You may think that teaching a student how to brush their teeth should be pretty low down the list of educational priorities. Yet poor dental hygiene is a major problem for schools - and one they will increasingly come under pressure to fix.
The statistics paint a bleak picture. The US-based National Children's Oral Health Foundation believes that more than 51 million school hours are lost every year in the US to dental diseases, decreasing productivity and increasing educational disparities. Recent comments in the UK suggest that things are similarly desperate here.
Just last week, Professor Nigel Hunt, dean of the Royal College of Surgeons' dental faculty, said that hospitals could not cope with the "frightening" problem of child tooth decay. He called for warnings on sugary fizzy drinks to dissuade parents from buying them (see bit.lyToothGuide1).
Word of mouth
Numerous studies have also sounded warning klaxons. The Child Dental Health Survey 2013 published in March this year - which covers England, Wales and Northern Ireland - finds that 46 per cent of 15-year-olds and 34 per cent of 12-year-olds have "obvious decay experience" in their permanent teeth. Among younger children, 31 per cent of five-year-olds and 46 per cent of eight-year-olds have obvious decay in their primary teeth (bit.lyTeethSurvey).
These issues are, in turn, having a detrimental impact on children's well-being, with a fifth of 12- and 15-year-olds questioned experiencing difficulty eating in the three months before the survey. In addition, 58 per cent of 12-year-olds and 45 per cent of 15-year-olds report that their lives have been negatively affected by problems with their teeth and mouth.
Equally as disturbing are figures from the Health and Social Care Information Centre showing that more than 25,000 children between the ages of 5 and 9 were admitted to hospital for tooth decay in 2014 - an increase of more than 3,000 since 2010.
Dr Nigel Carter, chief executive of the British Dental Health Foundation, says these numbers are an improvement on 30 years ago. But he adds: "There is no doubt that the number of children admitted into hospital is verging on the unacceptable."
One of the root causes of the problem, according to Carter, is a "clear lack of understanding" of just how serious dental disease is. "Tooth decay and gum disease are entirely preventable and yet we are seeing figures such as 25,000 little children having body parts removed because of disease we know how to prevent," he says.
Certain factors appear to make some children more vulnerable to dental health problems than others. The Child Dental Health Survey highlights the fact that 26 per cent of 15-year-olds eligible for school meals have severe or extensive tooth decay compared with 12 per cent of their peers.
The impact on schools is acute. Those 25,000 hospital admissions are likely to require a day or more off school. Meanwhile, pain and discomfort will be distracting for students - even more so if they are unable to eat properly.
Stopping the rot
So what's being done to tackle the problem? In England, the National Institute for Health and Care Excellence (Nice) published guidelines in October last year urging schools to supervise three- to 11-year-olds in brushing their teeth for two minutes twice a day. The advice also recommends that pupils be given toothbrushes and toothpaste to take home.
This is a good starting point but more needs to be done, according to Carter, whose foundation launched its own education initiative, Dental Buddy, in 2013. The website provides information about dental hygiene along with downloadable resources for different age groups (see www.dentalbuddy.org).
Perhaps educators should follow the lead of a school in one of the most deprived areas of the UK. Warren Park Primary in Leigh Park, Hampshire, is ahead of the game in this area, having brought in whole-school toothbrushing more than 10 years ago. Every day after lunch, the 425 pupils return to their classrooms, collect their toothbrush from the "toothbrush bus", pictured far left, and brush their teeth as a class. The children who attend breakfast club do the same every morning.
"Deprivation is an interesting term as kids can be deprived of so many things," says headteacher Colin Harris. "My students are not deprived of the love of their parents, but many are deprived of money and the majority are deprived of a dentist - there simply aren't enough dental surgeries in this area."
Brushing up on skills
Responding to this need, Harris worked with local health officials to train staff in proper brushing and created a toothbrushing scheme to educate pupils.
"The impact has been massive," Harris says. "Dental issues created significant well-being problems and caused absences. We have solved those issues through this simple scheme. And hopefully we educate children so that they can - and want - to brush their teeth at home."
Why haven't more schools done the same? Many cite concerns of cost or time, but Harris says both are poor excuses. At Warren Park, each child has a new toothbrush each term and the cost is less than pound;1 per year per child, he says.
As for time, using smaller blobs of toothpaste than an adult normally would means that the pupils do not need water, hence teeth can be brushed in the classroom. Teaching assistants then wash the toothbrushes. As the children brush for only two minutes a day, there is practically no time cost, Harris adds.
Warren Park offers an example of what can be done with a little forward thinking. As problems with children's teeth continue to disrupt education - and as the Nice guidelines become more widely publicised - it is an example that many schools may wish to follow.