Blackburn-with-Darwen Council: Addressing the risk factors for tooth decay to improve childhood oral health

In 2019, Blackburn with Darwen had the worst childhood tooth decay rates in England: 51 per cent of five-year olds had at least one decayed, missing or filled tooth. Following the launch of a childhood oral health strategy in 2021, and through successful collaborative work with a range of partners, the number of five-year-olds with tooth decay has fallen by a significant 16 per cent in six years. 

Blackburn with Darwen is the ninth most deprived local authority area in England. Poor oral health is closely linked to deprivation and is demonstrated by the data for decayed, missing or filled teeth in the population. 

Tooth decay can affect children’s ability to sleep, eat, speak, play and socialise with friends. Other impacts can include pain, infections, poor diet, and impaired nutrition and growth – which can affect children’s ability to learn, thrive and develop. 

Oral health among five-year-olds attending mainstream schools is seen as a useful indicator to measure the impact of interventions to improve general health and wellbeing, including parenting, weaning and feeding practices, nutrition and school readiness. 

In 2018/19, Blackburn with Darwen had the highest proportion of five-year-olds experiencing tooth decay in England, with 51 per cent having at least one decayed, missing or filled tooth. This figure came from the 2019 national dental epidemiology programme (NDEP) oral health survey, which takes place every two years and collects information on five-year-olds at mainstream state-funded schools. 

Since then, targeted action by strategic partners in Blackburn with Darwen, led by the council’s public health team and involving the NHS, the community, voluntary and faith sector, schools and local residents, has seen year-on-year progress in improving the oral health of local children. 

Blackburn with Darwen’s public health team published the ‘Blackburn with Darwen Oral Health Improvement Partnership Strategy 2021-26’, which was developed in collaboration with partners and stakeholders. 

The strategy recommended whole-population and behaviour change approaches to address some of the common risk factors associated with poor oral health. It addressed the oral health of children and young people, vulnerable adults and older people. 

Public health has been working with a range of partners to deliver on these recommendations through interventions which are weighted towards communication, culture and behaviour change. These interventions include: 

• A supervised brushing scheme, ‘AP Smilestars,’ delivered by community dentistry provider AP Smilecare, running in more than 80 early years’ settings such as reception classes, children’s centres and nurseries, to equip young children with the skills to look after their teeth.
• Staff working in early years settings and other key staff, such as health visitors, receiving annual in-person oral health training, plus regular refreshers, through the AP Smilestars team.
• Supported by Food Active, ‘Kind to Teeth’ oral health parent champion networks offering peer support in the community.
• Toothpaste, toothbrushes and free flow sippy cups provided to children at their 8-12 month checks through health visitor teams, to encourage good oral hygiene from a very young age.
• Working with NHS England to ensure every child is registered with a dentist by the age of one.
• Targeted education programmes in schools with the highest rates of tooth decay, including Food Active’s ‘Give up loving pop’ campaign.

The results speak for themselves: the percentage of five-year-olds in Blackburn with Darwen experiencing tooth decay has fallen by 16 per cent in just six years. This progress has been consistent since the 2018/19 figure of 51 per cent, falling to 40 per cent by 2021/22 and to 34.8 per cent by 2023/24 (NDEP oral health surveys).

Abdul Razaq, Blackburn with Darwen’s Director of Public Health, said this approach had involved sustained effort, resource and commitment from all partners and from the community. “Good oral hygiene has a huge impact on children’s general wellbeing, their eating, speech, self-esteem and even their education,” he said. 

“Tackling children’s oral health is complex and we have addressed it by focusing on what works, support, education and behaviour change, working with a range of very supportive local partners.” 

Councillor Julie Gunn, Executive Member for Children, Young People and Education, said: “While we’re proud of how far we have come since 2019, we will continue to keep up the momentum of our oral health work to bring tooth decay rates down further. We’ve developed some really strong working relationships with a range of local agencies right across Blackburn with Darwen that have been a part of this journey.” 

The long-term vision is for an increase in children starting school with a full set of healthy teeth, who will then grow into adults and older adults with healthy, strong teeth and gums. 

Abdul Razaq said: “People are interested in how we have achieved our excellent results, and it’s based on evidence-based interventions and support. We have taken an approach of social mobilisation, peer education, support, the community and voluntary sector, a great series of providers who can get the job done, and working with schools around children’s health.

“We have an innovative family-orientated community dentistry provider who have been great in terms of providing services to children. Schools have taken up the offer, our communities and politicians have been great ambassadors for the oral health strategy. 

“We are making sustained strides through all that great collaboration work and the interventions are making a big difference. We will continue to enhance our local offer with the new national oral health supervised toothbrushing monies. Our success highlights that despite the challenges, we can make an impact if we have the right interventions.” 

For more information contact Charlotte Pickles, Public Health Specialist or Rachel Tyrrell-Smith, Public Health Development Manager: [email protected] or [email protected]