dental chair


toothbrushing. Tis comprehensive approach involving every child is one of the main reasons that Childsmile has been so successful. For children already brushing twice a day at home the benefit may be marginal but for those who do not brush regularly the preventive effect is huge.1


Healthy snacks and drinks are also an important part of the programme.


Childsmile Practice Childsmile Practice was successfully piloted among health boards in West of Scotland between 2006 and 2008. However, since October 2011 it has been integrated into the Scottish Statement of Dental Remuneration (SDR) and all practices delivering NHS care to children are expected to deliver Childsmile interventions. Dietary advice that fosters good oral health behaviour –


including information on nutrition and drinks (to prevent decay) – must be realistic and achievable. When it comes to toothbrushing, Childsmile highlights when to brush, the types of brushes and toothpaste to use, the amount of toothpaste, and methods and demonstrations where parents brush their child’s teeth to foster skill acquisition. Te programme also provides fluoride varnish applications in all children over two years of age, twice a year. Tis is all in addition to routine dental check-ups. Te Childsmile Practice programme is designed to improve the


oral health of children in Scotland from birth by working closely with dental practices. It is a universally accessible child-centred NHS dental service using a network of primary care dental service providers, both independent contractors and public dental services. Families are referred by a health visitor to a dental practice or to a dental health support worker (DHSW). Te DHSW will contact the family of children from the age of


three months to make a first appointment for the child with a local Childsmile dentist and provide a link between dentists, the family


30 year trend in the percentage of Scottish Primary 1 children free from obvious tooth decay


100


80 60 40 20 0


64% n


42.3% n


n 25%


1 Evidence supporting this approach can be found in The Cochrane Review: “Fluoride toothpastes for preventing dental caries in children and adolescents provides the evidence that supports the core programme” (Marinho VCC, Higgins JPT, Sheiham A & Logan S, 2013)


Year (not continuous), *OPCS Survey AUTUMN 2015 19 n n n 38% n n


45.1% n


n n 51% 54% 58% n n


 Dr Colwyn Jones is a consultant in dental public health and Head of the Evidence for Action Team at NHS Health Scotland


68.2% n


n 67%


and the health visitor. If required the DHSWs give additional dental health support to children and families most in need and try to get children who have been identified as not currently attending, to visit a dentist. Additional support is given to children and families most in need through home visits, community initiatives and primary care dental services.


Childsmile Nursery and School Childsmile Nursery and Childsmile School were mainly piloted in East of Scotland health boards. Te core programme includes universal toothbrushing in all nursery establishments. Tis is enhanced by targeting fluoride varnish applications to regions with the highest levels of socio-economic deprivation, which are the areas in Scotland where regular dental surveys have shown more children have tooth decay. Extended duty dental nurses (EDDNs) work in health boards or independent practices and provide preventive advice and regular fluoride varnish applications. Childsmile School targets primary schools in areas with the


highest levels of socio-economic deprivation and tooth decay among children. Tere is also daily supervised toothbrushing in primary 1 and 2 classes and regular fluoride varnish applications.


Tackling health inequalities Childsmile follows what Geoffrey Rose called a population or universal preventive approach. Tere is no evidence to suggest that it has widened dental health inequalities, quite the opposite. Tis universal or structural approach to prevention, which does not rely on individual behaviour change, is one key lesson from the success of the Childsmile programme. Te second lesson is very much simpler: the programme is properly funded. Childsmile has succeeded but there is still a lot to do as


one-third of five-year-old children still suffer tooth decay, even if less severe. Tis is a painful, miserable problem which can be entirely prevented. Childsmile has successfully evolved since it started and this learning approach involving all staff means the programme will continue to build, tweak and change a successful preventive formula for the benefit of the Scottish population. What about the rest of the UK? Te best advice to other


countries is to first get universal nursery toothbrushing with fluoride toothpaste in place.


Percentage caries experience free


1983* 1987/88 1989/90 1991/92 1993/94 1995/96 1997/98 1999/00 2001/02 2003/04 2005/06 2007/08 2009/10


2011/12 2013/14


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