The Nation’s Oral Health

This month is Mouth Cancer Action Month, a charity campaign set up by the British Dental Health Foundation (BDHF) to raise public awareness of mouth cancer. The campaign has been long running; spearheaded by the late Richard Horner, founder of Scope Group and well known among the dental media and trade, in 1998. He retired in 2003 and handed over the project to the BDHF, who have done much work to raise awareness of mouth cancer;  pushing through changes in legislation in relation to the tobacco industry, including a direct marketing ban and the smoking ban.

Over the last year concerns over the Nation’s oral health have hit the headlines; from concerns over children’s oral hygiene, the effect of sugar and proposals for a ‘sugar tax’, and more recently revelations regarding the poor state of professional footballers’ teeth. This article will consider the nations awakening interest in all things oral health, and what impact this has on the fight against mouth cancer.

Children’s Oral Hygiene

In 2013 the Health and Social Care Information Centre commissioned a survey in relation to Children’s Dental Health. This survey has taken place every 10 years since 1973 to track changes in the oral hygiene of children.  The results were published in early 2015 and found the following:

·         The nearly a half (46%) of 15 year olds and a third (34%) of 12 year olds had “obvious decay experience” in their permanent teeth. This was a reduction from 2003, when the comparable figures were 56% and 43% respectively.

·         The proportions of children with some untreated decay into dentine5 in permanent teeth have also reduced, from 32% to 21% of 15 year olds and from 29% to 19% of 12 year olds.

·         In 2013, nearly a third (31%) of 5 year olds and nearly a half (46%) of 8 year olds had obvious decay experience in their primary teeth6. Untreated decay into dentine in primary teeth was found in 28% of 5 year olds and 39% of 8 year olds.

·         In 5 year olds, the average number of primary teeth with obvious decay experience (dmft) was 0.9. Among 5 year olds with such decay, the average number of teeth affected was 3.0.

·         In 12 year olds, the mean (average) number of permanent teeth affected by obvious decay experience (DMFT) was 0.8. Among 12 year olds with any such decay, the mean number of teeth affected was 2.5.

The survey also looked at lower income families by assessing the oral health of children who had free school meals. The findings for this group were as follows:

·         A fifth (21%) of the 5 year olds who were eligible for free school meals had severe or extensive tooth decay, compared to 11% of 5 year olds who were not eligible for free school meals.

·         A quarter (26%) of the 15 year olds who were eligible for free school meals had severe or extensive tooth decay, compared to 12% of 15 year olds who were not eligible for free school meals

Around this time the Faculty of Dental Surgery at the Royal College of Surgeons of England (RCS) also published a report in relation to the state of children’s oral health. The RCS was seriously concerned about the state of oral hygiene in children and noted the regional inequalities in the results. The report confirmed that in 2013-14 approximately 46,500 children under the age of 19 were admitted to hospital with a primary diagnosis of dental caries.  The RCS estimated that 90% of dental caries are preventable.

Sugary drinks have been blamed for the poor oral hygiene in children, with many seeing sugar as the new tobacco. We reported on this in Issue 4 of our Dental Bulletin, at which time Tesco had banned sugary drinks from its shelves and Coca-Cola had funded research which down-played the effect of sugary drinks on teeth.

Since that Dental Bulletin the Government has come under increasing pressure to implement a sugar tax and for the food industry to have clearer packaging as to the amount of sugar in their products.

Jamie Oliver has been a campaigner for the sugar tax for a while, even implementing the tax in his own restaurants. He has a ‘five point sugar manifesto’, which includes the sugar tax and banning advertisements for junk food before 9pm. On 19^th October 2015 he also appeared before a committee of MPs to discuss the sugar tax, in which he asked David Cameron to ‘frankly, act like a parent’ with the food industry.

Meanwhile, Jeremy Hunt was accused of delaying Public Health England’s (PHE) report on the subject, which was meant to be published in July 2015. The report was finally published on the Government website on 22^nd October 2015; it appears his hand was forced after Dr Alison Tedstone, director of diet and obesity at PHE, went public with details of the report.

The highlights from the report are:

·         Treating obesity and its consequences alone currently costs the NHS £5.1bn every year;

·         Reducing the Nation’s sugar intake in the next 10 years to the recommended 5% (or 30g per day) could save the NHS £484m a year;

·         The influencers to buying sugary products include:

o   Advertising:

o   Food retail price promotions. Foods with higher sugar content are among the highest food retail price promotions on offer in stores:

o   Taxation on products:

·         Evidence shows lowering sugar in foods will help reduce consumption. This has a proven track record in relation to the reduction of salt in foods;

·         The report recognises that one single action will not be effective and a combination of changes will be needed to reduce the sugar intake of the Nation. Eight changes are recommended and these include:

o   A price increase of  a minimum of 10-20% on high sugar foods:

o   Reduce and rebalance price promotions;

o   Reduce opportunities to market and advertise.

What is evident from reading all the reports above is that children from lower income families are amongst the worst affected. Yet the Government is still reluctant to take action against the food industry. This is surprising as greater public awareness of the risks of sugar will surely help increase calls for change, hopefully resulting in similar action being taken against the food industry as has been achieved with the tobacco industry. 

Professional Footballers

On the opposite end of the spectrum, recent research has shown that wealthy professional footballers are amongst the worst culprits for bad oral hygiene.

Research carried out by University College London and published in the British Journal of Sports Medicine, found that nearly 4 out of 10 professional footballers have ongoing tooth decay; 57% have tooth erosion; and 8 out of 10 have gum disease, which in some cases was irreversible. Compare this with the national average, where 3 out of 10 adults suffer from tooth decay.

So why is it that professional footballers have such bad oral hygiene? Again, sugary drinks may be to blame, with the footballers drinking sports drinks during training sessions and games to help maintain energy levels. However, with appropriate oral hygiene, it has not been proven that drinking such drinks would harm teeth.

Similar research was carried out by the same study author, Professor Ian Needleman, on professional athletes during the London Olympics in 2012 and this report had similar findings in relation to the state of the athletes’ oral health.

Many people may be surprised at how oral hygiene can have an impact on one’s health and well-being in general. 7% of professional footballers and 18% of professional athletes said bad oral health had affected their training.

Dr Claudio Peru is a specialist endodontist and the principle at Chiswell Green Dental Centre.  CGDC have been working with Watford FC for the last two years, during their rise to the football Premier League. Dr Peru is responsible for the dental health for the players. His view on the importance of dental health in elite sports people is as follows:

“The importance of ensuring optimal dental health for professional athletes, including footballers, cannot be understated. By ensuring the dental health of players, they are able to train and perform during matches without being impaired by acute or chronic dental problems. There is an obvious economic advantage to the club. In particular we find that by addressing occlusal imbalances we are able to optimize neuro-muscular coordination and the postural balances. This is particularly important for the competitive performance of athletes.”

The studies did not give any conclusions as to why these professionals had such poor oral hygiene; many saying they visited a dentist regularly. With access to the best dentists and products surely there is no excuse for this.

Mouth Cancer Action Month

Mouth cancer is one of the few remaining cancers that is likely to increase in numbers in the coming years; the disease has already increased by a third in the last decade. In the UK last year 6,767 people were diagnosed with mouth cancer.

Mouth Cancer Action Month hopes to raise awareness of the symptoms of mouth cancer and the benefits of taking action early on.  The key message from this campaign is that early detection is key and it encourages the public to regularly visit their dentist.

The British Dental Association (BDA) has published an article highlighting the vital work dentists and their teams have in making the public aware of mouth cancer and early detection. It confirms that if detected early there is a 90% survival rate; compared with 50% where diagnosis is delayed. 

The BDA is also supporting HVP Action’s campaign for the HVP vaccination given to girls to be extended to adolescent boys (rather than just those between 16 and 40 who are having sex with men as recommended by the Joint Committee on Vaccination and Immunisation). It is thought that the HVP virus is likely to rival tobacco as the number one cause for mouth cancer in the coming years; the rate of mouth cancer is expected to double between 1995 and 2025.

If you want to get involved in Mouth Cancer Action Month you can visit their website here. We will be doing our part to raise awareness; look out for JFH Law’s #bluelipselfie.

Laura Pearce, Senior Solicitor