Article Text

Original research
Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland
  1. Jamie BR Kidd1,
  2. Alex D McMahon1,
  3. Andrea Sherriff1,
  4. Wendy Gnich1,
  5. Ahmed Mahmoud2,
  6. Lorna MD Macpherson1,
  7. David I Conway1
  1. 1School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
  2. 2Public Health Scotland, Edinburgh, UK
  1. Correspondence to Professor David I Conway; david.conway{at}


Objectives Child 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.

Setting Education, health and community settings, Scotland-wide.

Interventions Childsmile (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.

Participants 50 379 children (mean age=5.5 years, SD=0.3) attending local authority schools (2014/2015).

Design Population-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 measures Reach 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.

Results 15 032 (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.

Conclusions The 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.

  • community child health
  • public health
  • epidemiology

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  • Twitter @davidiconway

  • Contributors DIC and LMDM conceived this study. JBRK, ADM, AS, WG, AM, LMDM and DIC all contributed to the study design. JBRK with AM undertook data management. JBRK with ADM and AS conducted the statistical analysis. JBRK and DIC initially drafted the manuscript. All authors contributed to subsequent drafts and approved the final version.

  • Funding This work was supported by the Scottish Government as part of their funding of the evaluation programme of the Childsmile programme (Scottish Government Health Directorate—Evaluation of National Oral Health Improvement Programmes—2013–2016, 2016–2019).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the University of Glasgow Ethics Committee (Project number MVLS200150076).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.