“Our children can’t just sit in a chair while someone drills into their teeth,” explains Sarah Dickinson, acting headteacher of St Crispin’s special school in Edinburgh. “Many of them, when they do have dental work done, have to be given a general anaesthetic.”
And if a child has complex health problems, the risks associated with general anaesthetic increase, says Fiona Rodger, head of oral health improvement for NHS Lothian.
Prevention of tooth decay is therefore vital, which is why both women have praised Special Smiles, a programme that visits special schools and helps teachers and parents to encourage toothbrushing and reduce anxiety around visits to the dentist.
However, support around dental health specifically for children with additional support needs and their families is patchy, says Liz May, national coordinator for Action for Sick Children Scotland, the charity which runs the scheme. Yet this group of children is more likely to experience tooth problems.
The issue has become so pressing that the Scottish government asked this week for an “immediate review” of provision.
“The medicines children with ASN have to take often have high sugar content and it can be hard for them to brush their teeth,” Ms May says. “Some don’t want to open their mouth for toothbrushing or have a phobia of putting things in their mouth, making toothbrushing stressful and difficult for parents. That means dental issues often only become a priority when there’s a problem.”
‘Not routinely inspected’
Ms May is calling for Scotland’s national programme for improving children’s dental health, Childsmile, to be extended into all special schools. Currently the programme targets primaries in the 20 per cent most deprived areas of the country, providing children with fluoride varnishing twice a year until at least P4 and supervised toothbrushing in P1 and P2. It also assists families without a dentist to find one.
Ms May would also like to see children with ASN included in the basic national dental inspection programme, which takes place annually for children in P1 and P7.
“Children with ASN are not routinely included because they might not cooperate,” she adds. “But if we had that data and we knew a high proportion of children with ASN were getting teeth out in hospital that would be a reason to intervene.”
The latest figures on children’s dental health published last year show that two-thirds of Scottish P1s had healthy teeth, up from 51 per cent 10 years ago. However, the national target of 60 per cent of P1 children with no obvious decay has yet to be met in Scotland’s most deprived areas, where just 53 per cent of children have healthy teeth.
Special Smiles started in 2007 and by the end of March next year it aims to have worked in 116 special schools in 17 local authority areas. There are 145 special schools in Scotland.
At the end of this year the charity will find out whether the Scottish government will fund the Special Smiles programme for a further three years.
It would be money well spent, says Ms Rodger, who has been in dentistry for more than 20 years. “When I was practising, I routinely saw children coming through with ASN who had dreadful teeth, and that’s why I’m so prevention-minded now. Your oral health affects how you speak, communicate and eat, and if a child is constantly in pain then that can affect their behaviour,” she says.
St Crispin’s head Ms Dickinson agrees: “Most of our children don’t have the cognitive ability to understand what teeth cleaning is all about. They need the props and storytelling that programmes like Special Smiles use to understand.”
When TESS asked the Scottish government about the issue, public health minister Maureen Watt announced an “immediate review of service provision to children with additional support needs in education settings”.
“Families of children with ASN should have access to enhanced support, tailored advice and information to improve and maintain the child’s oral health,” she added.
Find more information on the project at bit.ly/SpecialSmiles
Cracking a smile
The Special Smiles project has just started at Langlees Primary School in Falkirk. It is being delivered to P1 to P3 pupils with a wide range of additional support needs in the lower enhanced provision unit.
The children have been given a miniature dental surgery complete with tools, and are encouraged to role play trips to the dentist.
Teacher Margaret Gilchrist says that play is vital in helping children overcome their fears. “Our children don’t understand unless they experience it for themselves,” she adds.