Evidence

These policies and guidelines form the evidence base for Childsmile.

The development of Childsmile was underpinned by SIGN Guideline 47 (2000) and SIGN Guideline 83 (2005). Between them, they presented the case for a programme which embraced the roles of a wide range of professionals in prevention of decay through evidence based activity. This included supervised toothbrushing, twice yearly fluoride varnish application, community based oral health promotion and regular visits to the dental team.

These guidance documents have been superseded by SIGN Guideline 138 (2014) which focuses on one to one interventions carried out by the dental team with children and young people aged 0-18 years. Key recommendations include, twice yearly application of fluoride varnish in all children and application of fissure sealants to permanent molars as soon after eruption as possible. The guide also reinforces the importance of twice daily supervised brushing with fluoride toothpaste between 1000-1500ppm, subject to risk assessment.

The Childsmile Programme embodies all of these recommendations, incorporating oral health promotion and clinical prevention and utilising the support of professionally trained dental health support workers working in their local communities.

The Prevention and Management of Dental Caries in Children, Dental Clinical Guidance (Scottish Dental Clinical Effectiveness Programme, 2010) presents clear and consistent advice to support dental professionals to deliver preventive care and where necessary manage caries.

The latest Systematic Cochrane Review (2013) highlights the benefits of fluoride varnish extend to all children, if applied systematically across all age groups.

The Oral Health and Nutrition Guidance for Professionals (2012) provides agreed, consistent, evidence-based guidance on oral health and nutrition for professionals. The guidance provides clear oral health and nutrition advice for the whole population. A special focus is given to under-fives as intervention in the earliest years is vital for improved outcomes in the short and long term and will positively impact across the life course.

Public Policy Context

From April 2010, the Health Improvement, Efficiency, Access, Treatment (HEAT) target nine for child oral health was developed to focus on reaching the most disadvantaged children.

This requires at least 60 percent of three- and four-year-old children in each Scottish Index of Multiple Deprivation (SIMD) quintile to receive at least two applications of fluoride varnish per year by 2014.

The Childsmile programme is based on a robust evidence base which is further detailed below.

An Action Plan for Improving Oral Health and Modernising Dental Services in Scotland (Scottish Executive, 2005)

This action plan also outlined the Scottish Government’s target for NHS Health Boards, stating that 60 per cent of five-year-old children should be decay free by 2010.

Promoted a shift in balance of care towards prevention rather than treatment by targeting the early years age group.

Better Health, Better Care (Scottish Government, 2007)

Better Health, Better Care announced that Childsmile will be ‘rolled out as a new schools based prevention dental service’ incorporating fluoride varnish applications to children’s teeth and fissure sealants applied as appropriate.

Equally Well: Report of the Ministerial Task Force (Scottish Government, 2008)

Equally Well reiterates its commitment to children’s dental health during the early years.

Getting it Right for Every Child (GIRFEC) (Scottish Government, 2008)

GIRFEC places children’s and young people’s needs first. It ensures that they are listened to and understand decisions which affect them and they get more co-ordinated help where required for their well-being, health and development.

It requires that all services for children and young people – social work, health, education, police, housing and voluntary organisations – improve how they work together to support children and young people.

The integration of Childsmile within mainstream national child health programmes will ensure child dental health to becomes part of core business in the future.

Early Years Framework (Scottish Government, 2008)

The Early Years Framework seeks to shift the focus of service provision to early identification and early intervention, these philosophies are congruent with Childsmile.