With one in four five-year-olds experiencing dental decay in the UK, and children from the most deprived areas suffering more than twice the level of decay as those from the least deprived, one nursery in west London has decided to confront children’s oral health problems head on.
Little Darling Childcare in Harrow became the first non-dentist winner of the National Smile Month Dental Award earlier this year when it was recognised for its work on oral health.
Harrow had the highest proportion of five-year-olds suffering from tooth decay in London in a 2017 national oral health survey. The average number of decayed, missing and filled teeth among five-year-olds across England was 0.6, while in Harrow it was 1.9.
The nursery has a more personal reason for targeting oral health problems, too. ‘The backdrop to our project is that we had a three-year-old child in the nursery whose teeth you could see were not quite looked after,’ says owner Sanjay Morzaria.
‘We told her mum to make sure her teeth were brushed and to cut out sugar, but it got put on the backburner. We could see it getting worse and asked them to go to the dentist, but they delayed and delayed until finally we said we would have to report it for safeguarding. The girl was finally taken to the dentist, but it was too late, and they had to surgically remove all but two of her teeth. At that point I felt I had to reflect on my nursery, and myself as a practitioner, as it really felt like we had failed this child.’
BEING PROACTIVE
In the three years since this incident, staff have attended Levels 1 and 2 training in keeping teeth healthy, and an oral health specialist visits every year to run refresher sessions. The nursery also runs four workshops per year for parents and staff of other nurseries. As a result of their training, staff brainstormed ways to incorporate good oral health into all areas of provision.
On registration, families now receive a list of local dentists, as well as a dental form asking them when their child last visited the dentist, whether any issues have been identified, and what they are.
‘Parents sign the form digitally and we keep it as a record, so we can chase up and remind them about appointments and keep an eye on any problems,’ explains Mr Morzaria. ‘We want to be very proactive right from the start.’
BRUSHING UP
The nursery has also reviewed its menus to exclude sugary foods. ‘Our setting is 90 per cent Asian families, and so a lot of our food was typical of our culture, which unfortunately tends to be very sugary, fried food,’ Mr Morzaria says.
‘We’ve had to change the menus completely to make them better for children’s teeth. It really is an eye-opener when you realise how much we are overloading on sugar.’
Children brush their teeth during the day at nursery and each have their own colour, animal and symbol which corresponds to their brush. A wide variety of resources are provided to promote oral health across all areas of learning, including puppets for children to practise toothbrushing on, mirrors and timers for parents to use with children when brushing at home, and pencils and rubbers with teeth on. Even Spanish lessons feature songs about the dentist and different parts of the face and mouth.
Mr Morzaria signed up to become a member of the Oral Health Foundation, which keeps him updated on the latest information and provides resources to use for National Smile Month.
The setting also bases activities on relevant events, such as National Cherry Day, when children bake with cherries and learn all about eating healthy fruit and vegetables.
CHILDREN WITH SEND
The nursery makes a concerted effort to support children with special educational needs. ‘Where SEN have been identified, we pay for an oral health hygienist to visit the child and their parents at home to teach and mentor them on issues and find solutions,’ Mr Morzaria explains. ‘It is much more comfortable and effective to explain things to families in their own environment, and I accompany the hygienist personally so the children have someone familiar with them too.’
The hygienist will introduce families to different approaches to make toothbrushing easier, such as three-headed toothbrushes which clean the front, back and top of the mouth in one swipe.
Mr Morzaria adds, ‘One child with SEN was rejected from five dentists, because the appointment could end up taking four times longer than usual. Luckily, we managed to find someone who fast-tracked them and the child was seen within two weeks. If they had to wait, they could have lost teeth.’
SPURRED ON
With tooth decay the number one cause of hospital admissions for general anaesthesia among children in the UK, Mr Morzaria says nurseries can help reduce the burden on the healthcare sector by encouraging early intervention.
It costs Little Darling Childcare around £550 a year for its work on oral health, but Mr Morzaria believes it is worth every penny. ‘Overall, the cost is marginal when taken as a proportion of the cost of running the nursery,’ he says, ‘but the saving to the NHS is enormous.’
The lessons learned by the nursery have inspired good practice. ‘I failed a child and I feel really bad about that,’ Mr Morzaria admits. ‘But I feel good that the children who followed her have benefited. My failure spurred us on to do something for all our future children, and because we learned from it, it became something positive.
‘People often don’t realise the capabilities of our industry and the impact we have in so many different areas. We are now working with our local authority to see how we can share what we have learned with other local settings.
‘It is important to recognise oral health as a vital health issue and to approach it holistically and strategically in your setting.’
See also our poster – Growing up, part 6: Looking after our teeth
Official advice
Dr Nigel Carter, chief executive of the Oral Health Foundation, advises, ‘The cornerstone of good oral health for both the young and old is brushing twice a day with a fluoride toothpaste for two minutes.
‘Children up to three years old should use a small smear of toothpaste, about the size of a grain of rice, with a fluoride level of at least 1000ppm (parts per million).
‘After three years old, they should use a pea-sized amount of toothpaste that contains 1350ppm to 1500ppm. Children should be supervised when brushing up to at least the age of seven.
‘You should also make sure that they do not rinse, but spit out the toothpaste, and that they don’t swallow any if possible. This way the fluoride stays in the mouth for longer and will be more effective.’
FACTS AND FIGURES
- Almost a quarter (23 per cent) of five-year-olds have suffered from tooth decay.
- Children from more deprived areas (34 per cent) are significantly more likely to experience decay compared to those from less deprived areas (14 per cent), according to Public Health England.
Seasonal cooking
WHAT’S SEASONAL IN OCTOBER?
Autumn is peak season for mackerel, when the fish has up to 30 per cent fat, which enhances its flavour and ensures it is packed with nutritional value. Look for mackerel with a shiny body and bright eyes. Fresh mackerel should be rigid, and should not droop if held horizontally by the head.
Keep mackerel cool and eat within 24 hours as oily fish spoil faster than white fish. It can be frozen. You can bake, grill, barbecue or pan-fry your mackerel. To check if it is cooked, slit the fish at the thickest part, where the flesh should be just opaque but still moist.
NUTRITIONAL VALUE
Mackerel is one of the healthiest seafood options. As an oily fish, it is a rich source of omega-3, which forms building blocks within the brain and prevents and reduces the development of cardiovascular diseases. The fatty acids within omega-3 improve endurance and help maintain clear skin.
Mackerel is also a great source of protein and Vitamin D. Selenium, an antioxidant which supports a healthy immune system and good cognitive function, can also be found in the fish.
RECIPE
Homemade mackerel pâté
- Serves: 20
- Typical portion size for one to four years: 60g
- Preparation time: 10 minutes
- Cooking time: None
Ingredients
- 600g (4 x 212g) canned mackerel in brine, drained
- 200g cream cheese
- 60ml (4 tbsp) semi-skimmed milk
- 200g (4 heaped tbsp) plain whole milk yoghurt
- 80ml (4 tbsp) lemon juice
Method
- Use a fork to finely mash the fish.
- Add the cream cheese, milk, natural yoghurt and lemon juice to the fish and mash into a paste.
Serving suggestions
Serve with baked potatoes and salad.
Note: Pâté bought from a shop should not be given to young children for food safety reasons.
Recipe adapted from: Nature Trails Day Nursery, https://bit.ly/2Iyum9x