New Public Health England survey finds children in special schools are more likely to have teeth removed

Children in special support schools have slightly lower levels of tooth decay than children in mainstream schools but are more likely to have their teeth extracted, according to a new survey published today by Public Health England.

The first national survey of oral health in special schools - schools for children with severe special education needs and disabilities (SEND) - also show that those who experienced decay have more teeth affected and their oral hygiene is poorer. The number of children in special support schools with a substantial amount of plaque is double that of those attending mainstream schools (4% & 2% respectively for 5-year-olds and 20% & 10% respectively for 12-year-olds).

Tooth decay is a lifestyle disease caused by consuming sugary foods and drinks too frequently. It can be prevented by reducing sugar in the diet and brushing teeth with fluoride toothpaste twice daily.

The survey, broken down by region, shows wide variation in tooth decay prevalence and severity ranging from 10% to 33% for 5 year olds and 22% to 41% for 12 year olds. The North West region has the poorest dental health for both age groups in special support schools.

The key findings were:

• Around 1 in 5 (22%) 5-year-old children at special support schools has experienced tooth decay.
• Around 1 in 4 (29%) 12-year-old children at special support schools has experienced tooth decay.
• For 5-year-olds, the North West has the highest level of tooth decay at 33%; with those in the South West have the lowest at 10%.
• For 12-year-olds, the North West has the highest level of tooth decay at 41% and those in the South East have the lowest at 22%.
• Those children with tooth decay have an average of 4 decayed teeth at age 5 and 2 decayed permanent teeth at age 12, which is greater than those attending mainstream schools.
• The number of 5-year-old children at special support schools who have had one or more teeth extracted due to decay is double that of those in mainstream schools (6% and 3% respectively).
• Oral hygiene is generally poorer in children attending special support schools with more children having visible plaque at both age 5 and age 12 compared to their mainstream counterparts (4% compared to 2% and 20% compared to 10% respectively).
• In both age groups those with a behavioural, emotional or social difficulty have the highest levels of tooth decay; 28% of 5-year-olds and 42% of 12-year-olds.

Dr Sandra White, Director of Dental Public Health at Public Health England, said:

"Tooth decay is caused by too much sugar in the diet and children currently consume three times as much sugar than official recommendationsⁱ. Thankfully tooth decay can be prevented by not giving children sugary foods and drinks and brushing their teeth twice a day with fluoride toothpaste as soon as the first tooth comes into the mouth. It's also important to visit the dentist as early as possible to receive advice on good oral hygiene and to have free preventative treatment like fluoride varnish.

"Despite children in special support schools having slightly lower levels of tooth decay than children in mainstream schools, they are still very high so we must not be complacent. Children in special support schools are particularly vulnerable so they require an additional package of support to prevent and treat tooth decay. Local authorities and NHS England should take it upon themselves to provide dental services with specially trained staff who can cater for the multiple complex needs of these children."

As in mainstream schools, deprivation has an impact on tooth decay levels among special support school pupils; those from the poorest households have the highest levels of tooth decay. The regional differences found in the survey were consistent between special support and mainstream schools; therefore a continued focus on tackling wider inequalities is needed.

RCPCH responds to PHE dental survey

New Public Health England (PHE) survey finds children in special schools are more likely to have teeth removed (press release attached). In response, Officer for Health Promotion at the Royal College of Paediatrics and Child Health, Prof Russell Viner said:

"Children with severe special educational needs and disabilities (SEND) attending special schools have poorer oral hygiene and more teeth extracted than children in mainstream schools. This is perhaps not surprising, given that parents can struggle to get children with significant disabilities to develop good teeth cleaning habits and diets which guard against tooth decay. Children with disabilities may have difficulty with healthy eating, due to difficulty in chewing or swallowing food, very restricted ranges of food or parents being unable to afford healthy food. For these reasons, children with severe disabilities are also at higher risk of obesity, particularly as they may have physical limitations to the amount of activity they can do.

For these reasons, particular care and attention is needed to supporting families of children with severe disabilities to ensure they have access to healthy food choices, regular physical exercise and appropriate dental care. But its important to remember that we can protect all our children through wider efforts to improve health and reduce childhood obesity. There are a number of ways we can do this - introducing a tax on sugary rich, energy dense foods, marketing and advertising restrictions on food and drink targeted at children and limiting the number of fast-food outlets in close proximity of schools."