Our goals for oral health in children’s social care
We've been working closely with the Care Quality Commission (CQC) to look at the importance of good oral health for children. We want to tackle oral health inequality by driving improvement in the quality of oral care provision in children’s social care. The success of CQC’s ‘Smiling Matters’ project in adult social care shows the potential for making improvements.
All children are dependent on adults for access to a dentist, diet choices and oral hygiene support. For children living away from home, this responsibility sits with the staff who are caring for them. That includes children living in children’s homes, foster care and residential special schools, as well as young people living in supported accommodation.
We have a great opportunity to influence what happens for these children and young people.
Why oral health is so important
Oral health is vital for all, but even more so for children in care. Even though tooth decay is preventable, it:
- is one of the most common chronic childhood diseases worldwide, and it is the leading cause of needing to use paediatric general anaesthetic in the UK
- can cause pain and discomfort, leading to difficulty in eating, speaking and sleeping, and affecting academic performance as well as overall quality of life
- can result in abscesses, with some children becoming severely unwell or septic and needing hospital admissions
There are also wider concerns about poor oral health. Children may:
- experience embarrassment and be self-conscious about their smile, leading to potential psycho-social effects such as social withdrawal, anxiety and depression
- have impacts on their general health including heart problems, breathing problems, diabetes and joint inflammation
- have difficulty eating so that they are at risk of poor nutrition and overall health
Care-experienced children and those with special educational needs and/or disabilities (SEND) are more vulnerable to poor oral health. And we need to collectively make a change.
What we see on inspection regarding oral health
On inspection, we often see providers having difficulties in accessing dental services for the children they care for.
‘Not all children are getting access to dental care as they should be. Only half of children have had an up-to-date check-up. At times, the local authority funds private dental care. However, this is in response to children being in pain and not about planned and preventative dental care.’ - Extract from a local authority inspection report
Many children find it difficult to attend the dentist even if they have an appointment. Fear, poor past experiences and lack of support can make it hard for a child to attend. These difficulties can be exacerbated for children who are already traumatised or finding life difficult.
We also know that some children may find it hard to understand what might be happening when they visit the dentist and may also have increased levels of anxiety or fear. A parent of a child with autism told us that:
‘Sensory challenges are not only limited to inside the mouth, they also include harsh glare of bright lights, the loud sounds of drills and electric toothbrushes, and overpowering smells in the bathroom and clinic.’
Good practice in supporting children’s oral health
It is vital that children are supported to attend appointments and have a good oral hygiene routine. The importance of a good routine is increased when access to services is poor. Carers should support children in their routines and encourage oral hygiene whenever possible. We will highlight good practice when we observe this in inspection.
An inspector told us:
‘I had an inspection where a child had experienced a lack of dental health and hygiene. Due to their needs, they were unable and scared to tolerate dental check-ups. They had been supported by staff in the home to have a routine they came to not only accept, but enjoy. It helped to hold a toothbrush with pleasant sounds and experiences, for example. Then the support increased to incorporating positive messages about the dentist. The careful build-up of support and care led to the child being able to visit the dentist.’
And a manager of a children’s home told us:
‘The child was a teenager with complex needs who had not been to the dentist for over 2 years due to a previous poor experience. Staff spent a great deal of time slowly introducing the idea of the dentist through discussions. The home paid for an initial private appointment while awaiting allocation of an NHS dentist and supported the child through incentives to attend an initial check-up. Staff completed direct work about the benefits of attending the dentist and shared personal experiences to role model that it wasn’t as scary as the child thought. Staff offered lots of reassurance and attended all appointments with them.
When notifying the child of appointments, they would do a ‘countdown’ so the child had lots of time to prepare themselves. The child went on to have all their dental appointments and was able to be referred to the orthodontist as a result. The child has now had their braces fitted, which is a great outcome for them.’
Ofsted’s role in promoting good oral health
Oral health features in our social care inspection framework and Annex A form for children’s homes.
When we inspect, we may ask you a range of questions about the oral health of the children. These questions could be about preventing decay, their access to dental services or their oral health routines.
Questions about prevention could include:
- How do you ensure that children have a balanced and healthy diet, including any snacks and drinks?
- Are you reducing the intake of sugar where you can? Do you look for low sugar or sugar-free alternatives where available?
- Are sugar-free medicines being used when they are available?
- Does the child’s care plan feature oral health? How well is this followed? Is it updated after a dental visit?
- What other resources, such as dental passports or mouth-check forms, are being used?
Around access, we might ask questions such as:
- Do children have access to routine dental care? If not, what are you doing about this?
- Do you support and encourage children to go to the dentist?
We may also ask about routines, such as:
- Do staff remind children to brush their teeth regularly?
- Do staff support children with cleaning their teeth?
- Are there enough aids – such as toothbrushes, floss and mouthwash – available?
- Are staff role models for good oral hygiene?
Please do think about these questions, and the arrangements you have in place for decay prevention, access to dental services and oral health routines.
We want to make sure every child has good oral health and the right habits to continue that as they grow up.
Additional resources
There is staff training available from the NHS that you can refer to. This is designed to help staff feel comfortable in supporting children’s oral health, and it includes resources you can use. Although these are directed at SEND settings, you can adapt them for other use.
You can also find out more about oral health from CQC.