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Impact of Covid19 on Jersey School Children
PreCovid,childreninJerseyalreadyhadlimitedaccesstodental care with lengthy waits for appointments that did not supportthenationalrecommendedstandard of care. Our charity supported supervised toothbrushing programmes in ALL Jersey primary schools and most private nurseries. Super Smiles had collated good evidence that this was having a positive impact on the Oral Health of our children. Poor oral health impacts not just on the individual's health but also their wellbeing and that of their family.
Access to dental services has been severely impacted for children in Jersey with closures, staffshortagesandtheneedforgreaterinfectioncontrolmeasureswithindentalsurgeries e.g. Fallow time.
Oral Health inequalities are now far greater than before the pandemic. The impact of Covid 19 on Oral health is more severely felt by those who were already likely to have poorer health outcomes raising concerns aboutthecreationandexacerbation of Oral health Inequalities. However, it would be a mistake to only target the lowincome families. Risk of disease is not a fixed outcome butissubjecttochange.Covid19 has been a catalyst for this changeinDentalHealthriskformanychildrenfromallsocialeconomic backgrounds.
Children's dental health has been particularly impacted on as their teeth are more vulnerable to tooth decay. Covid19 brought many changes to daily routine. An increase in snacking and increased frequency ofsugarconsumptioninthehome during lockdown due to the change of routine and added stresses within the family unitduringthistimehasbeen well documented. Many children report not brushing their teeth asoftenasbefore,again due to the negative effect routine change had.
Whilst our toothbrushing programme had to stop during the lockdown period, the UK Government (13th Aug.2020) provided an excellent paper offering guidance to continue deliveringsuchprogrammesasthe benefits far outweigh the risk. All the private nurseries havestartedbrushingagainbut it has been harder to reestablishthebrushinginsome schools. This is largely due to the autonomy the schools have, with each Head deciding if it is somethingtheywanttosupportratherthanshouldsupportandnot considering the positive effects on the children's health. Many vulnerable children are missingoutongoodhealth opportunities because of poor support for policy implementation by Jersey Government.
Allconsiderationshouldbegiven to implementing an Island wide Dental Prevention Plan thatwillfollowaBiopsychosocialmodelandbringaboutsustainablechangewith measurableoutcomes.Abaselevel of disease needs to be established urgently. All children should be screened for disease as a matter of priority. Dental diseaseprogressesvery quicklyinchildrenduetothedecreased qualitive and quantitative properties of the enamel. The screening will also help establish areas of greater risk and an increased need for enhancedpreventivemeasures.
All children have the right to enjoy good oral Health and all children should have access to good dental health education form the early years through to secondaryschool.Teenagers have been severely impacted by Covid with very limited access to dental care experienced across all sectors.
The dental department is currently unable to support any consistent dental care. Children are waiting 7 years for Orthodontic treatment and in the community department over 5,000 children are awaiting a dental appointment, both for routine and restorative dental treatment. There is currently 1 full time dentist and 1 part time dentist working in the community department. The recall system is unable to distinguish between the lowrisk children requiring a routine dental checkup and those who have multiple cavities. The current dental system provided by the Government does not support the most vulnerable children, is not prevention focused and does not support the wider community in Jersey. The current situation is not transparent and does not allow parents to make an informed choice to possibly seek private dentalhealthcare,thusincreasing the burden on the department.
I believe there are several key areas that require immediate attention to help reduce the impact of Covid19 on the oral health of children and reduce the inequalities currently being experienced:
- Urgent screening of all Primaryschoolchildrencurrently eligible for dental care offered by the Government. This should be a Population Census screening and can be designed to identify prevalenceandseverityofdiseasecurrently experienced. Children suffering from dental diseaseshouldbeofferedtreatmentattheDental department.
- The Dental department should consider a temporary change in approach to dental care: Work should be carried out on the prioritised children only. AGP (Aerosol generating Procedures) will be minimised for the foreseeable future, favouring evidencebased techniques which are acceptable and successful for patients e.g., Stainless Steel crowns, Silver Diamine Fluoride, and extractions.
- Stabilisation Phase: Aim for a stabilisation phase accompanied by enhanced prevention in the lines of "Delivering better Oral Health" (PHE) may help keep a child pain/infectionfreeuntilthetimewhenAGPandroutinedentalcare can be more widely and efficiently provided.
- Sustained Prevention Programme. This should be offered to ALL jersey primary children as part of an ongoing concern. Schools identified and requiring enhanced support should be actively encouraged to participate. The positive effect of daily toothbrushingprogrammesinschools is well evidenced. Providing an oral health education lesson, focused on good Oral health care and healthy food/drink choices shouldbereinforcedannually.
SuperSmileshashadverylimited engagement with the Health Department and
Social Security over the years. We have been funded by charitable foundations for the past 10 years, namely AJC, Bosdet Foundation and One Foundation. We have the capacity with fully trained staff toprovideanOralhealthPrevention programme to
all nursery and primary school children. There is the possibility of expanding to incorporate Oral health lessons as part of PSHE in secondary schools.
Super Smiles will be happy to offer our full support to the committee and to the children of Jersey. If you requireanyfurtherinformationorclarity on any of the above points, please do not hesitate to contact us.
Yours sincerely
SarahPollard
(CoFounder)
Email: clemmy.pollard40@gmail.com
PSOnaverypersonallevelIam noticing many children who have previously experienced good dental health in their primary dentition, presenting with multiple cavities in their secondary teeth. This is quite unusual. I suspect the causes are multifactorial but a lack of regularroutinecareandFluorideapplication, together withanincreaseinsugarconsumptionhascontributedtothis.Parents are desperate
for support and help. The current situation really is unacceptable.