Agenda item

The Committee received a presentation from the Director of Public Health on the Oral Health Promotion Strategy which provided a data summary and details of the oral health in children in County Durham; County Durham’s oral health promotion strategy 2023-2028; supervised toothbrushing in County Durham; oral health strategy action plan; community water fluoridation and the next steps (for copy of presentation, see file of minutes).

Councillor Hovvels indicated that water fluoridation in the water was important and stated that it was an inequality right across the area as not all water within County Durham contained fluoride. She continued that she was interested in the outcome of the bid to the ICB investment board for funding to extend and expand local delivery and the timeframe and type of investment.

The Director of Public Health responded that in terms of inequalities community water fluoridation was not right across the County. The Council was waiting for the outcome of the Government consultation on the potential extension of the Community Water Fluoridation from the DHSC. The outcome of the ICB bid was imminent but they were also looking to see if there was anything else that could be done locally to extend and expand local delivery such as the supervised toothbrushing scheme.

Councillor Quinn raised concerns with regard to NHS dental appointments and difficulties registering children with an NHS dental practice. She stated that when she was a child water contained fluoride, and you drank water and questioned how many children actually now drink water from the tap.

The Director of Public Health responded that dental access would be covered under the NHS Dentistry Update. She continued that they were doing everything they could in terms of oral health promotion alongside Dentistry service access issues. They would like to see some of the oral health promotion work in early years extended to mitigate against the suspension of the supervised toothbrushing scheme during COVID. The Director of Public Health reiterated the importance of extending community water fluoridation to ensure that oral health inequalities were eradicated across County Durham and the wider North East. She stated the introduction of high fat, salty and sugary foods which are cheaper and more accessible than healthy food was exacerbating poor oral health. This was why the strategy could not sit in isolation it needed to sit alongside the work carried such as healthy weight strategy and work on high energy/fizzy drinks.

Councillor Quinn stated that the interventions in schools do work.

The Director of Public Health indicated that free toothbrushing packs were distributed at family hubs to make it as easy as possible.

Councillor Hovvels referred to the work carried out in Shildon around sugary drinks and asked the outcomes from this research.

The Director of Public Health responded that this work had helped to reform the policies that they were looking at locally in terms of the restriction of advertising high energy drinks. The research helped to inform some of the national discussions in terms of advertising and healthy weight as it was a published piece of work.

Councillor Lines referred to the data relating to children’s oral health and asked how robust the data was as he was concerned that people were ignoring issues and using over the counter painkillers as an alternative treatment where dental appointments were unavailable.

The Director of Public Health indicated that whilst the quantitative data was robust the service needed qualitative data to sit alongside this. She stated that this may be something that they look at as part of the strategy and get an understanding from local residents.

Councillor Lines stated that the reality was that there was a much bigger problem.

The Director of Public Health responded that their concern was the existing oral health inequalities and that was why the Oral Health Strategy was so important.

Councillor Lines asked if they encouraged people to speak about the issues and not ignore them.

The Director of Public Health stated that Healthwatch had undertaken an extensive piece of work on dental access and would recirculate the findings from this work.

Healthwatch County Durham confirmed that they had nearly 4,000 responses across the North East and Cumbria.

Councillor Adam referred to the consultation with the Health and Wellbeing Board and the Children and Young People’s Overview and Scrutiny Committee, but no consultation was held with the Environment and Sustainable Communities Overview and Scrutiny Committee notwithstanding that adding anything to the water had an environmental impact. He stated that he was not against fluoridation in the water and referred to research in America and stated that it was a toxin material and adding a toxin to a water supply was going to have an impact on the environment and the health of human beings. He continued that it was not to help human growth and was for help with oral health and asked how fluoridation could reduce tooth decay when we already had a supervised toothbrushing scheme and widespread fluoride toothpaste usage.

Councillor Adam also asked what evidence suggested that people were drinking tap water rather than bottled water and if more people consumed bottled water how would water fluoridation impact on levels of tooth decay?. He asked for the timescales for introducing fluoride into the water system. He also questioned the strong scientific evidence that water fluoridation was an effective public health intervention stating that some reports from the European Union and the Communities Health and Environmental Risk Committee who looked at the risks had stated that a large proportion of the European countries don’t have fluoridation in the water supply due to health concerns. He stated that there was a risk if you get too much fluoride and asked how this was controlled and that 80% of five-year-olds were using fluoride toothpaste and mouthwash and asked about the impact of over provision of fluoride.

The Director of Public Health responded that in terms of the consultation the Health and Wellbeing Board oversaw the Oral Health Strategy and was the Board to formally respond to the consultation. It was also opened out to the Adult’s Wellbeing and Health Overview and Scrutiny Committee and Children and Young People’s Overview and Scrutiny Committee and stated that a joint Health and Wellbeing Board and Environment Partnership development session would be held in April that could look at some of the issues and advised that the consultation also went out to others to respond to. She continued that they do have an existing community water fluoridisation scheme in some parts County Durham that had been in place since the 1960’s that was safe, effective and was highly regulated. Fluoride was a naturally occurring mineral, hydrofluoric acid which was the chemical that was regulated and approved nationally for that use. From an environmental point of view the carbon footprint of dental care if this can be reduced further it outweighs the impact in terms of environmental impact. From an evidence point of view, an evidence briefing was produced which looked at national and international evidence and believed that fluoridisation was a cost-effective intervention form a public health and inequalities perspective. The government was looking at the evidence and it was a Department of Health decision whether to extend fluoridation. She stated that the fluoridation in the American study was at a higher level that that proposed for the North East.

Councillor Adam referred to the inequalities and stated that he did not see in the 2023 strategy that they were tackling the dietary issues. He had watched a programme on healthy eating for children and additives added to make the food more appetising and encourage children to eat more of it. This had a greater impact causing tooth decay and stated that he was pleased to hear that they were carrying out tooth brushing and asked why the strategy does not focus on dietary habits and not consuming sugary drinks.

The Director of Public Health stated that they needed multiple interventions in terms of inequalities. She continued that this strategy sits under the joint health and wellbeing strategy and their core priority was around healthy weight and a high focus on good food in terms of a sustainability and an access point of view. They measure children and have a high level of children who are overweight and have an extensive range of interventions. They have an existing policy around takeaways in close proximity to schools and advised Members that a report on child obesity would be going to the next Children and Young People’s Overview and Scrutiny Committee and they may bring a report to this committee to show the work in relation to food and physical activity.

Councillor Robson stated that other countries don’t have issues accessing dentists, but you can’t access an NHS dentist in towns and referred to the successful stop smoking campaign and asked if something similar could be done for teeth cleaning.

The Director of Public Health referred to the joint work and communication was important and linking to some of the community organisations would be a good way forward and stated that dental health had improved over the years.

Councillor Hunt asked around the data for the enforcement in relation to the supply and purchasing of energy drinks.

The Director of Public Health stated that she would take this back to the community protection team and obtain details of the programme.

Councillor Hovvels stated that test purchasing was in place, and they do target areas.

Resolved: That the contents of the presentation be noted.