Introducing ‘Lift the Lip’ into health visits to improve early childhood oral health

Mary Wilson, Consultant in Dental Public Health

Public Health Wales

This Bevan Exemplar project aims to introduce a simple oral health assessment into the routine practice of health visitors.

Background

Tooth decay in children is more common in deprived communities and these groups are less likely to visit a dentist. Lift the Lip is a simple oral health assessment tool for pre-school children. It involves visually examining the front upper teeth to identify early signs of tooth decay. In Wales, the process requires the parent or child themselves to Lift the Lip, not the health professional. It is used whilst delivering caries prevention advice, and facilitating attendance to clinical dental services.

Aims

This project aimed to introduce Lift the Lip into the routine practice of health visitors.

Fifteen health visitors received training, and then introduced Lift the Lip during their visits with children aged 15 months to 3.5 years. They were provided with supporting promotional resources to explain the Lift the Lip assessment. After two months, experiences and attitudes were collected via focus groups and interviews, and transcripts were analysed independently by the authors.

Challenges

Urgent priorities during visits can negatively impact on opportunities to cover the full scope of their remit, including ‘Lift the Lip’.

“You may intend to do ‘Lift the Lip’ in a visit, but if they have all sorts of other things going on, you know they’re not going to take it on board. But I might have a little log in my head of people that I want to do it with maybe when the time is better.”

“We’re not asked to diagnose… it’s just looking for signs and to signpost on and refer if needed, which is part of health, so it’s part of our role anyway.”

“I actually found that I had a deeper, more meaningful conversation with parents, particularly if I identified some decay there.”

Health Visitors

Outcomes

Once trained, health visitors felt confident and capable of using ‘Lift the Lip’. Delivery of oral health messages was positively affected, with more personalised conversations and collaborative relationships. The health visitors appreciated that ‘Lift the Lip’ sits within a wider risk assessment and conversation about oral health behaviours.

Participants felt that using Lift the Lip added value to their role and strengthened their remit in promoting oral health, but wider uptake would rely on:

Next steps

This is the first evidence of the value of ‘Lift the Lip’ in the context of health visiting services in Wales, and demonstrates that it is both feasible and acceptable amongst participating health visitors. There is a need for ongoing monitoring and close working with clinical dental services to ensure it achieves its key objectives. Further work is now required to assess if Lift the Lip has positive effects on oral health and dental service attendance.

Acknowledgements

The project was a collaboration between the Designed to Smile and Healthy Child Wales programmes.

The project was supported by a grant from the Royal College of Surgeons England Faculty of Dental Surgery and British Association for the Study of Community Dentistry, and was initiated following a Travelling Fellowship awarded by the Winston Churchill Memorial Trust.

“I think we are in the right place to do it because we’ve got access to the children. We are the ideal candidates to be advocating it.”

Health Visitor

Part of cohort Bevan Exemplar Projects 2017-18