A Report on the Oral Health Needs of a Specific Target Group of the Population

A REPORT ON THE ORAL HEALTH NEEDS OF A SPECIFIC TARGET GROUP OF THE POPULATION

THE BROWNIES

INTRODUCTION

I was tasked to produce a report on a chosen target group. The target group that I chose was the Brownies. This is a group of girls aged between 7 & 11 years old. The aim of my report is to highlight specific health problems of young children. I also aim to identify the main barriers to dental care, which children may experience, and show detailed examples of how to over come them. I will also highlight their socio-economic considerations, and the need for oral health education and promotion for the young. The target group should cover the needs for both the parents and the children.

DEFITIONS

The word parent means ???one who has begotten or borne offspring, father or mother??™. And the word child means ???young human being, boy or girl??™. The word Brownie means an elf like person who is a member of the junior branch of guides. Definitions are from the Collins dictionary.

Today??™s parents can range in age from the youngest mother at 12 years of age and the youngest father at 11 years of age to the oldest mother to give birth was 62 years of age and the oldest father is 82 years of age.
Parents come from a wide range of social economic and ethnic backgrounds.
Social economic status of the parents does have an effect on the dental needs for that group.

CHILDREN OF SCHOOL AGE

The environment in to which the children are brought up in varies, as the extended family was over taken by the nuclear family. In many families both parents work. Therefore, a number of children are looked after by their grand parents, during the school holidays and after school until the parents finish work. This is due to high cost of childcare.

Young children are dependent on their parents for their oral health needs. As society changes, more and more children have more control over their lives. Children today are becoming more aware of the media, peer pressure and their surroundings. Advertising companies know how to convince children that their products are the best and make children think they will be popular and one of the in crowd if they buy these products. They use TV and sports personalities to advertise such products and give free toys away to incise them to buy these items. Social learning theorists accept that children learn a great deal from reinforcement and punishment but they claim that children also learn by observing and imitating. If children see that someone??™s behaviour leads to something pleasant, they are likely to try and copy it. Therefore it is the parent who needs targeting in any oral health education strategies.

UK POPULATION

There is an estimated 58,836,700 people living in the United Kingdom in mid 2001. This is an increase since 1981 of 2.5 million people.

The mid-2001 population of the constituent countries of the United Kingdom is estimated as Follows:
England 49,181,300 (83.6 per cent of the total UK population)
Scotland 5,064,200 (8.6 per cent)
Wales 2,903,200 (4.9 per cent)
Northern Ireland 1,689,300 (2.9 per cent)

Chart showing the population break down of the United Kingdom (Million)

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From the 2001 Census it reveals that there were 11.9 million dependent children under the age of 16 in the United Kingdom: 6.1 million boys and 5.8 million girls. Children made up 20 per cent of the population in 2001 compared with 23 per cent in 1961.

Population of children male and female (Million).
[pic]
Projections suggest that the population who are children will continue to fall to around 18 per cent of the population by 2011.

Nearly one in four (22.9 per cent or 2,672,000 dependent children) live in lone-parent families ??“ 91.2 per cent of which are headed by the mother. More than one in ten dependent children live in a step-family (1,284,000). The majority, though, live with both natural parents (65.0 per cent).

Some children live in ???workless??? households with over two million (17.6 per cent) in households where there are no adults in work. In Muslim households this is even higher with more than a third of children living in households where no adult has work.

Muslim children also experience much more overcrowding (more than two in five ??“ 41.7 per cent ??“ compared with an average of 12.3 per cent) and one in eight live in a household with no central heating compared with the average of 5.9 per cent ??“ one in 16.

Around 6% of the population in Great Britain is made up of people from ethnic minorities. Ethnic minority groups have a very young age structure.

ORAL HEALTH NEEDS

The information we give as dental professionals should be aimed at the parent and carers, and when appropriate the children themselves. The information given by the dental health educator should be relevant to the age group and should not conflict with other information given by other health professionals. The oral heath needs for this target group are:
? Diet
? School Dinners
? Caries
? Erosion
? Orthodontics
? Media Pressures
? Peer Groups
? Body Image
? Eating Disorders
? Dietary Fads
? Regional Differences
? Culture Differences
? Social Trends and Changing Dietary Habits
? Availabilities of NHS Dental Care
? Social Class
? Education
? General Health
? Barriers to Oral Health
? Cultural Differences
? Oral Health Education and Promotion

DIET

Diet is an important variable in any equation of health status (Forsyth et al 1994). It is, therefore, useful to identify whether low-income households eat less healthily than other households, thus exposing themselves to another exogenous risk factor associated with reduced health status. From the findings of the national survey it demonstrates some clear relationships. A clear pattern of dietary deprivation emerged from the survey, which indicated that low-income households eat far more unhealthily than other households. A third (32.2%) of low-income households eat less than two servings of fruit per week, compared with 18.9 per cent of other households. Virtually all households unaffected by low-income eat vegetables at least twice a week, while a small proportion (7%) of the low income families do not. Some 43 per cent of low-income households ???rarely ??? or ???never??? eat whole-wheat or rye bread, while the corresponding proportion for other households is found to be 28.6 per cent. Sugary foods are eaten more than once a day by 16.2 per cent of low-income households, compared to one in ten of all other households. Furthermore, fried food is consumed more than twice a week by a remarkable 71.4 per cent of the low-income families, compared with just 31.6 per cent of other households. The results shown overall that the findings relating to dietary intake of households indicated that households that were unable to heat their homes adequately were also unable to eat healthily.

|TABLE: Low Income Families and Diet |
| |Low-Income Households % |Other Households % |
|Fruit < twice/week |32.2 |18.9 | |Vegetables < twice/week |7.0 |3.1 | |Whole-wheat or rye bread: rarely or never | | | | |43.0 |28.6 | |Sugary food >once/day |16.2 |10.0 |
|Fried food > twice/week |71.4 |31.6 |

The Estimated Average Requirements for children are quite high in relation to their body size. The calories requirement can be seen in the table.

A Table showing the Estimated Average Requirements for children aged 7-11 years old.

|ESTIMATED AVERAGE REQUIREMENTS FOR ENERGY IN THE UK (PER DAY) |
|AGE RANGE |MALES |FEMALES |
| |Kcal |Kcal |
|7-10 Years |1970 |1740 |
|11 Years |2220 |1845 |

SCHOOL DINNERS

School meal provision has a key role to play in the diets of young people. Although new nutritional guidelines for school meals were introduced in England and Wales in 2000, schools are still heavily influenced by the practice of ???best values???, allowing catering companies to compete for contracts. Catering companies operate under tight budgetary constraints and the healthy eating agenda can often be a low priority. It is often argued that they respond to customer demand (that is, young people what chips more than they want baked potatoes) as they operate their business for a profit. Nutrition Action Groups (SNAGs) have an important role to play in the provision of school food in that they can influence what food is actually provided for children in schools throughout the day. Through young people working in partnership with school caterers, teachers and health promotion, a healthier approach to school food provision can be provided. However a whole school approach needs to be adopted for a SNAG to be successful with committed members of staff who are allocated time in their teaching schedule.

Even though schools have attempted to address nutrition issues through the health promoting school model, as part of the European Network of Health Promoting Schools, the diets of young people remain a cause for concern. If government targets on health are to be achieved, particularly in relation to prevention, it is essential that health education generally, and especially nutrition education, are embedded in the National Curriculum. Although many schools are a setting for health promotion, there is considerable scope for nutrition education with young people outside the school environment; working with young people. Schools could forge links with youth workers, who work in partnership with young people, in settings that allow them to feel relaxed and empowered.

Therefore it is very important for children to be educated and taught sensible eating habits from a young age, making sure they have a varied healthy diet.

With more working parents and busier lifestyles dining habits have changed from families sitting at the table eating healthy meals of meat and vegetables which the mother spent a lot of her time cooking for the whole family. In this day and age there is an increase in convenience meals, which contain high levels of salt and fat. These meals are quick and easy to prepare. This enables the parents to fit more into their busy lifestyles. A lot more families do not sit up at the table but eat their meals in front of the television from trays on their laps.

CARIES

Dietary habits established during this period of growth and development will play an important factor in the development of or the prevention of dental caries.
Children aged 7-11 have a mixed dentition, a mixture of both permanent and deciduous teeth. Some parents are not too concerned about the deciduous teeth seeing them as a temporary dentition until the permanent dentition erupts. They need to be aware of the importance of deciduous teeth due to their role as predecessors for permanent teeth and their role in alignment. Research indicates that the dental caries in the deciduous dentition is an indication of a child who is high risk for caries in the permanent dentition. Dental hygienist who observe children with caries in the deciduous teeth need to work with parents and children to promote changes of attitudes and behaviour to prevent the further progression of dental disease.

Dental caries, in young children maybe due to grazing. The habit of ???grazing??™ with a succession of sugary snacks and drinks throughout the day has become popular. A contributing factor to grazing is the changing in lifestyles of children. With it being harder for children to play outside with the risk of being abducted. It has become the norm to sit in front of the television or playing on the Playstation or computer. As they sit for long periods of time, children may graze on snacks such as crisps and chocolate bars and sip carbonated drinks. This can lead to many health problems later in life. There is also an increase of obesity in children and also epilepsy possibly due to the increase time spending staring at the screen, which can bring on a fit.

The British Medical Journal states that one in ten children are obese and one in seven are overweight. It is a large concern as it affects the child??™s general health as well as the child??™s oral health. If these children continue to lead this kind of lifestyle, greater problems of health concerns can stem in later life. This is due to lack of exercise and a diet of unhealthy snacks.

It is accepted that there is a relationship between dietary patterns and social depravation in society and that there is now a polarization of dental caries experience. The majority of children still have little or no caries, but a minority, often from the most socially deprived groups continue to have considerable caries experience.

The children??™s Dental Health Survey 1993 is the third national survey of children??™s dental health to be carried out by the Social Survey Division (ONS): previous studies were conducted in 1973 and 1983.

There was little change over the ten years in the proportions of children with actively decayed primary teeth, and the improvement in the proportions with known decay experience can be attributed to smaller proportions having filled teeth.

The improvement between 1983 and 1993 in the proportions of children with decayed or filled teeth were greater among eight to ten year olds. It fell from 71% in 1983 to 61% in 1993.

Levels of primary decay were particularly high among children in Northern Ireland, where active and treated primary decay among the children compared to children in England. Three quarters of seven and eight year olds in Northern Ireland had active decay or filled teeth in the primary dentition.
The Chuck the Sweets off the checkout Campaign (1994/1995) was aimed to remove sweets from the supermarket checkout, to make them sweet free. This was encouraged from many mothers as their children always pestered them to buy them sweets when they were waiting in the queue at the checkout. Also many slimming groups were very pleased with this campaign and help support it. As it brought awareness of how companies were marketing this very clever technique at children and slimmers.
Chuck sweets off the checkout campaign found. The consumption of confectionary is a concern for many members of the public especially those with children. It is of particular concern for the health of children due to the nutrient diluents effect of high sucrose foods, like sweets, which provide calories of energy but have an otherwise generally poor nutrient profile. In addition the dental risk of frequent consumption of non-milk extrinsic sugars (NME sugars) in large quantities, particularly between meals is well documented.

Dental decay is not a trivial disease. It can be painful, disabling and disfiguring. The last national survey of children??™s dental health showed that children aged 7, 54% had decayed teeth. This may mean these children will need more dental treatment to maintain these heavily restored dentitions if re-educating the parents and children about the frequency of snacking on sugary foods

EROSION

In June 2000, the government published the latest National Diet and Nutrition Survey (NDNS) commissioned jointly by the ministry of Agriculture, Fisheries and Food (MAFF) and the department of health (DH). The survey of young people is the largest survey of it??™s kind undertaken in the young British population (Gregory et al, 2000).

Another concern with this age group is the increased consumption of fizzy drinks. Three-quarters of young people consumed standard carbonated soft drinks, and 44% of boys and 46% of girls drank diet varieties. Carbonated drinks are more widely available than ever before. This group is at risk from developing erosion from constant sipping and over consumption of these carbonated drinks and fruit juices. Fruit juices and concentrated squashes were also consumed by approximately half of all participates.

More boys than girls, and more children from the lower socio-economic groups, had moderate or severe erosion. Some degree of erosion is present in a majority of children. Early identification of those at risk of moderate to severe erosion is essential for prevention.

Also many of the fast food outlets offer fizzy drinks with their meals. Also given the children a free toy. These ploys all encourage children to choose these unhealthy options.

ORTHODONTICS

At this age group, children aged 7-11 years old, are going through a transitional phase and have a mixed dentition, which may require orthodontics. This normally starts from the age of 11 and can carry on into late teens. It has become much more popular with children today with the increase of other children having appliances with a lot more choices of colours for bands and it is much more fashionable than it was 30 years ago.

Orthodontic treatment includes a range of procedures or treatments to correct the position of the teeth. About 25% of children will have orthodontic treatment at some stage in their life, having either extractions or an appliance or both. Some General Dental Practitioners offer orthodontic treatment, those who don??™t will be able to refer patients to dentists who limit their practice to orthodontics or orthodontic departments at district and teaching hospitals.

The most common reasons for a patient to want to have orthodontic treatment are they are normally not completely happy with the appearance of their teeth. This all contributes to an individuals self image, and confidence about their selves. Other children can be quite cruel and tease their peers if they have a malocclusion. Which also encourages the child they want to have orthodontics.

The addition of an orthodontic appliance and in particular a fixed orthodontic appliance greatly complicates tooth brushing and leads to accumulation of greater amounts of plaque.

Patients undergoing orthodontic therapy are frequently undergoing treatment during pre-pubertal growth sport, where the incidence of gingivitis may be high and hormonal changes may result in an enhanced response to plaque.

MEDIA PRESSURES

Media and advertising have the potential to have a positive or negative effect on oral health and oral health has an effect on children??™s beliefs. The media can affect oral health in a positive way if the message given is factually accurate, and does not conflict with other health messages. The advertising of confectionary and high sugar drinks portraying as healthy or appealing choices that ???will not ruin your appetite??™ or will ???replace lost energy??™. The average child watches somewhere in the region of 20,000 television commercials each year, many of which are for food products. They know what they want and so do their friends, because they have seen it on telly. The fact is advertising works. It is an enormous influence on consumer choice. The Independent Television Commission (ITC) have rule governing food advertising aimed at children based on the 1992, White Paper, The Health of the Nation. It convinces us that sugary, completely nutrient-free drinks are healthy, and we have come to believe that a few added vitamins and minerals make a chocolate breakfast cereal acceptable. Children will not have a healthy present or future if they are always fed what the advertisers say they should eat.

The habit of grazing on a succession of sweet fixes has also become popular and even fashionable. Using pop groups, sports player to advertising crisps, sugar drinks to make them more appearing to this target group. This has an enormous effect on children??™s teeth.

PEER GROUPS

Peer group pressure, play a major role as an influencing factor when a child is choosing a particular type of food. A young child may feel pressured by their peers to purchase high fat unhealthy snacks, instead of healthier alternatives. They want to eat the same as their friends, as they don??™t want to feel left out and want to feel as if they fit in. These food choices they choose may not be what you want them to eat.

As a child gets older, there??™s an increasing amount of freedom over food choice, and foods are often eaten outside the home ??“ at friends??™ houses and at school. Additionally, outside pressures ??“ such as peer pressure and advertising ??“ start to influence food choice.

BODY IMAGE

In today??™s society, especially for girls, but it is also now effecting boys. Body image is very important to fit in. There is an emphasis placed on a female physique that is lean and thin. Males need to have a six-pack. Young children have been brought up with the image of the Barbie doll and Action man. Perceiving this body image as the norm of how people should look in today society. Also the increase of children??™s magazines showing images of young woman, exposing them to the ideal of what the body image should be. These magazines have a positive impact on these young people. These magazines also contain a lot of advertising, to encourage these children to buy their products.

Boys also have to fit in to the media expectations of male models, fit football stars. They all portray the perfect body that they need to fit in as the normal body shape.

Garner, Garfinkel, Schwartz and Thompson (1980) documented that, over the past 20 years, magazines, supermodels and actresses have become progressively thinner. The media for thinness has led to a strong emphasis on dieting as a means to achieve this ideal.

This then leads on to eating disorders and dietary fads.

EATING DISORDERS

Anorexia nervosa is an eating disorder. It is the third most common chronic illness in teenager girls. Anorexia is prevalence in upper socio-economic classes. There is evidence that anorexia is a manifestation of attitudes such as ??? I hate my body??™ brought on by western media stereotypes of thin long legged beauties. These attitudes start from an early age when children are given Barbies to play with, watch pop artists who are all tall and thin and models who are used to advertise on the television. The media use these models as they sell products. Also there may also see their parents starting diets such as Weight Watchers or slim fast and take on the attitude that dieting is the norm and if you want to be beautiful you need to be slim.

Bulimia nervosa is a serious eating disorder where, as a way of coping with difficulties in their life, binge on large amounts of food with no feeling of control over what they??™re doing. As many as one in ten young women, binge and purge or use laxatives or diuretics to help cope with anxiety about their weight. The bingeing and purging can also take a toll on health. Which can result in stomach rupture and metabolic complications following excessive (self-induced) vomiting. A dental concern with people making themselves vomit, is that when they vomit they bring up acid from the stomach which erode the enamel on the teeth.

DIETARY FADS

Fad diets are on the increase with a new one being developed every week. Females diet more and more to fit in and try to copy models and famous people in the media.
Many children go through different fads throughout their lives this can be from being fussy with certain foods, eating only foods their friends eat, becoming aware of issues like becoming a vegetarian or wanting organic foods.

The Atkins Diet

This is one of the most famous low carbohydrate diets, written by Dr Robert Atkins. There has been a lot of controversy over this diet in the news recently as many people believe it is not safe. A young girl died, but there is no evidence to prove that the Atkins Diet was the cause of her death.

This low carbohydrate diet is based on the premise that a diet low in carbohydrate leads to a reduction in the body??™s insulin production, resulting in fat and protein (muscle) stores being used as it??™s main energy source.

The aim of this diet is to force the body to use fat as it??™s main energy source, when this happens a person produces ???ketone bodies??™ to fuel parts of the body that can not use fat as an energy source ??“ the brain, and red blood cells, in particular. When this happens a person is said to be in a state of ketosis ??“ characterised by smelly breath (an acetone smell like nail varnish) and side effects such as nausea and fatigue.

In the short term, most people do lose weight and they lose it very quickly. However, the majority of weight loss comes from loss of water and muscle tissue, not fat which is what you need to lose weight permanently, losing precious lean muscle tissue. Muscle tissue is metabolically active, and burns calories even when at rest. A decrease in the amount of muscle tissue will lead to a decrease in the number of calories you need each day to maintain your weight, making it much harder to keep your weight under control when you stop following the low carbohydrate diet.

This is not the healthiest way to lose weight. As this diet is not a balanced diet, as this diet only allows you to eat only a small amount of fruit, vegetables and grains, which is definitely not enough for the recommended daily allowance. Experts claim that if the Atkin diet is followed long term, may increase the risk of kidney, bone and liver problems.

Many celebrities such as Catherine Zeta Jones, Jennifer Aniston and Geri Halliwell all use this diet as it is very good for a short term weight loss for losing weight for films and being in the public eye.

Slim Fast

This is a meal replacement drink, in a form of a shake. It is available in many flavours such as chocolate, strawberry and vanilla. The diet allows you to have a shake for breakfast and lunch and a then you have a proper dinner. They have also now brought out pasta and snack bars. These shakes are meant to have all the dietary nutrients needed. I feel this kind of diet is good for short-term weight loss but as soon as you start to eat normal food instead of the shakes the weight goes back on very quickly.

REGIONAL DIFFERENCES-

There are a lot of regional food differences through-out the UK which could have an effect on a Childs diet. The following are some traditional examples but although they are traditional it shows that different areas around the UK do have different eating habits.

Scotland:- Haggis, Oatcakes, Grouse and it has been known in some areas to Deep fry Mars bars!.

Ireland:- History states that Potatoes was the main source of the Irish diet and this still shows today, with a lot of there meals using potatoes. Colcannon being there traditional dish made from Mashed potatoes, cabbage mixed with onions, milk, salty butter and peppers.

England:- The different counties in England all have different eating habits from the North with the Lancashire Hot Pot, the Midlands with there Melton Mowberry Pork Pie and down to the South West where they are famous for there Cornish Pasties.

Wales:- Is not to be left out,they also have a few traditional dishes,the most famous being Welsh Lamb. Other traditional dishes are, Cawl- a rich stew made with bacon and scraps of Welsh Lamb vegetables and there national emblem the Leek.Then you have Bara Birth which is a Tea Bread. Welsh cake-scone like tea cake. Laverbread this is made from seaweed and oatmeal fried into crisp patties for breakfast

CULTURAL DIFFERENCES

The United Kingdom has a large ethnic minority groups spread throughout the country. These numbers are increasing with the new influx of asylum seekers arriving to the country each day. They may find many barriers in terms of oral and general health care, which may be in the form of access to services and language naming some of the barriers they could face.

Certain ethnic minority beliefs and attitudes are different to that of the UK. In some cultures they do not allow women to treat them. This may cause problems in a dental surgery or a hospital if emergency treatment is needed.

Other problems they could face are getting to these services. This may range from public transport, gaining access to local shopping centres and possibly finding work. Ethnic minorities may find it difficult for a number of reasons such as not speaking the language. If an ethnic minority cannot speak English they may find great difficulties in gaining access to these services

SOCIAL TRENDS AND CHANGING DIETARY HABITS

Home cooking has become less frequent and more convenience foods are used instead. Traditional set meals are declining and are becoming the thing of the past. There is now more grazing occurs throughout the day. These snacks can be high in sugar, salt, and in fat. Being low in fibre, fruit and vegetables therefore it is not a balanced nutritional diet.

The number of overweight children has nearly doubled in the last decade. One out of four children is overweight or at risk for becoming overweight. With the increase of easy attainable snacks being eaten by children. There is a high risk of children becoming overweight and being obese. This can lead to other health problems. As sixty percent of children aged 7 ??“ 11 years have one or more heart disease risk factors. Also type II diabetes, once considered an adult disease, is becoming more common in overweight children. These are very worrying figures. The contributing factors are the changes in today??™s life styles.

In this day and age with more children eating high fat, high salt diets and taking very little or no exercise as only 29 percent of children attend daily physical education classes.

AVAILABILITIES OF NHS DENTAL CARE

The provision of dental care may not be easily obtainable. The numbers of National Health Service (NHS) dentists willing to take on new patients are becoming fewer. As private practices are on the increase.

In the 90??™s there was a larger amount of qualified dentist so the government decided to cut the number of dentists they needed. Because of this, there are fewer dentists per person today. With some areas having more dentist compared to other regions.

Recently in the news a dentist decided to allow to see more people on the NHS books, this led an increased interest as many people flocked to the practice to be registered as many people can not afford the private treatment available, but with the lack of NHS dentists available, more and more people either reluctantly pay the high private fees or don??™t visit the dentist at all as they can not afford the prices.

SOCIAL CLASS

Throughout human history there have been inequalities in the health of classes and populations, caused by social factors. With the introduction of British National Health Service, with its ideal of equal access to medical care for all groups in society it was assumed that differences in the health of different social (occupational) classes would be eliminated. We now know that this has not happened, and this has been amply documented in various reports such as the black report (Inequities in Health) and the health divide.

The Registrar General??™s scale of 5 social occupational classes

Class I Professional eg Lawer, doctor, accountant
Class II Intermediate eg Teacher, nurse, manager
Class III N Skilled non-manual eg typist, shop assistant
Class III M Skilled manual eg miner, bus driver, cook
Class IV Partly skilled eg farmworker, bus conductor,
(manual) or packer
Class V Unskilled manual eg cleaner, labourer

There is more emotional stress and chronic ill health in the ???lower??™ occupational classes.

Generally lower class is sometimes an assumption that people are less educated. This is not true with new government education strategies it not always synonymous.

AFFLUENCE

With the increase of working mothers and in many families there are two incomes coming into the family, Children are receiving more pocket money to spend mostly on sweets and fizzy drinks.

The Family Expenditure Survey collects information about the expenditure pattern of children in the UK. Children aged 7 ??“11 spend they majority of their money on food and drinks

Lack of money in the home may lead to fewer resources needed for good oral hygiene practice. The priority for floss and Electric toothbrush may be way down on the list of essentials. Nutrition may suffer, as low-income households tend to eat less fresh fruit and vegetables and eat more refined carbohydrates and process foods.

EDUCATION

Schools are an ideal place to learn and practice good nutrition. And the classroom is the best place to start. Good nutrition and education helps children grow and learn and do well at school. Research has found that a well-nourished child have higher test scores, better school attendance and fewer classroom behaviour problems.

Parents and other family members are good sources of passing on information, but the information needs to be correct and up to date. Therefore it is very important to educate the whole family not just the children.

Next to parents, teachers are children??™s most important role models. When teachers talk about good nutrition and choose healthy foods, chances are greater that children will too.

Health visitors need to be targeted so they are passing on the same information, as the dental health teams so there are no mixed messages, as sometimes the health message can be contradicting.

GENERAL HEALTH

Social and Medical advances have resulted in many more people living longer. The average child born today can expect to live 25years longer than was the case in 1900.

Another important change since 1900 is there are fewer babies being born in western societies. These two trends have led to a different population structure with fewer younger people and more older people. As the number of older people increases, so does the pressure on society to make sure provision is made for them.

BARRIERS TO ORAL HEALTH

One of the barriers would be transportation to the dental practices. A survey completed by the office of population census surveys stated that just over half of the people sampled found it difficult to get to the surgery as it was too far away. While a quarter, complained of poor public transport. Less than one in ten said that the surgery hours were inconvenient.

Working parents may find it difficult to take children to the surgery if the surgery hours are inflexible. Working parents may not be able to take time off work to take their children.

Also another barrier could be fear, many parents can remember what it use to be like visiting the dentist as children which may have been a very frightening experience. Many things have changed over the years, and dental services have shown some vast improvements from up to date technology to patient care. These fears can be passed on to the children, as the parents may still not attend the dentist and therefore do not encourage their children to go. This can then lead to only visiting the dentist when they are in pain creating a scary painful experience for that child.

CULTURAL DIFFERENCES

Cultures often have different views on aspects of life, also including Oral Health. The use of sugar in diets of Asian families can be used as rewards and many Oriental families cook with large amounts of sugar. Diet advice to different cultures needs to be specially targeted and would be good practice to understand about the Culture. Language may also be a barrier and present a problem, as the patient may not be able to understand. They may be able to come with someone who does understand and will be able to translate. Pictures and visual aids may also be a good way to overcome the language barriers. Maybe leaflets in other languages can be bought to keep in the surgery to explain the treatment they will be under going, there are many Oral Health Education Leaflets available.

Ethnic minorities may find it very difficult to become registered with a dental practice as many NHS practice are full and are not taking on new patients whereas private practices charge a lot of money and these prices may be too much for them to afford. Especially if they have a large family or they are on a low income.

ORAL HEALTH EDUCATION AND PROMOTION

Improvements in oral health need to be targeted by education. Oral health promoters bringing awareness to children and their parents or guardian can achieve this by.
Oral health advice to schoolchildren, which includes:

Tooth brushing

Tooth brushing is the main method for removing dental plaque. Children should be encouraged to brush twice a day with a small amount of fluoride toothpaste.

Parents should encourage and supervise tooth brushing until around the age of seven years old, depending on the child.

Disclosing Agents

The use of disclosing agents can be used to motivate a child, as it is a fun way to see where they are missing with their toothbrush. So it is a good aid to check the effectiveness of a brushing technique. It also can show the child and they can visibly see where the plaque is present as it is then stained. They can then remove this by brushing the plaque away with their toothbrush.

Fluoride Therapy

Fluoride therapy is also an important measure in the prevention of caries, particularly in children as the teeth are developing. There are many supplements available as drops and tablets to mouthwashes. There are many considerations to take into account before fluoride therapy choice is chosen.

Fluoride is a naturally accruing compound found in water but it can also be artificially added to the water. It large amounts fluoride can be toxic so it is very important to make sure too much fluoride is not consumed.

Fissure Sealants

Tooth enamel is more susceptible to dental caries especially in the pits and fissures of newly erupted molars and premolars. A dentist can prescribe a dental hygienist to carry out a fissure sealant in a high caries susceptible patient. Fissure sealants are used as preventive treatment and are applied to the pits and fissures of teeth; the most vulnerable sites for the onset of caries. Fissure sealants were introduced on a widespread basis in the 1970s and the 1998 Adult Dental Health Survey was the first of the decennial surveys to include an assessment of the presence of sealants. The Dentist or Dental Hygienist will apply a small plastic coating to the pits and fissure to prevent caries occurring.

Dental Attendance

Children should be going to the dentist every 6 ??“ 12 months so that their dental health can be monitored. The child??™s attendance pattern normally reflects the attendance pattern of their parents. Also another factor is the ability to register with a dentist in the area that they live in as this plays a very important part of attendance.

Oral health education is a small part of a child??™s life. Being influenced mainly by their parents or their carers. Children need to be taught good oral health habits from a young age this includes their diet and incorporating sensible eating habits and good oral health care.
Oral health care can be categorised as Primary, Secondary and Tertiary prevention.

PRIMARY PREVENTION

Primary prevention operates before the disease is present and is targeted at healthy individuals who are considered to be ???low risk??™. The objective of primary prevention is to produce a healthy environment for healthy individuals. This could mean encouraging and allaying fears of young children concerning the importance of regular dental visits, and starting good habits to be continued throughout life.

SECONDARY PREVENTION

Secondary prevention operates before the disease is obvious and strategies for secondary prevention are directed at ???high risk??™ target groups. At this stage importance is placed on changing the behaviour that is putting the individual at risk of developing disease.

TERTIARY PREVENTION

Tertiary prevention is given when an individual is in the advanced stages of a disease. The object of tertiary prevention is to provide a cure where disease is reversible or treatable and to rehabilitate those with untreatable disease to make the most of the remaining potential for healthy living.

For health education to be effective, it needs to be targeted not only at the children themselves, but also at the parents or their guardians. Oral disease is preventable, with the right education the lives and health of the children as a whole can be improve and this can continue throughout their lives.

CONCLUSION

This report has addressed many issues relevant to the health needs of children. Barriers to care and inequalities in health are factors, which need to be addressed not only by us as Health Care Professionals, but by the local authorities and the government.

The average child born today can expect to live 25 years longer than was the case in 1900. Therefore Oral Health Education to this target group is essential, as they are the future generation of society, and will one day become parents themselves and will be passing on their knowledge to their children. Therefore children are our future and it is therefore very important we teach them good habits from an early age. They will then be able to pass this information on to their offspring and future generations.

The government needs to rethink Health Education and give more priority to Oral Health Education as I feel prevention is definitely better than cure. Therefore investing more money into more mobile community educators to go into schools on regular basis and educate these children from a young age, and involving their parents. Also improving the conditions for qualified dentists to work in the NHS sector, other than going Private. There is a long way to go before these changes will ever be made.

REFERENCES

? Collins English Dictionary 1991

? National Census 2001

? International Journal of Health Promotion and Education Volume 41 number 1, 2003.

? Dental Health Journal Volume 40

? Oral Health Education ??“ Children of School Age Booklet. School of Dental Hygiene handouts.

? Children??™s dental Health in the UK (1993) Maureen O??™Brien

? Orthodontics and Children

? Diet and Nutrition Handouts- School of Dental Hygiene

? Nutrition Action Group leaflets

? Chuck The Sweets Off The Counter Campaign Department of Health 1994/1995

? Eating disorders Leaflets

? WWW.dentalpath.com

? WWW.itsofficial.net

? Nutrition And School Children. WWW.nutrition.org.uk

? WWW.statistics.gov.uk

? WWW.news.bbc.co.uk/health

? WWW.dent.bris.ac.uk

? WWW.nutritionexplorations.org/educators

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