The perfect smile is child’s play

09 February, 2011 / infocus

The Childsmile programme got a £15 million thumbs up from health minister Shona Robison last month after it played a key role in helping boost the number of children with no sign of tooth decay to record levels.

The 2010 National Dental Inspection Programme (NDIP) found 64 per cent of Primary 1 children have no sign of tooth decay, exceeding the government’s target of 60 per cent.

And Childsmile has helped improve oral hygiene by combining targeted and universal approaches through four components – Core, Practice, Nursery and School.

The plan is that every child will have access to a tailored programme of care within Primary Care Dental Services, which includes free daily-supervised toothbrushing in nurseries and free dental packs to support toothbrushing at home.

Children and families in greatest need will be given additional support at home and in the community. There will also be enhanced support within Primary Care Dental Services and clinical preventive programmes in priority nursery and primary schools, with children referred to dental services where needed.

“While this programme is being further funded as a result of the ministerial announcement, the roll-out has been under way for a couple of years,” said West of Scotland Programme Manager Peter King. “With this announcement we have scope to ensure Childsmile is even more extensive.”

There are a number of opportunities for dental professionals to get involved in the programme too, according to Peter.

“Dentists can enroll their practice to become a Childsmile establishment,” he said. “This will involve the dental team taking referrals of children from health visitors, providing toothbrushing and dietary advice and applying fluoride varnish.”

Dental nurses also have the opportunity to become involved through the practice route, Peter added, working as part of the Practice team, or through involvement in the Nursery and School components. This will involve them working as an extended duties dental nurse (EDDN) applying fluoride varnish in a community setting on prescription from a dentist.

However, the overall picture relies on multi-disciplinary working, especially so in relation to the School and Nursery elements.

“Close partnerships with education colleagues are vital to establish these services,” said Peter. “However, day-to-day delivery in each board is carried out by EDDNs working closely with education colleagues and dental health support workers (DHSW).

“The main focus is the development of skills for life through support and encouragement of toothbrushing and healthy eating, as well as the application of fluoride varnish.

“All EDDNs and DHSWs undertake an NHS Education Scotland delivered training course before performing any frontline Childsmile delivery.

“To be able to apply fluoride varnish, prospective EDDNs must also undertake a period of directly observed practice prior to being fully qualified. During this training phase they will be mentored by a dentist.”

While Childsmile is now rolling out nationally, it was actually conceived as a pilot back in 2005, when the then Scottish Executive published An Action Plan for Improving Oral Health and Modernising Dental Services. According to Peter, this highlighted high levels of dental decay and, in particular, the fact that children from the most disadvantaged areas of Scotland commonly demonstrated the highest levels of decay.

“By the age of three, over 60 per cent of children from areas of deprivation had dental disease,” he said. “A commitment was made to establish a comprehensive preventive care system for children and young people, which includes enhanced services for those most in need.”

As a result, the Scottish Government worked with partners that included health boards, schools and general dental practitioners across Scotland to develop the Childsmile programme.

“Overall, the programme has developed considerably since the pilot stage,” said Peter. “The focus of the programme now is to consolidate on its developments so far and further support integration of all four parts of the Childsmile programme in all 14 health board areas.

“A national structure is in place to support local delivery on a regional basis. A programme board provides guidance and input from a broad range of stakeholders across the country.

“Strategic decision-making and direction is provided by a National Executive. Among others, this involves three regional programme managers – for East, North and West – who have responsibility for supporting development in their region.”

The 2010 NDIP key results show that the mean number of obviously decayed, missing and filled teeth (d3mft) per P1 child in Scotland was 1.52, a continuing improvement over previous surveys.

The NHS Board with the lowest average number of teeth affected by dental disease was NHS Borders at 0.91, while NHS Greater Glasgow and Clyde had the most at 1.85.

Across Scotland, 64 per cent of P1 children showed no signs of obvious decay experience in any of their primary (first) teeth – the best result since surveys began.

NHS Borders had the highest proportion at 77 per cent, while NHS Western Isles had the lowest proportion at 56 per cent.

Overall, the proportion of children in 2010 with no obvious decay experience now exceeds for the first time the National Target of 60 per cent set for this child age group by the Scottish Government for the year 2010.

There continues to be a strong association between social deprivation and dental disease, with those in the least deprived areas having fewer teeth affected by dental decay than those in more deprived areas. However, across all deprivation categories in Scotland, the percentage of P1 children with no obvious decay experience is continuing to increase.

For more information, visit

The benefits of fluoride varnish with Prof Lorna Macpherson

Many scientific studies from around the world have shown that fluoride varnish is effective in reducing the decay rate in children when used in addition to brushing teeth regularly with fluoride toothpaste. A Cochrane Systematic Review (Marinho et al. 2002) confirmed the statistically significant caries-inhibiting effect of fluoride varnish.

Fluoride varnish works in three ways:

• it slows down the development of decay by stopping demineralisation

• it makes the enamel more resistant to acid attack (from plaque bacteria), and speeds up remineralisation (remineralising the tooth with fluoride ions, making the tooth surface stronger and less soluble)

• it can stop bacterial metabolism (at high concentrations) to produce less acid.

The Scottish Dental Clinical Effectiveness Programme (SDCEP) published Prevention and Management of Dental Caries in Children in June 2010. It recommends twice yearly application of fluoride varnish in the dental practice setting to children aged two and over as part of standard prevention measures for all children and an additional two applications a year either in practice or school/nursery for children deemed to be requiring enhanced prevention.

Childsmile in a nutshell

Childsmile Nursery and School aims to have every nursery child in Scotland, and in some P1 and P2 classes, offered:

• free daily supervised toothbrushing within their nursery or school

• free dental packs, which contain a toothbrush

• 1000ppm fluoride toothpaste and an information leaflet

• oral health education.

In some nurseries, Childsmile teams will visit and:

• apply fluoride varnish to teeth (twice a year)

• advise parents about caring for your child’s teeth at home.

The Childsmile Practice program
me is designed to improve the oral health of children in Scotland from birth by working closely with dental practices. It aims to provide a universally accessible child-centred NHS dental service.

Childsmile is introduced to the family by the public health nurse or health visitor who will refer them straight to a dental practice and:

• contact children from the age of three months

• make a first appointment for the child with a local Childsmile dental service

•provide the central link between dental services, the family and the public health nurse or health visitor

• give additional oral health support to children and families most in need

• link children who have been identified as not currently attending a dentist, with local Childsmile dental services.

How is Childsmile being rolled out?

The integrated programme is being rolled out in all 14 Scottish health board areas throughout 2011-12. It is expected that NHS Boards:

• work towards achieving targets for toothbrushing

• ensure that toothbrushing packs and other resources are distributed to children as directed

• meet target for involvement of 20 per cent of nurseries in Childsmile Nursery Fluoride Varnish Programme

• meet target for involvement of 20 per cent of schools in Childsmile School Fluoride Varnish Programme, to P4 by 2012

• record routine data systematically to allow monitoring and evaluation of the programme

•have systems in place to ensure children referred to a Childsmile Dental Health Support Worker are seen

• ensure all dental practices are approached and offered the opportunity to become Childsmile Practices

• ensure practices are recruited and supported to offer Childsmile interventions

•ensure sufficient places are available to enable all children referred to Childsmile Practice, directly or via a DHSW, to be registered with a Childsmile Practice.

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