Improving child oral health worldwide
University of Glasgow research underpinned the design, implementation, and evaluation of a multicomponent community based child oral health improvement programme for Scotland (Childsmile).
The approach has now been adopted internationally, with the Childsmile methodology endorsed by the World Health Organization (WHO) and designated as public health best practice by the European Commission
Problem
Although preventable, dental caries (tooth decay) is a serious public health issue that affects 520 million children worldwide.
This condition is strongly linked to socioeconomic and health inequalities, with associated symptoms and hospital admissions potentially limiting educational attendance and attainment.
Research
Childsmile was designed to improve oral health and reduce inequalities among children in Scotland through working with health visitors; nursery and primary school teachers; dental practitioners; health-support workers; and local communities.
University of Glasgow has led research and evaluation of this multicomponent intervention since its inception in 2006. Key findings include:
- A decline in childhood dental caries since implementation of nursery supervised toothbrushing, with the greatest benefit seen among children from the most socially disadvantaged areas.
- Nursery supervised toothbrushing also reduces financial costs associated with treatments for childhood dental caries, providing annual savings to NHS Scotland that far exceed the expenditure required to implement this programme.
- Limited reach of nursery and school fluoride varnish applications (FVA) among disadvantaged communities highlighted the need to reallocate resources towards areas with the greatest levels of socioeconomic deprivation.
- Dental health support workers (DHSWs) proved effective in facilitating registration of young children at dental practices, supporting early action to prevent dental caries.
Activities
International recognition for Childsmile has occurred via dissemination of University of Glasgow research at knowledge exchange and engagement events with key stakeholders interested in implementing national child oral health improvement programmes. For example:
- Hosting an international Childsmile symposium, where speakers included the WHO global oral health lead and government representatives from Chile and Israel.
- Participating in a Malawi Ministry of Health workshop on the development of the first oral health policy for this country.
- Working with WHO oral health leads to deliver a workshop that highlighted the Childsmile approach and appropriate strategies for southeastern European countries. This workshop (sponsored by oral health charity The Borrow Foundation) was attended by senior policy makers from Albania, Bulgaria, Croatia, Romania, Serbia, and Slovenia
- Giving presentations and workshops in Chile, China, Croatia, Ireland, the Netherlands, Poland, Serbia, and South Africa; and hosting colleagues from Australia, Brazil, Chile, Israel, Malawi, the Netherlands, Nigeria, Saudi Arabia, southeastern Europe, and Thailand.
Outputs
Childsmile has become the leading model for development, implementation, and evaluation of child oral health improvement programmes internationally.
Outcomes
- In response to the University of Glasgow cost analysis of nursery supervised toothbrushing, the Childsmile approach was taken up by Israel.
- The Chilean Ministry of Health established the Sembrando Sonrisas child oral health improvement programme, with University of Glasgow researchers advising the team.
- The Vanuatu Ministry of Health ratified policy for a programme based on Childsmile (Gudfala Tut Skul).
- The Malawi Ministry of Health convened a multi-agency taskforce (including University of Glasgow) to develop and implement its national oral health policy, with Childsmile components forming the central strategy for preventing dental disease among children.
- University of Glasgow researchers supported the development and initiation of a pilot nursery supervised toothbrushing programme in Croatia.
- Romania and Serbia undertook baseline child oral health surveys to inform national policy development.
- University of Glasgow research contributed to the development of Gezonde Peutermonden, a pilot programme adopting DHSW-related elements of Childsmile into well-baby clinics in the
- Netherlands.
- WHO included Childsmile as a case study for its Oral Health Country/Area Profile Project website.
- The European Commission adopted the Childsmile methodology as public health best practice to
address United Nations Sustainable Development Goals for noncommunicable diseases.
Impact
The number of Israeli nurseries participating in supervised toothbrushing rose from 627 in 2015 to 2,200 in 2018. The Ministry of Health subsequently adopted this intervention as part of its national dental service for children living in disadvantaged towns and cities.
Sembrando Sonrisas delivers supervised toothbrushing and FVA to over 400,000 nursery school children in Chile yearly, with dental caries in 5-year-olds reduced from 58% in 2015 to 53% in 2019.
By February 2020, 32 schools in Vanuatu had introduced supervised toothbrushing, with expansion to an additional 40 schools planned. FVA was adopted by 22 schools, also with plans for expansion