Supporting children’s oral health: Experiences of parents and caregivers of under-10 children

In September 2023, Buckinghamshire, Oxfordshire, and West Berkshire Integrated Care Board (BOB ICB) funded three Healthwatch (Healthwatch Bucks, Healthwatch Oxfordshire and Healthwatch Reading) to undertake a community-based research project to understand some of the challenges that parents and caregivers face when looking after the oral health of children under 10-years-old. The project was supported through the Core20PLUS5 Connectors initiative, a national NHS programme working to reduce health inequalities.

The three Healthwatch teams each recruited and trained five ‘Community Connectors’ – local residents interested in local health issues and with connections to their communities, and living in an area identified as deprived. They interviewed parents and caregivers in their community about their children’s oral health.  Together the Healthwatch projects heard from a total of 215 parents and caregivers, relating to their experiences of supporting oral health care to 271 children.

Participants represented a wide range of demographic characteristics and included parents and caregivers of children with and without special education and needs and disability (SEND). Main findings 

Parents and caregivers said they were involved in their children’s oral health, including supervising brushing, checking teeth and gums, and brushing their teeth.

Most parents and caregivers said they had an awareness of the risks of poor brushing and of consuming too much sugary food and drink. 

Many were concerned about their children’s teeth and gums as well as being able to access dental care when they needed it.

Three broad areas of support helped (where available) parents and caregivers care for their children’s oral health: 

• Behavioural support – teaching good oral health using educational resources (e.g. games, videos, songs, television programmes), positive routines, and watching siblings or parents brush, rewarding good hygiene, and supportive supervision. 
• Practical – including buying special toothbrushes and toothpaste, using timers for brushing, brushing together as a family, reducing sugar intake, and being flexible with brushing routines. 
• Professional – getting information and advice from dentists, health visitors in the early stages of child development, their children’s school, and through healthy eating at school. 

Parents and caregivers faced challenges in four main areas: 

• Awareness and education – gaps in knowledge and understanding of oral health and dentistry services, lack of information and advice, including tailored information for families with children with additional needs. 
• Behaviour and practice – including children’s resistance to brushing teeth, sensory issues and limited dexterity of children with additional needs making it difficult for them to tolerate brushing or dental treatment. 
• Family and caring – challenging family and personal circumstances, difficulty managing their children’s diet and sugar intake, and the need to buy special toothbrushes and toothpaste. 
• Access to dental care – finding and registering at a dental practice, getting an appointment, language barriers for people whose first language is not English, and options for families with children with additional needs. 

Most parents and caregivers said they had registered their child or children with a dentist and most children had visited a dental practice twice or more in the past year. However, some children were not registered and several had not recently been seen by a dentist. Families said they found it difficult to find a local NHS dentist to register their child or to get treatment for a dental problem. 

Parents and caregivers of children with additional needs found it particularly difficult to find dental care that met their child’s individual needs. Not all of them knew about alternative support such as community dental services. 

Parents and caregivers had mixed experiences of getting dental appointments. Some experienced long waits or unavailability, cancellations, emergency-only appointments, and inflexible booking times. 

Parents and caregivers recognised that the Covid-19 pandemic had affected the availability of appointments. Experience of visiting the dentist 

Parents and caregivers were mainly positive about their children’s visits to the dentist. 

Positive experiences focused on dental staff giving useful advice, clear explanations, and having a child-friendly approach. 

Parents and caregivers of children with additional needs valued dental practices where staff understood neurodiversity, accommodated their children’s needs, and provided supportive care. 

Negative experiences included environments that were not SEND-friendly, insufficient appointment times or delayed/cancelled appointments, and frequent changes of practice staff. 

Parents and caregivers offered many suggestions they felt would improve children’s oral health. These broadly focused on: 

• Expanding oral health education and information to all children and adults, including advice for supporting children’s dental care and home, and tailored information for parents and caregivers of children with additional needs. 
• Oral health promotion activities aimed at healthier food, oral health in schools, and better oral hygiene practices. 
•  Increasing availability of NHS dentists and appointments. 
• Promoting awareness and a SEND-friendly approach in all dental practices. o Integrating services to encourage collaboration between health and non-health professionals. Improving access to language and translation support for people whose first language is not English, including written materials and interpreting services.