Listen to June O’Sullivan talk candidly with Dr Linda Greenwall – founder of the charity, Dental Wellness Trust about the urgent need for free supervised tooth brushing programmes to be implemented across Early Years settings and schools.
According to the latest figures by the Local Government Association which show nearly 45,000 hospital operations were performed to remove children’s rotten teeth during 2018/19 as a result of tooth decay and high sugar diets – never has there been a more pertinent time to address this preventable crisis.
Although tooth decay does not discriminate, it is strongly associated with deprivation and social exclusion says Dr Greenwall. This was made worse during 2020 when dental practices were forced to shut and many children were unable to attend appointments as well as their nursery. Alarmingly, almost three-quarters of children have not seen a dentist since the start of last year – despite recommendations that children have annual check-ups.
Better dental hygiene taught at an early age will have long term benefits for children’s teeth, fewer nursery days lost and better overall health and wellbeing of our children.
I'm very pleased on talking early years to have Linda Grima with me who is going to introduce herself in more detail, but is a great campaigner for oral health. And you know, the issues of tooth decay with so many small children. So I'm kind of going to treat Linda like she's the tooth fairy. And she's going to talk us through some of this stuff. And actually, while this is a podcast at the moment, actually, she's, she's live in front of me here from a dental surgery, in our dental garb with her mask, and the whole lot all around. Feels very strange, at the same time, very connected. So very, very big welcome to you, Linda, to talking early years. And perhaps you'd like to tell our audience about you, and what you do and your charity and all the work you've been doing. Okay, so, my name is Linda Greenwald. I'm a dentist, and I qualified in South Africa in 1984. And I then came to London, and I did specialist training and to do advanced restorative problems. And my master's research was actually on tooth whitening. So I do a lot of teaching on teeth whitening lectures all over the world, which is now all on zoom about tooth whitening and cosmetic dentistry. And 11 years ago, I felt it was really important to be able to reach more people and give back and I looked at what I can do to give back and we set up the dental wellness trust, it was something that was very close to my heart. And I planned for three years to set this up. And when we looked at what can be done and how we could do it, we realised there's so much need that's not being attended to. And so we set up the dental wellness trust and what we started firstly in South Africa, where I'm from the Cape Town, and in Cape Town we look after 15,000 children, and we do daily tooth brushing with them. We have amazing women called toothbrush mamas, which in the UK, they wonderful teachers that are toothbrush mamas they named them, they named themselves that name. They go to the schools every day, and they check on the brushing and they check on the sustainability. During COVID. What happened is that people were out of work in Cape Town because of lockdown. And so we are toothbrush mamas set up 13 soup kitchens, and between March and December, we actually served 100,000 meals, wow, the children in our communities where we do our tooth brushing. So it's called out the charity is called dental wellness trust, because wellness is very close to our heart. And it's not just dental, because if you don't eat well, and don't have a nutritious food, it affects everything. So especially in our soup kitchens, we made sure that the children had nutritious meals, and that they continue to wash their hands and COVID is absolutely essential, and continue to brush their teeth. And we then took the information that we learned all our experiences. And we brought it to London and to England and we implemented tooth brushing programmes. And we do that now in 50 schools and nurseries with the same programme the hand washing and the tooth brushing. It's very interesting, there is so many things that you just said they're very interesting. But the one thing that's really shouting out at me is the business of wellness. And obesity is a big issue in London with child obesity, and, and the nutrition and interesting again, we ran a number of school and food banks during well before COVID but more in COVID but one of the things I noticed as well in in food banks is that people don't necessarily put healthy food into the food bank so they're one wonders about you know, how do you balance be grateful for what you get bread the other hand is actually the food that you wouldn't choose to give if you had a choice kind of thing in terms of its healthy healthiness in terms of its ease and easiness to cook and also the in terms of its sort of taste value for children. So I just just wonder a bit more about about that and because I'm assuming and I again correct me on this is that what you know, poor teeth cavities are caused bombed by a lot of sugar, is that right? Absolutely. So the tooth decay is majority related to sugar and not brushing. So the sugars related to the diet and also related to snacking and having sugar every hour for example a child will eat one sweet and then not eat another sweet and then another sweet thinking only if I just have one little sweet that will be okay but actually What we know about sugar is that if you are going to have your sweets, then just have them all in one go. We discussed you can't deny children sugar, or you can't deny them sweets, because that could lead them could to be completely obsessive if they go to a birthday party. Although no one's having birthday parties at the moment, if that child is denied sugar goes to a party and there's a tray of sweets, the child will empty those sweets in their pocket to take home, because they've never seen the sweets. So you have to have, you have to be realistic and practical. I have four sons and four boys that I've had to bring up. And I have this constant discussion about sugar, and all those things. So it's a little wall that we that we have in our family in terms of what we do eat and what we don't eat. So what we discussed was that we can have sugar, we our sugar time is Saturday after lunch, and then all the sweets get eaten then, and then they go and brush their teeth rather than just have a sweet that's what the research shows you if you constantly have sugar, that's when the pH drops in your mouth. And then the sugar bugs start to proliferate. So it's all about saliva and healthy eating. But when you come back to what is the most important thing, there's some simple ways in terms of what we can eat healthily that is cost effective and not expensive. So of course, we would like fruit. We would like the children to eat fruit, and we've banned all fizzy drinks, no drinks whatsoever, and very much we have a campaign and dental wellness, just about all the banning of all fizzy drinks. All of those sodas, not none of them the energy drinks, the sodas, the all of that none of them contain any nutritional value. And when we started campaigning, I took them all out of my house. They're completely banned. And we have water. And we have occasionally we might have fizzy water, but that's it. We just stopped it immediately. Interesting on that. On that note, actually, it's interesting about the fizzy drinks and stuff. But one of the things that many parents were completely a bit crap, but a bit cranky with me was the business of fruit juice. So at least it's milk or water. And oh, yeah, no choice. That's it. Um, but they used to think that fruit juice was good and it full of you know, vitamin C, and it's good for your children because they wouldn't eat fruit for them. So can you just blow apart the myth about fruit juice for us before you move on because it should, I think we get but fruit juice people are very confused about. So if it was just freshly squeezed, if it just an orange and squeeze, that's a different story. But the the storebought are introduces particularly apple juice, there contains so much added sugar. It's like just putting sugar water on your child's teeth. And unfortunately, we see so many incidents of parents who've been giving their children apple juice thinking it was healthy, and the child got a mouthful of tooth decay. And then we have to work on a strategy to balance it to reduce it. And to stop it but they have to they have to the the juices are really not what they are what we perceived as being healthy because of the added ingredients. And the trouble is that the apple juice will stick on the children's teeth, particularly between the teeth, they sipping it slowly etc. causing these cavities which are devastating. They're not tiny cavities, they're absolutely devastating. So yeah, we just we really advise no Apple, just if you really, really have your child is screaming for an apple juice. And there we used to have apple juice, you start by diluting diluted by half and then diluted by half that had only looks like apple juice, but it's really water. And it's us to train and educate our parents who we look after. And the kids. Once we teach the kids about healthy eating, they will also they're quite delighted with that in terms of discussing with their parents everything they've learned that sometimes when we have rhymes and songs about fruit and what should be in my lunchbox, and how we throw away the sugar. We throw away the sweets and the children educating a kid right from the beginning on healthy eating and tooth brushing and and hand washing sets a child up for life. Because they can then take responsibility for their own health even though they little they can wash their hands Well, they can be taught to brush their teeth, brush their teeth well so that they can have a healthy, healthy, healthy Foundation, which is really key. And that's the same and so we would assess the diet. We assist the diets of the kids when we see this decay because some of the severe decay has this very controversial but severe decay has also been linked to child abuse because they say how can the child that gets so much decay absolutely devastating, and that they've done studies about this. As to assesses I'm not saying one cavity But if you can, it's the parents role and responsibility to keep their children healthy. Yes. So when you say cavity, Linda, you mean a hole in your tooth, I mean, a hole in the tooth. Yeah. And the way that it starts, it can start as a tiny little tiny, tiny hole on the biting surface of a child's tooth. But often there's the decay is in between the teeth, which is really difficult. And that's where it's progresses. And on baby teeth that can progress very, very quickly. So the key is to have to brush with a fluoridated toothpaste. So they're getting enough protection from the fluoride in the toothpaste and toothbrush properly to remove the plug off the healthy off the surfaces of the teeth. Just just for a second then. So we have seen children where they've basically got stumps, just stumps, rotten stumps in their in their mouths, and there was a there was talk and again, blow this out of the water are corrected in whatever way you like. But is it true that one of the biggest causes for small children under five going into hospital is to do with teeth and tubs decay? Absolutely. And the figures are quite severe. At the moment, I'm just I just checked on the figures again, but over quarter 26% of five year olds in London suffer from tooth decay, making London the third worst area in England in terms of childcare outcomes. After the Northwest and Yorkshire and Humber those are the two Those were the 2019 data, you know, with with COVID, it's a little bit the stats are different. But we do know that 48,000 kids go into hospital in England every year to have a general anaesthetic to have the rotten teeth taken out. And that is huge. And when I heard about this, because I thought how can there be there's a sophisticated National Health Service, how can it get to that level. And it's very, it's very sad for me and I often speak to parents about how we can prevent all that. And it's one of the key things for the charity, to educate about how we can prevent this from happening from the children going having to go into hospital. The other big thing is that 30% of us not attending school is because the child's got toothache. Really. Yeah. So what we've been looking at with when we implement our tooth brushing programmes in school, is the amount of time missed from tooth ache or having to go to the dentist should reduce because the children are brushing their teeth in school, and they have an improving the health of the kids teeth. And just by the way, the right to oral health is a basic human right. Yes. And also, I mean, again, correct me if I'm wrong, but my assumption is that actually having teeth is important in terms of learning to speak, that it surely must have some impact on the way the mouth and the gums are used about the muscles in the mouth and all of that. So you want to just kind of kind of explain that a bit to us, the teeth that the mouth, the teeth and the tongue all have a responsibility in the speech and the growth in the mouth. And the teeth that you know the teeth develop at various stages, that first tooth comes through at the age of about six to nine months, the baby tooth comes through, and all that we need our teeth to function to eat, to talk to communicate. And also for parents when we smiling. Yeah, as a child with rotten teeth with stumps in their mouth will feel embarrassed to smile and low self esteem because of the state of their teeth. They do notice it. Then the other children respond one day we were teaching in school. And we were teaching tooth brushing and the little one of the little boys. His teeth were all black and the kids all teased him to say wow, this is terrible. Look, your teeth are so black, they're so dirty. And he's not brushing, he was very shy and humiliated by that. So we need our teeth for all these functions, especially communicating and smiling. Now that's a really good point the smiling actually because you forget about that. But um, and then how important though is in terms of communication, given the whole COVID thing actually we should be more alert to that than ever really what when you're either on a screen are you're using you you know you're you're the you're reading, you're trying to read people a bit more effectively through a screen so to be able to smile, it's actually quite significant. Absolutely. And some of our patients my adult patients want to be zoom gorgeous. So then when they are on zoom, their teeth look gorgeous and we're working on that as well. But it's really very key for the child health and development to have a healthy mouth and be able to eat without pain. And when the child at a major life event if a child has to go into hospitals and have a general anaesthetic, and, you know, you want to avoid that at all costs, so you were talking about the child with stumps, that is normally from nursing bottle decay, where the child goes to sleep with the bottle, or they put juice, when they put apple juice in the bottle and the child is sucking on the bottle the whole day long. That's when the tooth would the the juice has also got acid in service, the sugar component, the acid, which is eroding the teeth as well. And that's why they become stumps like that. And then yeah, talk about dummies as well, it's dummy. The dummy is a factor in all of this because I mean, that can be quite an emotive discussion point for for parents, for anyone you know, with a small child, we often think about the dummy as limiting the language that you know, but in terms of teeth, is it is it true, you call your teeth to be crooked and and the long term use of the dummy can call to what's called an open bite. And where the dummy forms, the shapes of the tooth is the the teeth become that angle where there's space for the dummy. And so that restrict the tongue growth, develop and restrict the teeth growth. And the child can talk with a list of etc. So there's times for dummies, I've just become a grandmother. And so I'm a little granddaughter now, and she does need her dummy for certain times when she needs to be pacified. So I get it. But as soon as you can, the damage should go. All right. factor as well. And then tell us a bit about how you think we I mean, I think there's an interesting debate about what we can do in this in the earlier sector and what parents do. And I think there's a tension sometimes between, you know, if we're cleaning the teeth with the children after lunch and stuff we are we're simply allowing parents to abdicate their responsibility to actually make sure that the child cleans their teeth at the end of the day before they go to bed, which is to kind of challenge that some of the staff say to me, Well, why are we doing that? Should they not be doing this as part of their home pattern? You know, is this not a parent responsibility? How do we get round that in in a kind of practical way? Given that actually, for some nurse, she's putting toothbrushes in and toothpaste and all of that is actually quite a you know, a practical nightmare? To be honest, you know? So how do we kind of persuade people that this is worth it? Well, the research has been very, very clear that supervised toothbrushes in school can reduce children's tooth decay from 20 to 40%. Wow, it's absolutely major. And when you look at what it what is the best thing we as communities can do. It's shown to be supervised toothbrushing programme, our toothbrush programme is called Live smart, because it's smart to live to live healthfully. And so I know that it can be time consuming for nurseries for earlier settings, and for teachers. But the health benefits far outweigh the time that it takes for children to do this. The other benefit is that the community health is a positive message. So children loved the programme. It's fun, they love it, that's a group activity. The child has learning manual dexterity that they're holding the toothbrush. But this active, this active participation in a group activity like this sustains their health for the rest of their life. It's really key. So although it may take a little bit of time, it's one of the most essential things that schools can do. And we would like to see all schools and all earlier settings implementing this in England, they have it in Scotland as well. And in Wales, designed to smell child smell programmes. But this is absolutely one of the key things that we can do. And you say, well, we therefore education not only education, but health but the two programmes running together health and education in this makes a huge, huge difference. It's absolutely mega. And we appreciate all the schools that are doing the toothbrush, we'd love to do more. And we we've had Colgate support us so we have the toothbrushes ready to educate and help implement in more schools. If for some children, the only time they clean their teeth is in the nursery, because the parents don't do it at home. How does that impact on their general oral hygiene and health and well being? What we've discovered is that at least if the child does it once a day in a supervised setting, that's a major thing. Parents with multiple kids and exhaustion and getting dinner ready and getting the child out in the morning. You know there's a lot of responsibility on parents and so they don't have to have time to supervise brushing or they don't have time to nag the child or they're absolutely exhausted just making dinner in the evening to be able to do the soap It's an added benefit, it would be great if the child is brushing in the morning and the evening. But the reality is that it doesn't happen. So that's why that is why in the school, it's the most advantageous thing to do it as a group activity. So so because I know a number of my staff said, What's the point, if we only do it once will that matter, but you're saying it actually matters once really matters once thoroughly. And because the way that the programme runs it, we put on some fun music and the time it's time together, and the teachers supervising that actually are brushing, we watch the manual dexterity, but that kids are actually brushing, and they're getting the toothpaste in for those two minutes. So they are brushing quite well, which makes sense, rather than sucking, because every time they say something, or biting the brush, right? So they are actually and but because it's a group activity, and they're learning from each other, and they're learning from the teacher, it actually makes a huge difference. And the research is quite profound on this making a huge difference. And then the last thing that staff often ask about as well as the toothpaste, so when my children were growing up, I simply gave them a smaller amount of Colgate, you know, whatever I was having they had, but then then they invented all these children, ones with fancy names and little dinosaurs on it. And with flavours and everything, which, you know, are actually quite pricey for one. Yeah. So, you know, doesn't matter if they use ordinary toothpaste, just smaller amounts, we like the children, or children under three to use a grain of rice sighs so it's really a tiny, tiny mouth. It's like a little smear, right? Tiny a grain of rice. So you just basically, tip just put it on very, very slightly. And when we teach up to the teachers, we teach them how tiny is a grain of rice size. And a child over three should have a pea sized amount, right? It's also very little because most nozzles are quite thick. Yes. And you can bring it out onto the brush. So it's really at the tiniest little really little pieces is quite enough. Then there's discussion between the parts per million fluoride. So under three, they have less fluoride. So that's 1000 parts per million. Over three, they have 1400 parts per million of the toothpaste. You know the adverts used to show a long piece of toothpaste on the whole brush. Yes, yes, that's absolutely not necessary because they want you to buy more toothpaste. Yes. So it's really the tiniest little bit. And it's actually the brush touching the teeth. And the last thing we teach, which is really key for everybody is to brush your tongue. The tongue brushing is really key because the bacteria, the sugar bugs, the halitosis bacteria, the stagnation, bacteria all in your tongue. If you if you stick your tongue out, and you brought bread from the left side, to the middle side to the right side, and you just do three swipes, that makes a huge difference of brush of all that bacteria harbouring in the tongue. My goodness. And then the so is it true that now people are saying you should brush your teeth dry. You can brush your teeth drive you don't have to the the rule is spit, don't rinse. So after you brush your teeth with the toothpaste, you spit out you don't have to renew you don't have to have your tooth brush wet. You don't you know people when they put the toothpaste on, and they put the water on and then they stop brushing. Yeah. So when I'm brushing their own teeth, I will actually check in the mirror. And sometimes I do brush dry just to see that I'm getting off the block. And then I'll put the toothpaste on. But you don't have to do long as you spit. Don't rinse is the message. So the days of putting your head on to the top and having a good ol rinse are over. Absolutely. So before we go cuz this is the most interesting I have to say for lunchtime podcast. And is there anything else you you think any other bit of good advice before we can we conclude this? So I think also discussing for snacks what kids should have for snacks. Okay, introducing healthy snacks, taking away rewarding children with sweets. There could be other reward systems such as a pencil stationery, an apple of fruit, a trip, walk around the block with Mum, something rather than just easy, easy things such as sweets, and there's so many. If you introduce the snacks quite early, the fruit, the hummus, the rawicz that was what the child knows and they don't look to go for sugary snacks. Because this is you know that the healthy eating is really really key so that you'd find that in every night. And with most childminders would provide that sort of thing. The one thing we did get caught up on was for a long time, we all thought reasons were a good option. And then we were told them or not. So that that that was a bit of a shock to everybody. I think that the reasons do have some they actually lower your blood pressure. But they do have some they do have some benefit in small amounts. It's always about quantity. All right, yeah. So you could still give them a few reasons. But but with water? Yeah, that's right. Yeah. But the cheese, things like cheese and crackers, and cut up fruit and rawicz. Those are all great healthy snacks. And that's what you should see in any decent nursery, I think, are with any Yeah, well, well, well thought out. childminding setting through so. And I'm sure they do that in the school. So that's good. So that is we've we've had quite a lot of truth, wisdom from the tooth fairy today. Wonderful. So I'm going to thank you very much. And I will do a blog to support this with all the links to the dental, dental, wellness, and to live smart as well so that they can easily access it. And I'm hoping that some people will take us up on that and that will introduce the tooth brushing at their home, at their nursery and anywhere else that they can persuade. Absolutely. Thank you so much. It was a pleasure. Pleasure. Bye Bye now. Our next podcast on talking early years would be with Anya Sater, who has just completed part of the coaching and leadership programme for London. And I'm going to talk to Anya about why coaching matters in the early years. Thank you for joining me today. If you liked what you heard, please share it. Check us out on our website.