, the researchers recommend that “school-based oral health support needs to be easy and attractive for teachers to incorporate into their day-to-day work and utilize social aspects such as class-based activities.”