Dental caries and obesity must be tackled together, says BSPD

08 December 2020
3 min read

The British Society of Paediatric Dentistry (BSPD), the organisation committed to improving the oral health of children in the UK, is calling for more co-ordinated steps to tackle both dental decay and obesity to stop thousands of children growing up to face a lifetime of disadvantage.

It has published a position statement on obesity and dental caries which includes a new analysis from Public Health England (PHE) showing that children who are underweight, overweight or very overweight are more likely to have experienced dental decay than those of a healthy weight. New research on sugar consumption is also included: current figures suggest children and young people consume up to three times more sugar than the recommended levels.

The statement highlights that the children who are suffering most with dental caries and obesity are from the most deprived areas, making the conditions symptomatic of widening health inequalities. Children from deprived areas of the UK are twice as likely to be obese.

The British Society of Paediatric Dentistry (BSPD) wants to see clearer food labelling and further sugar reduction in food and drinks frequently consumed by children. It supports:

  • Healthy lifestyle campaigns such as those led by Change4Life in England and Wales and the ‘Eat Better, Feel Better’ initiative in Scotland.
  • Measures designed to halve the prevalence of childhood obesity by 2030, such as the soft drinks sugar levy and restrictions on the advertisement of unhealthy, food and drink, especially high sugar products.

It also calls for:

  • Co-ordinated and multi-agency approaches to the management of obesity and dental decay.
  • An extension of the free school meal scheme to cover holiday periods for those most in need.

Originally published in 2015, the updated 2020 position statement includes new statistics and research.

Data from the four UK nations shows almost one in four children in England, Wales and Northern Ireland are overweight or obese when they begin school, rising to one in three by the time they are ready to start secondary school. In Scotland, nearly a third of children – 29 per cent – are at risk of being overweight or obese.

Dental caries
The latest data from surveys of five-year olds shows:

  • In England, 23 per cent had dental decay (2019), while 12 per cent of three-year-old children already have visible dental decay.
  • In Scotland, 26.5 per cent of five-year-old children have obvious dental decay (2020).
  • In Northern Ireland, 40 per cent had obvious decay (2013).
  • In Wales, 41 per cent had visibly untreated decay (2013).

A general anaesthetic is frequently recommended for dental extractions because the child is too young to co-operate or needs too much work to be treated in the dental chair or is too anxious to cope. For obese children, a general anaesthetic carries greater risks; they will require additional pre-anaesthetic investigation to identify any breathing problems and may need to spend longer in hospital.  

Diet is critical to both conditions. Low nutrition foods, high in sugars and saturated fats and low in fruit and vegetables, are a main contributory factor for obesity. Currently, obesity and dental decay are tackled independently by different arms of the NHS. The BSPD believes there needs to be a greater willingness for all agencies to work innovatively together.

One example of effective collaboration is the practice of children being weighed at hospital dental appointments. At Edinburgh Dental Institute, paediatric specialist trainee Jessica Large – the lead author of the position statement – introduced screening of body mass index (BMI) for children attending new patient appointments. She identified that 14 per cent were above a healthy weight; they were offered onward referral to 'Get Going' – a local weight management service.

Claire Stevens, spokesperson for the BSPD, said, “We need to change the way we think about oral health, starting with a more holistic way of looking at children’s needs.

“Our updated position statement shows that the most vulnerable in our society are most at risk of a lifetime of poor health arising from poor nutrition, affecting both their oral health and their weight.

“In our clinics, our members see children who are obese at one end of the spectrum or underweight at the other. A poor diet is the unifying factor between their dental health and their weight. Children who have poor dental health and are obese are likely to experience a lifetime of disadvantage.”

The position statement also highlights that there are doubts about the affordability of the Eatwell Guide. The food budget of over half of UK households is likely to be insufficient to meet the guide’s recommendations, potentially increasing the risk of excess weight and dental decay.

Finally, there is increasing evidence that excess weight is associated with an increased Covid-19 risk. A report on the impact of the Covid-19 pandemic by the All-Party Group for a Fit and Healthy Childhood (2020) highlights how Covid-19 has placed further strain on inequalities, including food security and availability.

The BSPD is keen to work within a healthcare system in which:

·      All clinicians have a responsibility towards the overall wellbeing of their patients.

·      Collaborative patient care is supported and encouraged.

·      Referral is made (where appropriate) to the provider or specialist with the optimum training and skills for diagnosis and treatment.