Welcome to the Smile4Life Launch

Wednesday 27th October 2010

Helen DentonExecutive Director for Children and Young People

and Chair of Lancashire Children’s Trust

Collaborative Working

The Children and Young People's Plan

Julie GuestPolicy Development Officer for Health

Lancashire County Council

Eric RooneyConsultant in Dental Public Health NHS

Cumbria and Lancashire

What is Smile4Life?

Background

• Local Area Agreement (LAA) identified children’s oral health as a local priority• Lead for Lancashire County Council

identified• Children and Young People’s Oral Health

Strategy developed and approved by the LA/NHS partnership “Be Healthy Theme Group”

Julie Guest, LAA Lead for Oral Health

Melanie Smith, Dental Public Health Project Manager

Mel Catleugh, Consultant Dental Public Health

Eric Rooney, Consultants Dental Public Health

The Project Team

Developing the Programme

• Consultation events:– Children & Young People– Children & Young People Workforce– NHS Oral Health Teams

• The aim of the consultations were to find out:– What was already happening in Lancashire– What the gaps were– How the gaps could be addressed

The findings were developed into the

Smile4Life Programme

What is Smile4Life?

• A programme that supports co-ordinated activity with the aim of:– Reducing dental caries (tooth decay) in

children and laying solid foundations for good oral health throughout life

• Focussed on 4 key areas

Smile4Life Award Scheme

Enables Early Years Foundation Stage settings to demonstrate and be recognised for their oral health

improvement activity through the

• NHS Oral Health Improvement team to act as experts and advisors

• Local Children’s Centres to identify Oral Health Champion

• Dental practice staff to link with local settings

Implementation of the Smile4Life Programme

NHS Support for Oral Health Champions

Support the Oral Health Champion, using a standardised training and support package, to:

• Promote a Smile4Life environment by focussing on the four key oral health changes

• Work through the Programme Workbook

The Smile4Life Workbook

Programme Workbook

Programme Workbook

• Supports the implementation of the

Smile4Life Programme

• Helps them understand their current approach to oral health improvement

• Helps settings plan their activities• Helps them evidence their approach• Prepares them to achieve

the Smile4Life Award

Step 1 Work through the workbook and develop a plan

Step 3 Submit the evidence

Step 2 Implement the plan using the resources and collect supporting evidence

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Additional Resources

Additional resources have been developed to support the programme which include: • Leaflets• Poster• Standardised Displays• Website (hosted by LCC)

Evaluation Design• Process Evaluation

– Monitor the numbers of settings taking up the programme

– Review of the materials and support• Outcome Evaluation

– Monitor the achievement of the Smile4Life Award

– Monitor the oral health of the children

Percentage of 5-year-old children with decay experience (deciduous teeth) inLancashire Local Authorities including 95% confidence limits, 2007/08

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Monitoring Oral Health

Smile4Lifein the Early YearsDot SmithInterim Lead for Sure Start, Early Years and Childcare ServiceLancashire County Council

• Shared commitment to improve oral

health in the early years

• Strong partnerships and shared vision

• Building on existing good practice in Lancashire's Children’s Centres

• Early intervention and prevention

• Ante-natal sessions for mothers-to-be delivered in Children’s Centres including oral health messages

• Continued support with oral health in the post-natal period

Maggi MorrisChair of Lancashire Directors of Public Health

Director of Public Health, Central LancashireChair of Be Healthy Theme Group

Integrating Oral Health within the Public Health Agenda

Lord HoweParliamentary Under Secretary of State

(Department of Health)

Official Launch of the Smile4Life Programme

Group A – those with on your packs

Please help yourself to coffee in the foyer for the next

ten minutes and then return to the Oak Room

Group B – those without

Please stay to browse the displays for the next ten

minutes and then go to the foyer and help yourself to

coffee.

Both groups to reconvene at 11.20

Coffee and Displays

Sue GregoryDeputy Chief Dental Officer for England

Overview and National Direction for Oral Health Improvement

Launch of the Smile4Life Programme

Sue Gregory

Deputy Chief Dental Officer

27th October 2010Woodlands Conference Centre, Chorley

Decayed, missing or filled teeth (DMFT) at age 12 in the EU

http://www.euro.who.int/hfadb

Comparison of mean dmft/ DMFT for 5, 12 and 14-year-olds England and Wales, from 2000 to 2006

AGE YEAR MEAN dmft/DMFT

MEAN dmft/DMFT for chidren with caries experience

% CHILDREN CARIES FREE

5

2005/06 1.51 3.88 61%

2003/04 1.55 3.9 60%

2001/02 1.52 3.83 60%

11/122004/05 0.66 2.12 69%

2000/01 0.89 2.35 62%

14 2002/03 1.48 3.03 51%

Inequalities

Choice

Choosing Better Oral Health:An Oral Health Plan for England

Common Risk Factor Approach and Oral Health

Fits well with ‘Choosing Health’

Poor quality diet Inappropriate infant

feeding practices Poor oral hygiene Smoking Excessive alcohol

consumption

Prevention in practice

Simple messages Concise advice Evidence based with

strength of evidence Practical and easy to use Good reference for sugar

free medicines and fluoride concentration in toothpaste

Links with healthy eating

Studies that have been carried out by universities and commercial units were assessed by members of the working group.

Where a systematic review had been completed this highest level of evidence was accepted.

Items of evidence were pieced together to allow consistent messages to be produced.

Understanding the Evidence Behind the Messages in the Prevention Toolkit

Windsor Dental Practice, Salford

Hygienist

Smoking cessation adviser

Extended duties dental nurse

Therapists

Parents should brush or supervise brushing twice daily as soon as teeth erupt

Use only a smear of toothpaste containing no less than 1,000ppm fluoride

Do not allow children to lick or eat toothpaste from the tube

Children up to 3 years

Children 3–6 years Brush last thing at night and on one other occasion

Brushing should be supervised by an adult

Use a pea-sized amount of toothpaste containing1,350-1,500ppm fluoride

Do not allow children to lick or eat toothpaste from the tube

Spit out after brushing and do not rinse

Fluoride toothpastes are effective in reducing caries

in the deciduous dentition

1 study involving 2008 children

37%

reduction in caries in the deciduous dentition

Marinho et al. 2003

Evidence: Type 1

Fluoride toothpastes are effective in reducing caries

in the permanent dentition

74 studies involving 42,300 children

70 contributed to meta-analysis

24%

reduction in caries in the permanent dentition

Marinho et al. 2003

Evidence: Type 1

Frequency

Concentration

Rinsing

Amount

Factors affecting effectiveness of fluoride toothpaste

Brushing twice a day is more effective than once a dayEvidence: Type 1

Brushing twice a day reduces caries by a further 14% when compared with once a day

Marinho et al. 2003

Summary of clinical trials

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Fluoride level (ppm)

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Koch (1982)

Mitropoulos (1984)

Triol (1987)

Stephen (1988)

Conti (1988)

Fogels (1988)

Winter (1989)

Marks (1992)

O'Mullane (1997)

The benefits of fluoride toothpaste are concentration dependent

For every increase in concentration of 1000 ppm F there is a further 8% reduction in caries and vice versa

Evidence: Type 1

Marinho et al. 2003

Rinsing Method DMFS Incr

Use beaker (large vol) 6.9

Use brush 5.9

Head under tap 5.8

Use hand (small vol) 5.5Chesters (1992)

Reported behaviourEvidence : Type 3

Encourage spitting out of excess

Do not rinse with a large volume of water after brushing

Evidence:Type 3

The amount of toothpaste applied is not associated with the benefits

of fluoride toothpaste

Evidence:Type 3

30/01/15

Does the amount of toothpaste influence the effectiveness of a fluoride toothpaste?

Amount N (%) Mean DMFT

23 (1%) 5.96 (5.82)

3.68 (N=547)524 (18%) 3.58 (3.92)

2,024 (70%) 3.69 (3.69)

317 (11%) 4.24 (3.79)

3.76 (N=2,341)

Increment

The impact of variables on the effectiveness of

fluoride toothpaste

OPTIMAL

Twice daily

No beaker

1450 ppm F

Sub-optimal

Once daily

Beaker

1000 ppm F

Approximately 40-50% difference

in caries prevalence

Exploring the 4 Key Oral Health Messages

Frances PearsonOral Health Improvement Lead

NHS Cumbria

Science

=

Sugar+Bacteria Acid=

Tooth Decay+ TeethAcid

Science

Every time you eat something that contains sugar, you create conditions which allow tooth decay to develop

Science

So it is VERY important to limit thenumber of times this happens

Hidden Sugars in Foods and Drinks Sugars come in many disguises, so check

labels for hidden sugars such as:

HoneySucrose Glucose Glucose SyrupDextroseFructose Maltose

LactoseMolasses Invert Sugar SyrupMaltodextrinMaltoseOligofructose Hydrolysed Starch

Did you know?

Fruit juice and dried fruit can adversely

affect teeth because of their high concentration

of sugars and are not recommended for

consumption between meals

Kerry PlaceOral Health PromoterNHS East Lancashire

The Purpose of Brushing

• To keep gums healthy

• To apply fluoride toothpaste which strengthens and protects teeth from decay

Healthy Gums

Pale pink/Flat

Tight against the teeth

Do not bleed on

brushing

Amount of Fluoride Toothpaste

Smear(up to 3 years old)

Pea-size(over 3 years old)

Role of Parents/Carers

Up to the age of 7 years, children need help with brushing:

– Manual dexterity

– Spit don’t rinse after brushing

Margaret WilliamsSenior Oral Health Promotion Officer

NHS Central Lancashire

• General Health

• Oral Health

– Gum disease

– Oral Cancer

Relevance of these messages

Relevance of these messages

Gum Disease Oral Cancer

Tobacco

Tobacco use

–Smoking

–Smokeless

Alcohol

Men should not regularly drink more than 3 – 4 units of alcohol a day

Women should not regularly drink more than 2 – 3 units of alcohol a day

Alcohol

4% Vodka, Whiskey etc.

Tequila, Sambuca etc. 13%

330ml Bottle:1.3 units

440ml Can: 1.8 units

568ml Pint :2.3 units

Small (25ml): 1 unit

Large (35ml): 1.4 units

Double (50ml): 1.9 - 2 units

Small (25ml):1 unit

Large (35ml):1.3 units

Small Glass (125ml):1.25 units

Std Glass (175ml):1.75 units

Large Glass (250ml):2.5 units

Bottle (750ml):7.5 units

Bottle (275ml): 1.4 units

Binge Drinking

Binge drinking is defined as drinking an excessive amount of alcohol in a short space of time

• For men, that’s drinking 8 units during one session

• For women, that’s drinking 6 units during one session

Cecilia JaquesOral Health Promotion Officer

NHS Central Lancashire

Reasons for visiting the dentist• Prevention rather than cure

– Forming good habits

• Dental decay rapid process in children

• Early professional intervention– Opportunity to ask for fluoride

varnish

• Bump to birth and beyond– Free treatment for children and

pregnant & nursing mothers if you are an NHS patient

If a tooth is knocked out, stay calm and get the child

to their dentist as soon as possible

If a child does not have a regular dentist, contact the

NHS Help Line or NHS Direct for Advice

Dealing with Dental Trauma

NHS Help Lines

• NHS Central Lancashire 01772 777397• NHS Blackpool 01253 655200• NHS North Lancashire 01253 306378• NHS East Lancashire 0845 533 3230• NHS Cumbria 01228 603900

Thank You!

Thank you for attending today’s launch of the Smile4Life Programme. We hope you found it useful and will support the Programme in your area of work.