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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 healthcare services.

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

Figure 1: Percentage of 5-year-olds free of dental decay
experience 1987–2006, Lothian

Local action

The Childsmile Programme, which is nationally funded, consists of many elements. NHS Lothian is currently engaged in the following parts of the programme.

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.

Childsmile Nursery

ChildsmileThis 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.

Childsmile School

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.


key points

  • 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.