One of the great ‘givens’ of creating
sustainable health services is that
we should, where possible, move
demand away from providing
services that offer treatment, to
those that prevent the illness.
This approach is at the heart of work to prevent
oral health problems. By starting early – and
ensuring our children have very good oral health –
we are helping to reduce dental and oral disease
in later life and create more sustainable oral
Oral health in Lothian children
Thanks to the effective local implementation
of the National Childsmile Programme, the
oral health of children in Lothian has started
to improve following a 15 year period of little
change. Childsmile is an evidence based oral
health improvement programme which promotes
the development of positive oral health-related
behaviours in young children. The improvement
in oral health of five-year-old children in Lothian
since the Core Toothbrushing element of the
programme began in 2001 is very encouraging
(see Figure 1). In addition, the forthcoming
introduction of the Childsmile Nursery element
will assist NHS Lothian in achieving the HEAT
target of over 60% of primary one children
being free of obvious tooth decay by 2010.
The 2007/08 National Dental Inspection
Programme (NDIP) survey is currently underway
and the results will be available late 2008 to
monitor progress in Lothian.
Figure 1: Percentage of 5-year-olds free of dental decay experience 1987–2006, Lothian
The Childsmile Programme, which is nationally
funded, consists of many elements. NHS Lothian
is currently engaged in the following parts of
Core Toothbrushing Programme
We provide free toothbrushes and fluoride
toothpaste to all children on several occasions
between the ages of six months and five years.
Children who are at greater risk of dental
decay are also given additional supplies of free
fluoride toothpaste and toothbrushes, usually
via their Health Visitor or other health workers.
In addition, we are working towards achieving
the target of all nursery schools offering free
daily supervised toothbrushing from age
three upwards. Currently 80% of nursery
schools are involved, with both local authority
and private nursery schools participating.
To provide additional support to children
who may be at greatest risk of dental decay,
children who attend primary schools in high
priority communities will also be offered daily
supervised toothbrushing in both P1 and P2.
The Core Toothbrushing Programme also
improves the general diet through promoting the
importance of healthy snacks and drinks in the
nursery environment, which will not only improve
dental health but will work with parents and
nurseries to help to reduce childhood obesity.
This scheme, currently being rolled out in
NHS Lothian, is a preventative programme for
children in nursery school establishments and
is targeted at children who would benefit from
additional preventative care. This additional
care takes the form of a twice yearly fluoride
varnish application to children’s teeth by
dedicated Childsmile Teams. The teams are
led by Extended Duty Dental Nurses who have
been specially trained to provide this care in the
nursery environment. This is the first time in the
United Kingdom that specially trained dental
nurses have undertaken a clinical role. The
Extended Duty Dental Nurses are supported by
a new member of the dental team, the Dental
Health Support worker. The Childsmile Teams
will also deliver oral health education advice
contributing to a common risk factor approach
for improving general health. The Childsmile
model is actively promoting skill mix and career
development within the dental profession.
This scheme will build on the Childsmile
Nursery Programme and will provide a primary
school-based preventative dental service for
children aged four and upwards. Again, the
programme will focus on the children who
would most benefit from preventative care.
NHS Lothian is looking forward to delivering
Childsmile School in 2008.
- The Childsmile Programme adopts a
population and a targeted approach to
improving oral health. Used together,
these approaches should help improve
the oral health of all children and narrow
inequalities in dental health.
- Childsmile is a partnership which
includes parents/carers, the NHS, local
authorities’ education departments and
the private sector.
- To complement the Childsmile
Programme and also to support
improvements in dental health for
the whole population, the Scottish
Government should also consider the
introduction of water fluoridation. That
really would be a sustainable approach to
preventing oral health problems.