Children are being admitted to hospital with serious tooth decay in growing numbers as a result of sugary diets, the failure to brush properly and poor care from dentists.
Hospitals in England are treating more than 30,000 children for dental problems every year, and the number of teeth being pulled out under general anaesthetic has risen by two thirds in less than a decade, a study reveals today. The most common age for a child having a rotten tooth out in hospital is five.
Hospitalisation for dental problems is now a serious health issue, even though decay — or dental caries — could easily be prevented through regular brushing and check-ups, the researchers conclude.
Previous reports suggested that rates of tooth decay had increased only slightly among children in recent years. But the latest study, to be published in the British Dental Journal, indicates that some toddlers and children have such poor oral hygiene that they are ending up in hospital as emergency cases, or having their teeth pulled when preventive treatment with fluoride treatments or fillings would have been more appropriate.
The dangers of severe or delayed dental treatment were illustrated recently by the case of Sophie Waller, an eight-year-old with a fear of dentists who starved herself to death because she refused to open her mouth after having eight milk teeth removed by a paediatric hospital consultant.
The researchers from Peninsula Dental School, Plymouth, and University College London, examined data from Hospital Episodes Statistics (HES) to identify a “disturbing trend” of increasing hospital admissions for children up to the age of 17 with caries and other dental conditions between 1997 and 2006. The number of teeth being pulled because of tooth decay among the under-18s increased from about 20,000 in March 1997 to 33,500 in April 2006, they found.
The study period predates the introduction of new contracts for NHS dentists in 2006, but analysis of the most recent HES data, for 2007-08, shows that the trend for hospital referrals is continuing, with 36,000 admissions for caries among those aged 14 and under.
The findings may support calls, from Alan Johnson, the Health Secretary, and others, for fluoride to be added routinely to water supplies as a key means of tackling tooth decay. This already happens in some areas of England, but has been opposed as “forced medication” in others.
Overall, 470,113 children were treated in hospital for dental problems during the study period. More than half involved a primary diagnosis of dental caries and 80 per cent involved extractions. More than 5 per cent of those required two or more teeth to be removed - one teenager was admitted to hospital to have teeth taken out seven times in nine years.
The use of general anaesthesia in dentistry was moved from dental practices to hospitals as a safety measure in 2001, but the researchers said that this would not explain the year-on-year increase in the numbers.David Moles, Professor of Oral Health Services Research at Peninsula Dental School, who led the study, said that several factors may have contributed to the rise in hospital admissions, including dentists choosing to refer children to hospital to be sedated if they did not feel able to manage them in their own surgery. "But if children are ending up in hospital having their teeth pulled, it suggests they are not receiving the appropriate care and treatment at an earlier stage," he said.
Young children given a general anaesthetic could be exposed to an unnecessary risk of complications or even death, he said. One child in ten experiences minor side-effects after an anaesthetic but about one in 20,000 develops a serious allergic reaction. Poorer children were twice as likely to need treatment as those from more affluent areas, he added.
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