Agenda item

The Director of Public Health submits a presentation on Oral Health.

The Director of Public Health submitted a presentation to update the commission on oral health in Leicester. It was noted that:

• Leicester had experienced persistently poor oral health outcomes across both children and adults. Over one in three children examined were found to have dental decay, and when enamel decay was included, the figure rose to over 42% of five-year-olds.
• These early signs of decay were particularly prevalent in the east of the city, which consistently showed the worst oral health outcomes.
• Aylestone was an outlier with much lower rates and required further investigation.
• Leicester reported the third highest oral cancer mortality rate in the country, highlighting the serious implications of poor oral health for the population.
• Analysis revealed that areas with water fluoridation and comparable deprivation levels had significantly lower rates of dental decay.
• Emergency tooth extractions were notably higher among children in the east of the city, suggesting that many were not accessing care until urgent intervention was needed.
• A new enamel decay indicator had been introduced to identify early warning signs before decay progressed further. Four in ten children aged five showed signs of enamel decay, and these were less prevalent in fluoridated areas, indicating the potential of water fluoridation as a preventative measure.
• Public health actions focused on leading the Oral Health Promotion Partnership Board to drive improvements and reduce inequalities.
• A formal request was submitted to the Secretary of State to consider water fluoridation across Leicester, Leicestershire and Rutland.
• Broader health improvement initiatives were promoted through the Live Well service, covering key areas such as diet, smoking including smokeless tobacco and E-Cigarettes, alcohol and physical activity.
• National campaigns like Fizz Free February, National Smile Month and Mouth Cancer Action Month were supported, alongside the distribution of oral health resources for people of all ages.
• A major focus was placed on the supervised toothbrushing (STB) programme for children. This evidence-based initiative was offered to early years settings and primary schools across the city and had contributed to significant improvements in oral health before the pandemic.
• However, the programme was paused due to COVID-19, and while it had since resumed, uptake had not yet returned to pre-pandemic levels. As of quarter three in 2024/25, uptake reached 45% in early years settings, 13% in primary schools and 33% in SEND schools. In total, over 4,000 children were participating in daily toothbrushing activities within their education settings.
• Efforts were made to increase programme participation, particularly in priority areas, by reallocating and recruiting staff, developing mentoring schemes and enhancing educational resources.
• Surveys highlighted common barriers such as limited time in the day, implementation challenges and uncertainty over whether schools or parents were responsible. A community-based approach was being developed to address these issues and promote shared ownership.
• Leicester received £119,088 in additional funding from central government to support the rollout of supervised toothbrushing in the most deprived communities. A collaboration with Colgate-Palmolive provided thousands of toothbrushes and tubes of toothpaste to be distributed to children. The funding enabled staffing and expansion efforts without needing to rebuild the programme from scratch.
• In response to high rates of oral cancer, a targeted adult-focused action plan was introduced. It aimed to raise awareness of symptoms, reduce risk factors and improve access to healthcare.
• Collaborative work took place with local communities to address specific cultural behaviours such as chewing tobacco and betel nut use, particularly within South Asian groups.
• Training was delivered to pharmacists and GPs to support earlier detection of Oral Cancer, and efforts were made to improve HPV vaccination uptake and system-wide data collection.
• Oral health support also extended to care home residents, with a strong emphasis on prevention and quality of life. Training was delivered to care staff, including managers and wellbeing champions, to support residents with daily oral care, including denture hygiene.
• Out of 94 care homes in Leicester, 14 had completed the training and 20 more were booked. The need to expand this programme further was recognised, with ongoing support provided through adult social care connections.

Following the presentation, as part of questions and discussions it was noted that:

• Members welcomed the focus on schools and endorsed the message that promoting oral health should be a city-wide effort, not limited to the most deprived areas.
• Leicester’s changing demographics added complexity to the issue. The main concern raised was the severe lack of access to NHS dental treatment and many residents unable to afford private care. New private dental practices had appeared, particularly along Narborough Road, but the number of NHS dentists taking on new patients remained very limited.
• There was a shared view that NHS dentistry was fundamentally broken, and that national reform was urgently needed. While some funding had been made available for urgent treatment in the region, this only addressed a small part of the wider issue.
• The current NHS dental contract was considered outdated, and members acknowledged that substantial national change would take time.
• Concerns over Leicester’s declining position on oral cancer outcomes were raised, despite previous assurances that care in the city was strong.
• Questions were raised around whether there was fatigue in early years settings, especially with pressures from other public health programmes such as vaccinations. It was suggested that a better understanding was needed of why some early years settings had disengaged from supervised toothbrushing, with many staff unaware of the need to brush children's teeth or unsure how to prioritise it.
• Although the toothbrushing scheme was available to all schools in the city, efforts had been focused on the most deprived areas due to stronger links between poor oral health and deprivation.
• Concerns were raised about overall population density and the insufficient number of dentists available.
• Members asked for clarification on how five-year-olds were examined and were informed that there was a statutory requirement for local authorities to carry out surveys in partnership with community dental services. In severe cases, follow-up care was arranged, while in less serious cases, information was sent home to parents. It was highlighted that new measures of dental decay could be reversed with good brushing, avoiding the need for fillings or other interventions.
• Discussions also covered the potential benefits and concerns around water fluoridation. While some members supported the idea, others raised concerns about individual choice, misinformation, and public hesitancy.
• National consultations were taking place in other parts of the country, but it was recognised that implementation would take time and funding remained a key barrier
• There was interest in the link between oral cancer and certain cultural behaviours, such as chewing tobacco or shisha smoking. It was confirmed that a working group had been established to explore the risks of shisha use, and that public health teams were working with communities and licensing services to raise awareness and reduce harm.
• The commission discussed the limited uptake of the supervised toothbrushing scheme, noting that only 10 out of 33 identified schools with high rates of dental decay had agreed to participate. Officers explained that the scheme was voluntary and efforts were being made to engage more schools through curriculum integration, parent engagement, and mentoring offers. Schools were aware of the scheme but fitting it into their day-to-day activity remained a challenge. The team was also working with libraries and book buses to distribute information more widely.
• Concerns were raised about toothpaste availability in food banks and suggested approaching supermarkets for local support or promotions. Officers confirmed that resources were being distributed through a network of food banks, but logistical challenges limited coverage. Donations of toothpaste and brushes were available and were being shared across partners wherever possible.
• Questions were raised around how to better target men aged 55 to 74, who are at highest risk for oral cancer. Officers responded that targeted work was being carried out in key areas of the city, using health improvement services to tackle smoking and alcohol use.
• It was noted that some areas such as Evington and Belgrave showed lighter shading on decay maps, potentially due to lower numbers of hospital extractions. However, the data could not be linked directly to individuals, and extractions might reflect other factors, such as injuries. Shisha and vaping were identified as areas needing more education, especially among young people.

AGREED:

1.    That the report was noted.

2.    NHS dentistry would be added to the work programme