Childsmile: The Child Oral Health Improvement Programme in Scotland

Studies suggest that fluoride varnish (FV) application can reduce dental caries in child populations. The multiple-component national child oral health improvement programme in Scotland (Childsmile) includes nursery-based universal supervised toothbrushing and deprivation-targeted FV applications, together with community and dental practice prevention interventions. This trial, a double-blind, two-arm randomised control trial, aimed to assess the effectiveness and cost-effectiveness of the nursery-based FV applications plus treatment-as-usual (TAU) Childsmile programme interventions, compared to TAU Childsmile interventions alone, in children not targeted to receive nursery FV as part of the programme. Participating children in the first year of nursery (aged three), with or without existing caries, were randomised to either FV or TAU and followed up for 24 months until the first year of primary school. Treatments were administered at six-monthly intervals. The primary endpoint was “worsening of d3mft” from baseline to 24 months. Secondary endpoints were worsening of d3mfs, d3t, mt, and ft. Individual record-linkage captured wider programme activities and tertiary endpoints. A total of 1,284 children were randomised, leading to 1,150 evaluable children (n = 577 FV, n = 573 TAU, 10% dropouts). Mean age was 3.5 years, 50% were female (n = 576), 17% had caries at baseline (n = 195), all balanced between the groups. Most children received three/four treatments. Overall, 26.9% (n = 155) had worsened d3mft in the FV group, and 31.6% (n = 181) in the TAU group, with an odds ratio (OR) of 0.80 (0.62–1.03), p = 0.078. The results for worsening of the secondary endpoints were: d3mfs 0.79 (0.61–1.01) p = 0.063, d3t 0.75 (0.57–0.99) p = 0.043, mt 1.34 (0.75–2.39) p = 0.319, and ft 0.77 (0.53–1.14) p = 0.191. We calculated a number needed to treat of 21 and a cost of GBP 686 to prevent a single worsening of d3mft. There was a modest non-significant reduction in the worsening of d3mft in the nursery FV group compared to TAU, suggesting that this intervention is unlikely to represent an effective or cost-effective addition to the population oral health improvement programme.

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Comparison of the caries-protective effect of fluoride varnish with treatment as usual in nursery school attendees receiving preventive oral health support through the Childsmile oral health improvement programme — the Protecting Teeth@3 Study: a randomised controlled trial

BMC Oral Health ◽

10.1186/s12903-015-0146-z ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 4

Author(s):

William Wright ◽

Stephen Turner ◽

Yulia Anopa ◽

Emma McIntosh ◽

Olivia Wu ◽

...

Keyword(s):

Oral Health ◽

Randomised Controlled Trial ◽

Nursery School ◽

Controlled Trial ◽

Fluoride Varnish ◽

Health Improvement ◽

Treatment As Usual ◽

Improvement Programme ◽

Health Support ◽

Randomised Controlled

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Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland

BMJ Open ◽

10.1136/bmjopen-2020-038116 ◽

2020 ◽

Vol 10 (11) ◽

pp. e038116

Author(s):

Jamie BR Kidd ◽

Alex D McMahon ◽

Andrea Sherriff ◽

Wendy Gnich ◽

Ahmed Mahmoud ◽

...

Keyword(s):

Public Health ◽

Oral Health ◽

Dental Caries ◽

Deciduous Teeth ◽

Caries Experience ◽

Health Improvement ◽

Dental Practice ◽

Global Public Health ◽

Targeted Interventions ◽

Improvement Programme

ObjectivesChild dental caries is a global public health challenge with high prevalence and wide inequalities. A complex public health programme (Childsmile) was established. We aimed to evaluate the reach of the programme and its impact on child oral health.SettingEducation, health and community settings, Scotland-wide.InterventionsChildsmile (national oral health improvement programme) interventions: nursery-based fluoride varnish applications (FVAs) and supervised daily toothbrushing, community-based Dental Health Support Worker (DHSW) contacts and primary care dental practice visits—delivered to the population via a proportionate universal approach.Participants50 379 children (mean age=5.5 years, SD=0.3) attending local authority schools (2014/2015).DesignPopulation-based individual child-level data on four Childsmile interventions linked to dental inspection survey data to form a longitudinal cohort. Logistic regression assessed intervention reach and the independent impact of each intervention on caries experience, adjusting for age, sex and area-based Scottish Index of Multiple Deprivation (SIMD).Outcome measuresReach of the programme is defined as the percentage of children receiving each intervention at least once by SIMD fifth. Obvious dental caries experience (presence/absence) is defined as the presence of decay (into dentine), missing (extracted) due to decay or filled deciduous teeth.Results15 032 (29.8%) children had caries experience. The universal interventions had high population reach: nursery toothbrushing (89.1%), dental practice visits (70.5%). The targeted interventions strongly favoured children from the most deprived areas: DHSW contacts (SIMD 1: 29.5% vs SIMD 5: 7.7%), nursery FVAs (SIMD 1: 75.2% vs SIMD 5: 23.2%). Odds of caries experience were markedly lower among children participating in nursery toothbrushing (>3 years, adjusted OR (aOR)=0.60; 95% CI 0.55 to 0.66) and attending dental practice (≥6 visits, aOR=0.55; 95% CI 0.50 to 0.61). The findings were less clear for DHSW contacts. Nursery FVAs were not independently associated with caries experience.ConclusionsThe universal interventions, nursery toothbrushing and regular dental practice visits were independently and most strongly associated with reduced odds of caries experience in the cohort, with nursery toothbrushing having the greatest impact among children in areas of high deprivation.

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Communication Skills for Extended Duties Dental Nurses: The Childsmile Perspective

Primary Dental Journal ◽

10.1177/205016841500400121 ◽

2015 ◽

Vol 4 (1) ◽

pp. 64-66

Author(s):

Emma O'Keefe

Keyword(s):

Oral Health ◽

Communication Skills ◽

Patient Expectations ◽

Health Improvement ◽

Specific Training ◽

Core Component ◽

Good Communication ◽

Improvement Programme ◽

Training Programmes

Good communication and influencing skills are key competency areas for dental nurses and are highly relevant when working with children and their families/carers in Childsmile, a national oral health improvement programme for children in Scotland. The General Dental Council (GDC) identifies communication skills as one of the nine principles for registrants; a large number of complaints seen by the GDC relate to allegations around communication and patient expectations not being fully met. Much time and investment has been spent in researching the role of the Extended Duties Dental Nurse (EDDN) and ensuring appropriate training is provided. While there is specific training for EDDNs delivering the Childsmile programme, the programme appreciates that good communication skills are a core component of all training programmes for dental nurses. This paper sets out to explore the role of EDDNs in Childsmile and specifically looks at the importance of good communication skills and how it facilitates and impacts on the delivery of the Childsmile programme in a variety of settings.

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