Dental Health: Children

Baroness Gardner of Parkes Excerpts

Thursday 18th January 2018 Grand Committee

Asked by

[Baroness Gardner of Parkes]

To ask Her Majesty's Government what action they are taking to ensure that children receive regular dental examinations and any necessary treatment.

[Baroness Gardner of Parkes (Con)]

My Lords, it seems appropriate that the Committee should be discussing this subject today, as it fits in well with the British Dental Association’s campaign aimed at creating a greater public awareness of the need to ensure that children’s teeth receive the necessary care. In my view, preventive care is at the forefront of this.

I no longer need to declare a financial interest, as I retired from dental practice after about 35 years as a national health dentist on the fringe of the City, in Old Street, now known as the Silicon Valley of London, which underwent complete redevelopment of the 200 year- old small redbrick houses that were there in our day. The local residents were not keen on dentists, and came only when they felt their problems had become urgent. Patients were often not seen until their pain had become intolerable, and emergency extractions under local anaesthetic were fitted in for them between appointments—historically, at half a crown a time.

Sadly, local parents were unaware of the fact that permanent teeth, the first molars, erupt behind the baby teeth, and sometimes they were so badly decayed before they brought the child to the surgery suffering such severe pain that extraction was the only possible treatment. This was the worst possible start for a dentist-patient relationship.

Children who have regularly attended for dental check-ups or treatment are not upset at the thought of a dental appointment and have a much better prospect of taking an interest in their dental health throughout their lives. The system of school dental check-ups for pupils was of value, although one survey established that only one-third of those seen and advised to have necessary dental treatment followed that advice.

Sweets and sugary drinks have always caused damage to teeth, and I recall those vicious dummies—or comforters, as they were called—filled with sugary syrup, bathing the deciduous baby teeth with that damaging liquid. Sweets still seem to be blamed for most dental problems, but I do not intend to spend time on that aspect today, as I am sure others will. As a mother, I know how rapidly sweets become an addiction for children, and years ago I used to give advice that it is the 15 minutes after the sweet that matters, so it may be better for children to have a specific sweet time once a week, when they could have as many as they wanted, rather than the deceptive “just one” doing damage more often. Sweet drinks including an acidic element are a further problem.

In 1968, I was the first woman dentist ever appointed as a member of the Standing Dental Advisory Committee for England and Wales, and I served until 1976. I was an elected member of the General Dental Council from 1984 to 1986 and a governor of the Eastman Dental Hospital. I say that simply to make clear that I have never had any academic dental role, but was very involved as a basic national health practising dentist.

In 1988, I had the privilege of joining your Lordships’ House. I was particularly interested in the passage of the Health and Medicines Act 1988, and I moved Amendment 30 to retain free national health dental examinations for all. Realising that many Members of the House might not know much about the workings of national health dentistry, the day before the debate I spoke to as many Peers as I could find, asking that they attend and listen to the contributions before deciding how to vote. The responses were good and the debate was wide-ranging. My dental colleague, my noble friend Lord Colwyn, made an excellent contribution—I am grateful to him for speaking again today. Other speakers in 1988, the noble Baroness, Lady Masham, and the noble Lord, Lord Stoddart of Swindon, were both very supportive in helping to draw attention to the fact that all forms of health screening were free for national health patients. The amendment to retain free national health dental examinations was carried by 118 to 97, a majority of 21.

Following this, the Deputy Chairman of Committees called Amendment 31 and I intervened to say that he had told us that if Amendment 30 were agreed to, 31 could not be called. His reply was somewhat revealing:

“That is quite right. I was so surprised at the last result”.—[Official Report, 19/7/1988; col. 1239.]


Sadly, when this went to the Commons, the amendment was reversed by 300 votes to 284 and financial privilege was attached, so we were not able to re-debate the matter. I believe that this was the beginning of the end of national health dentistry as we knew it. My husband did beautiful crown and bridge work and patients would often ask him, “If I paid more, could I get a better crown?”. His reply was always, “No, everyone gets the best crown I can do”. He was a gifted silversmith, with his own hallmark and a liveryman of the Worshipful Company of Goldsmiths. He was one of many dentists with successful general national health dental practices really caring for their patients.

All national health dental treatment for children up to the age of 18 remains free now, but there are so many areas where there are very limited, if any, national health dental practices. The children no longer go along with their parents and are examined at the same time, as the parents are not going. There are, as I say, whole areas where NHS dental practices hardly exist. Last year, I was shocked to read that no NHS places for general anaesthetic surgical beds were available in Manchester, as all were taken by children requiring full clearances of their deciduous teeth.

Over some years, I have been asking both Written and Oral Questions on the difference in health patterns between Birmingham and Manchester, and the toothy answers are referred to as DMF—decayed, missing and filled. Birmingham has the best DMF and Manchester the worst. Apart from that—and I emphasise this—there is no difference in the health pattern. Birmingham has had a fluoridated water supply since the 1960s, so it has certainly been tried and tested over a long period. I emphasise that there is an optimal level which has to be constantly monitored and adjusted by the water authority by either adding or removing fluoride from the water supply to maintain this optimal level.

Australia has generally had fluoridated water supplies for many years. I visited a nephew of mine, a Sydney dentist who looks after the pupils at one of the big schools. He told me that he could tell by looking at their mouths the boys that came from country areas where the only water supply was rain water or river water. There was a markedly worse dental condition in those not benefiting from the controlled optimal-level fluoridated water supply. Time has moved on and there are now many fluoride toothpastes which help to maintain dental health, but optimal-level fluoridation of drinking water would be much more effective.

For a number of years, I have tabled Questions, usually for Written Answer, to establish the difference in general health and dental health between Manchester and Birmingham. I have chosen these cities as large successful cities which aim to provide their residents with the best possible healthcare. Birmingham has had a fluoridated water supply since the 1960s and Manchester has not. All health conditions in the two cities follow similar patterns. The one major exception is dental health. DMF in Birmingham is 0.8 and in Manchester—where it is the worst—it is 1.3.

Last year, I found it very disturbing to read that children in Manchester were taking up all general anaesthetic beds in order to clear their deciduous teeth. Apart from the pain and discomfort that these children would have suffered to reach this sad dental state, it will continue to cause problems, even when those teeth are all out, as the presence of the primary teeth maintains the space as the jaws enlarge to receive the larger secondary teeth. Many of the children who have had premature extractions will require lots of orthodontics to enable the secondary teeth to come into normal alignment.

My time is limited, so I shall conclude by quoting the recent statement from Australia’s National Health and Medical Research Council following a comprehensive study which makes clear the optimal and proper level of fluoridation for dental benefit without any adverse effect on general health. The statement that the council has put out is very strong and, as an Australian, I think I am entitled to quote it:

“It shows that community water fluoridation, as it’s used in Australia today, is effective at reducing tooth decay and is not associated with any general negative health effects”.


The headline states:

“With 60 years of data and 3000 studies”—


more than considered anywhere else in the world—

“Australia declares fluoride ‘completely safe’”.

I hope that we will really encourage the authorities here to look into this, as it would help children so much.