4 Ways campaigners want to improve children’s oral health


For years, those with an interest to improve children’s oral health have been campaigning for a national programme of prevention in England.  In September 2016, our CDO, Professor Sara Hurley announced her commitment to Smile4Life which will be launched in September 2017 [1].

So what should be included?


National programmes

If I were designing Smile4Life, the first thing I would do is look at Scotland’s “Childsmile” scheme and also the Welsh “Designed to Smile” initiative. I would be finding out what worked and where there were challenges. Scotland has 10 years on England when it comes to a national programme of prevention and although we have a different legislative structure, which means it’s the responsibility of local government to look after oral health promotion and not national government, we can still learn from their experiences. Childsmile utilises a mixture of upstream and downstream measures to great effect. They have provided clear evidence that investment in prevention pays dividends both in terms of improvements in children’s oral health and also a return on investment with reduced expenditure on dental general anaesthesia.


Early starts

One essential component of Smile4Life should be to ensure that children are accessing dental services in their first year of life as part of a “Dental Check by One” campaign. We should be encouraging new parents to register their newborn with a dentist, as they do a GP. I would like to see this become a cultural norm. As a profession we need to be confident in welcoming families, to support them as they wean their children and to provide clear and consistent preventive messages.


Increased supervision

I would also like to see more joined up care for children attending nurseries. Targeted supervised brushing programmes in nurseries have been shown to be effective and to offer return on investment [2]. Sadly, for some, this may be the only time their teeth are brushed in the day. In Greater Manchester we are also expanding our buddy practice scheme so that every nursery will be linked to a primary dental care service. This will enable us to identify high risk children and encourage their families to access care.

Targeted provision of toothbrushes and paste by post and via health visitors should also be considered and again has demonstrated a return on investment, as have targeted fluoride varnish programmes. It all follows the principles of universal prevention for all and enhanced measures for those most in need. We have to get prevention right from birth. If we leave it until the children reach school age, we have left it too late. As we know from the PHE survey of the oral health of 3-year-old children [3], 1 in 8 of our 3 year olds has signs of obvious dental decay.


Water fluoridation

Finally, I feel that the time is right to talk about water fluoridation. For years, we have shied away from discussing the benefits of water fluoridation despite the fact that we know it has the potential to reduce the persistent oral health inequalities we see in our nation’s children. The small but vocal anti-fluoridation lobby have kept water fluoridation off the political agenda, despite many seeing it as a near perfect public health measure [4]. When a lifetime of fluoridation per child costs the same as one small restoration, is it an intervention we should ignore? The dental community in Hull don’t seem to think so and their campaign to fluoridate the water in Hull is underway. I fully support their campaign and dream of the same for Greater Manchester.


So Smile4Life is an exciting opportunity to put prevention first, and about time too. I really hope that I will be writing again a few years down the line saying that this was the turning point for children’s oral health. If so, then credit will be due to our CDO for pushing through this initiative along with the Children’s Oral Health Improvement Board members and all those who campaigned so tirelessly to improve children’s oral health.


  1. https://www.england.nhs.uk/expo/2016/10/12/sara-hurley/
  2. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/560972/Rapid_review_ROI_oral_health_5_year_old.pdf
  3. http://www.nwph.net/dentalhealth/reports/DPHEP%20for%20England%20OH%20Survey%203yr%202013%20Report.pdf
  4. http://bspd.co.uk/Resources/Position-Statements


Claire Stevens is a Consultant in Paediatric Dentistry at Central Manchester Hospitals NHS Trust. She is Vice President and media spokesperson for the British Society of Paediatric Dentistry, mother to two young children and author of toothfairyblog.org which aims to educate parents to improve the oral health of children.



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