Sir, whilst agreeing with Sharif Islam1 wholeheartedly that logically it should be the role of parents to socialise their children, the simple fact is that parents don't. Nurseries, playgroups and other pre-school groups have been reported in the press as commenting and complaining about having to change nappies for untrained children, encourage or teach children to eat with utensils, and show them how to put on shoes and other clothing. It is not surprising therefore that basic oral hygiene procedures may also be neglected.

However, bearing in mind the considerable financial, resource, and psychological burden of dental disease in children, and the responsibility of governments to act for their populations, some action is required. Water fluoridation, the most cost-effective route to reducing decay, appears to be stagnating. Other methods need to be sought.

The York Health Economics Consortium published a rapid review of evidence on the cost-effectiveness of interventions to improve the oral health of children aged 0-5 years in 2016.2

The results were summarised by Public Health England3 including an infographic (Fig. 1) summarising the return on an initial investment of £1. After water fluoridation and targeted provision of toothbrushes and pastes by health visitors, targeted supervised toothbrushing came third with a return of 366%.

Fig. 1
figure 1

Comparison of cost efficiencies of oral health promotion interventions (Image courtesy of Public Health England. ©Crown copyright 2016, under the Open Government Licence v3.0)

Full size image

The stated aim of health promotion is to enable people to be responsible for and have control over their health (and that of their children). Capabilities, opportunities, and motivations are given as the basic conditions for adopting appropriate behaviours. But as this appears not to be working in practice, surely it is the duty of government to do whatever it can, if only to reduce the financial burden on us, you and me who pay for the health service, and reduce the suffering of innocent children.