Child Oral Health

Strategic Context

Consider the national strategic context for prioritising improvement action in this area (in conjunction with your health board’s annual plan and regional partnership board’s area plan). The strategic importance of a given topic is key to thinking about how our actions align with local or national initiatives and policies to deliver collective and measurable impacts on population health.

• In 2015-16 a third of children aged 5 to 6 years in Wales had experience of tooth decay; on average 10 children out of class of 30 would have tooth decay, with these 10 having 3.6 decayed teeth (WOHIU 2017).
• Evidence from the Dental Epidemiology programme for Wales demonstrates that oral health inequalities exist from as early as 3 years of age, and children living in the most deprived areas have the largest burden of dental disease.
• Experiencing tooth decay at a young age can not only cause pain and infection, but also disturb sleep, limit ability to focus attention and eat a varied diet, hinder speech development, and negatively affect self-image and mental health.
• Tooth decay is one of the most common reasons for childhood hospitalisation; it has a lifelong impact as poor childhood dental health is a predictor of poor adult dental health.
• In the vast majority of cases, tooth decay is entirely preventable through positive health behaviours (Designed to Smile).
• The Welsh Government set out strategic direction for oral health improvement in A healthier Wales: the oral health and dental services response (WG 2018).  
• A multi-faceted approach is required to improve population oral health, with a strategy which influences the wider determinants of health and addresses oral health inequalities.  Clusters will benefit from specialist dental public health advice when formulating plans to improve oral health of their local population.

Data analyses

Consider statistical indicators and other evidence on population needs to compare your own position to that of others, both within and without your health board (where possible). If relevant, consider any additional local data requirements that might contribute to an informed decision on action.

• Indicator: Description of a recommended indicator relating to this topic, which would inform population needs assessment.
• Data source and link: Who produces the analysis and where to find the most current analysis on their website (NB the most current analysis may not utilise the most recent data).
• Documentation link: Where to find general advice on interpreting the analysis e.g. what is/ is not included, any caveats, etc.

Improvement actions

Identifying priority actions involves seeking and appraising evidence on effective and cost-effective improvement options. The below options are a starting point for considering interventions at practice, cluster/ professional collaborative or pan-cluster level. The make-up of your cluster and the stakeholders you work with is likely to influence the type of actions you take.

Ensure frontline staff can offer oral health promotion advice

• NICE guidance Oral health: local authorities and partners (PH55) recommends ensuring frontline health and social care staff can give advice on the importance of oral health.
• As a preventative programme for children from birth, Designed to Smile involves a wide range of professionals, including health visitors and other early years services; the website provides information and advice tailored for parents and carers, and for professionals.

Work with partners to ensure oral health promotion and education is included within local early years health and social services

• The Healthy Child Wales Programme sets out details of the contact children and families can expect to have with health professionals; this includes dental health as a core component.
• NICE guidance Oral health: local authorities and partners (PH55) recommends including oral health promotion in specifications for all early years services; ensuring all early years services provide oral health information and advice; and ensuring early years services provide additional tailored information and advice for groups at high risk of poor oral health. 
• These activities are delivered by Designed to Smile, the national oral health improvement programme for children in Wales (delivered by NHS Wales Community Dental Services).

Advocate for the optimal local delivery of the Designed to Smile programme in nurseries and schools

• Designed to Smile is the national oral health improvement programme for children in Wales; it is underpinned by WHC/2017/23 and aims to help start good habits early by giving advice to families with young children, providing toothbrushes and toothpaste, and encouraging going to a dental practice before a child’s first birthday.
• Designed to Smile delivers supervised toothbrushing programmes and fluoride varnish programmes in nurseries and primary schools across Wales.
• NICE guidance Oral health: local authorities and partners (PH55) recommends supervised toothbrushing schemes for nurseries and primary schools in areas where children are at high risk of poor oral health; fluoride varnish programmes for nurseries and primary schools in areas where children are at high risk of poor oral health; raising awareness of the importance of oral health, as part of a 'whole-school' approach in all primary schools; and introducing specific schemes to improve and protect oral health in primary schools in areas where children are at high risk of poor oral health.

Improve access to NHS dental services

• In keeping with the General Dental Services (GDS) Reform Programme, support local commissioning that improves access and equity of access in areas of deprivation.
• Support primary care dental services to have a prevention and outcome focussed ethos.
• Provide accessible public information about local urgent care dental access (via 111 or a local helpline)

Last updated 15/06/24