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teeth. In many clinics the child is often shown by the surgery assistant who has received special
training for this task. Tiny children are unable to use the complicated techniques often taught to
adults and mothers often feel that the job is not being well done when the child uses the "scrubbing"
movements which come most easily. In fact, many experts now recommend that this is the best way
of cleansing the teeth.
It has been disturbing to see an increasing number of Asian pre-school children with rampant
caries—this may mean extraction of as many as eight teeth or more before the child is four years old.
These are children born in this country but a common factor is heavily sweetened milk given in a
bottle at night to children well into their second year. Where possible, health visitors have followed
up the children and given the family further instruction in the home. Language and cultural differences
may mean our help is not as effective as it might be. Many parents cannot understand why their
children's teeth decay. They, themselves, often have excellent teeth as they have frequently had
fluoridated water, particularly those from Kenya and some parts of India.
Handicapped children present many management problems in the dental surgery so a dental
officer has established a routine six monthly visit to the Wren Playgroup for Handicapped Children
in South Ruislip. She has visited when the mothers were present at a coffee morning and has found
them appreciative of advice on dental health. The children's teeth were also examined so that any
dental disease could be found and treated in the early stages. We are now aware that gum diseases,
ranging from a mild inflammation to chronic inflammation destructive of bone supporting the teeth,
can be found in young children. It may be particularly severe in some handicapped children.
Visits by dental officers to day nurseries have continued but lack of staff has meant that these
were not as frequent as would be advisable. A number of children have been found to need dental
treatment and they have been brought to the dental surgery by members of the day nursery staff.
This is of considerable help to single parents.
Talks on dental health are being given by dental staff to all expectant mothers attending antenatal
classes. Difficulty was experienced in the first half of the year as some ante-natal classes were
held at clinics where the dentist was only present for a few sessions a week. Adjustments have now
been made so that all mothers now receive dental health education. The aim is to inform them about
their own teeth and the problems they may encounter with their children. The majority of mothers
receive their dental care from general dental practitioners under the National Health Service.
Efforts have been made with newsletters to inform the dental practitioners of the message we give
to mothers so that we combine our efforts to give the most effective service.
The survey of dental health of five year old children in the Borough carried out in 1971-72
illustrates that there are still many pre-school children with untreated dental decay. Parents may be
unaware of the problems caused by extraction of baby teeth and may also be unaware that treatment
is available at the school dental clinic. Fortunately many children also attend the family dentist and
this is encouraged as the dental clinics would never be able to provide all the examination and treatment
facilities required. The emphasis must be on a joint effort by local authority and family practitioner
services.
Mentally Handicapped
The dental department is being approached with increasing frequency by parents of mentally
handicapped young people requesting help with dental problems. A dental survey of adults in
Uxbridge and Hillingdon Training Centres was carried out in April 1972 to assess the need for dental
treatment. It was estimated that 87 per cent of the adults aged sixteen years and over required dental
treatment. Their needs covered the whole range of dental services; fillings, dentures, gum treatment,
surgery and oral hygiene instruction. As only 45 per cent of mentally handicapped adults attend
training centres in the Borough, and the majority of the remaining 55 per cent are at home and
unemployed, the need of this group of people for dental treatment is probably great. A service is
being provided to advise parents where they may obtain treatment and arrangements have been
made with local hospital dental departments to see selected patients. However, it seems evident that
present services are not fully meeting the needs of these families. Expansion of existing services,
particularly hospital and local authority hospitals, depends on recruiting specialist staff experienced
in treating the mentally handicapped.
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