Dental neglect: A painful reality for 37% of Irish children

Those of us of a certain age remember angst-filled visits to the dentist as children. In the days before widespread preventive dentistry, needing a filling was relatively good news; being told you required an extraction was, sadly, not uncommon.

Deliberate dental neglect has only recently been recognised as a form of child abuse. Defined as “a persistent failure to meet a child’s basic oral health needs, resulting in a serious impairment of a child’s oral or general health or development”, some 60 per cent of paediatric dentists in Britain reported seeing cases of neglected dentition at least once a day.

A study of primary care dentists in the Republic, published in the Journal of the Irish Dental Association (JIDA), found that 37 per cent of dentists employed by the Health Service Executive (HSE) saw children with neglected dentition at least daily. According to Dr Evelyn Crowley, senior dental surgeon with Cork/Kerry community healthcare, and her co-authors, almost one in four HSE dentists saw children "who presented late with a serious dental problem that any reasonable person would have recognised as needing professional dental attention earlier".

Lack of awareness

Dentists surveyed felt that neglected dentition may not be recognised as neglect due to a lack of awareness and the low priority afforded to oral health in our society. Here is a reflection from one respondent: “The neglected mouth arguably is the neglected child. Just because there is no wanton physical abuse, the consequences of passive dental neglect can arguably be more damaging, with pain and poor nutrition and missing developmental milestones.”

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In the 18th-century teeth were extracted from poor children to be transplanted into the mouths of rich older people

Interestingly,Teeth, a newly launched exhibition at the Wellcome Collection museum in London, has social inequalities in oral health as one of two core themes; evolution of the profession of dentistry from backstreet barber to big business is the other.

Reviewing the exhibition for The Lancet, Richard Watt, professor in dental public health at University College London, says " the condition of the mouth is a barometer of your social status".

“Oral diseases are increasingly linked to socioeconomic status – a stark and visible marker of social disadvantage and deprivation. From early childhood across the lifespan to older age, oral diseases and their associated impacts are socially patterned in a consistent and universal way.”

The Wellcome Collection exhibition highlights that unfair and unjust inequalities in oral health and use of dental services are not a new phenomenon. A macabre etching by Thomas Rowlandson shows how in the 18th century teeth were extracted from poor children to be transplanted into the mouths of rich older people –"a somewhat gruesome example of social and intergenerational inequalities," according to Watt.

Blacksmiths

The exhibition illustrates how, in 17th and 18th-century Europe, only the rich had access to dental treatment: it includes examples of expensively crafted dentures made from hippopotamus ivory; and Napoleon's silver-handled toothbrush.

Meanwhile, the less privileged relied on barber-surgeons and blacksmiths for extractions to relieve their pain.

Over the past 50 years, there have been dramatic improvements in oral health in high-income and many middle-income countries. For example, in Britain in 1968, some 37 per cent of adults had no natural teeth, whereas by 2009 this figure had dropped to only 6 per cent. Groups who haven’t caught up, however, are those in lower income countries and the socially deprived in western society.

Which, as highlighted by the JIDA research, includes children in modern Ireland. The primary care salaried dentist is the only source for free dental care for children here, but access is limited due to poor staffing levels. This means not all poor dentition can be labelled as parental neglect; some cases are due to circumstantial neglect, whereby parents who want to access services cannot do so because of financial or other constraints.

It is regrettable that in an affluent society such as ours, some children are condemned to historic levels of poor oral health.

mhouston@irishtimes.com