United Kingdom - Designed to Smile - Promoting Better Oral Health and Delivering Fluoride Supplementation to Children in Wales

UK map

Introduction
"Designed to Smile" is a National Child Oral Health Improvement Programme started in Wales in 2009 (1). It aims to improve child dental health in Wales by bringing fluoride in contact with children's teeth using supervised toothbrushing. The programme is funded by the Welsh Assembly Government and will initially run for 3 years.

Background and Rationale
Recent data shows that over 50% of 5 year olds in Wales have experienced tooth decay with deprived areas being worst affected. Due to the preventable nature of the disease process the programme aims to encourage young children to brush their teeth twice daily using fluoride toothpaste. The use of fluoride toothpaste to reduce tooth decay has a large evidence base with other research showing those with childhood decay are far more likely to have serious dental problems in adulthood. The children included in the scheme will be taught the skills they need to maintain good oral health throughout life.

Project Outline
Designed to Smile intends to provide

Free toothbrushes and fluoride toothpaste to every child in Wales, promoting oral health in a national programme.
A key priority is nursery and school based
toothbrushing programmes.
A super pilot is currently being carried out in both urban and rural areas including over 300 schools and is composed of two parts. The main component is supervised toothbrushing with fluoride toothpaste for 3-5 year olds.
This is complemented with a promotional programme for 6-11 year olds.
Finally, a third component could be developed with oral health promotion from birth.

Specially designed vans have been developed featuring the friendly 'Dewi the Dragon' mascot and are used to visit the schools with a Designed to Smile team. This is made up of dental services educators who talk to the children about dental hygiene and provide toothbrushes and fluoride toothpaste.

Achievements
Having started at the beginning of 2009 the effectiveness of the programme has not yet been established. Milestones and targets have been set. By 2020 the mean number of decayed, missing and filled teeth of 5 year old children of the most deprived fifth of the population aims to be 2.4 (currently 3.1).

Conclusion
Designed to Smile is a public health programme with a holistic approach to healthy living and aims to establish good oral hygiene practice early on. The provision of extra preventative care to children will benefit those most deprived to help reduce inequalities.

References
1. Welsh Health Circular. 14th March 2008 Designed to Smile - A National Child Oral Health Improvement Programme Promoting Better Oral Health and Delivering a Fluoride Supplementation Programme. (http://www.wales.nhs.uk/documents/WHC(2008)008.pdf)

By Sarah Hatherell and Laurence Wood (Exchange dental students from Cardiff, Wales, UK, Oct - Dec 2009)