PREVENTIVE DENTISTRY
Keeping kids out of the
Colwyn Jones looks at the success behind the much-lauded Childsmile programme which has led to a demonstrable improvement in the oral health of children in Scotland
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HILD dental health in Scotland has seen a significant improvement which started before devolution in 1999. In 1994 only 38 per cent of primary 1 children were
dentally healthy, that is free from obvious deciduous tooth decay. By 2014 this had risen to 68 per cent. For children aged about 11 years in primary 7, those free from decay in the permanent dentition rose from 52.9 per cent in 2005 to 72.8 per cent by 2013. Tis is typically credited to a national population-based initiative called Childsmile.
Art and science Childsmile has a long history and is an excellent example of effective public health knowledge put into action. Dental public health has been defined as: “Te science and the art of preventing oral disease, promoting oral health and improving the quality of life through the organised efforts of society”. By these criteria Childsmile can be judged a success: the science being the solid evidence-base behind the programme and the art being the incremental development of Childsmile through the political process, working both nationally and locally with education departments in local authorities. It developed largely from two national demonstration
programmes run between 2006 and 2008, which had been in the government Action Plan for Modernising Dental Services in Scotland, published in 2005. However, this action plan resulted from a 2002 consultation: Towards Better Oral Health in Children – A Consultation Document on Children’s Oral Health in Scotland. Childsmile is funded by the Scottish Government and has
four main elements which, when combined, provide a comprehensive pathway of dental care that is tailored to the needs of individual children: Childsmile Core, Childsmile Practice, Childsmile Nursery and Childsmile School. Since 2011 all four elements have been delivered in all health boards throughout Scotland, but the early development of these was incremental.
Childsmile Core Te consistent finding before the mid-1990s was that tooth decay could
18 SUMMONS
be found in almost two-thirds of primary 1 children in Scotland. Decay in deciduous teeth can take up to two years to develop, so to have a preventive effect, fluoride needs to reach the surface of these teeth before children are three years of age. Te Childsmile Core programme aims to provide topical
fluoride to the teeth of every child in Scotland. It is available throughout the country, and every child (currently about 60,000 are born each year) is provided with a dental pack containing a toothbrush and a tube of fluoride toothpaste on at least six occasions by the age of five years. In addition, every three and four-year-old child attending nursery (whether local authority, voluntary or private) is also offered free, daily, supervised
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