1. Authors: E. Rooney 1, M. Catleugh 1, M. Smith 1, J. Guest 2, E Teasdale 3, L Fawcett 4,
1Public Health England, Cumbria and Lancashire, 2 Lancashire County Council, 3 Cumbria County Council, 4 NHS England, Cumbria
INTRODUCTION
METHODS
Dental health of children in Cumbria and Lancashire is comparatively poorer than in other parts of
England. Dental caries (tooth decay), is common in Cumbria and Lancashire. In 2008, data collected
as part of the National Dental Epidemiology Programme for England showed that 38% of five year old
children had experience of dental caries, (Fig 1). In addition, marked inequalities exist, with those
with the poorest life chances and the highest levels of deprivation being most likely to suffer from
dental caries (1). The consequences can include time away from school and the need for removal of
teeth under general anaesthesia, with its potentially life threatening consequences.
RESULTS
At the time of writing, 267 Oral Health Champions have been trained to support the implementation
of this programme .
One hundred and twenty one Children’s Centres and 146 other early years’ settings are
implementing the programme, reaching in excess of 85,000 children aged 0-5 and their family
members (Figs 4 and Fig 5). Five hundred and twenty three awards have been achieved.
CONCLUSION
The implementation of Smile4 Life is an example of using the WHO Primary Health Care Approach,
training local people working within their communities to successfully deliver a public health
programme.
Although Smile4Life was developed before the reorganisation of the NHS , the programme fits well
with the new commissioning responsibilities of local authorities, relating to Dental Public Health
Services. Its collaborative development has served to facilitate the partnership required between the
different elements of the Public Health system and shows the importance of developing the
workforce to achieve successful implementation of programmes.
DISCUSSION
Workforce development in Children’s Centres and early years’ settings has underpinned their
success in the achievement of Smile4Life awards and the implementation of the programme.
Development of Dental Nurses within practices enables the delivery of consistent evidence-based
preventive care, which complements and supports behaviour change interventions in communities.
This approach in Cumbria and Lancashire could be used to deliver Smile4Life and other public
health programmes in England.
ACKNOWLEDGEMENTS
The authors would like to thank following organisations for
their support of the Smile4LIfe Programme: Blackpool
Teaching Hospitals Trust ; Cumbria County Council; Cumbria
Partnership Foundation Trust; Lancashire County Council;
Lancashire Care Foundation Trust; Lancashire Teaching
Hospitals Foundation Trust
REFERENCES
1. NHS Dental Epidemiology Programme for England; Oral Health Survey of 5 year old children 2007 / 2008,
www.nwph.net/dentalhealth
2. Department of Health, British Association for the Study of Community Dentistry. Delivering Better Oral Health. An Evidence-
Based Toolkit for Prevention. 2nd ed. London: Department of Health; 2009.
Developing the workforce to deliver the
Cumbria and Lancashire Smile4Life Programme
The aim of this work was to develop the children and young people’s workforce in the local authority,
health and voluntary sectors, to deliver a sustainable programme for oral health improvement, branded
as Smile4Life, focussed on local children’s plans and now contributing to the dental indicator in the
Public Health Outcomes Framework.
These messages are informed by recognised and accepted evidence-based guidance to include
Delivering Better Oral Health: An Evidence-Based Toolkit for Prevention(2). In addition to
transferring knowledge, staff ensure that setting environments and activities support positive dental
health-related behaviour.
Figure. 2 - Smile4Life Messages
Figure. 1 - Dental Caries levels in Cumbria & Lancashire and England
To address this problem, Smile4Life was developed in partnership with local authorities. The approach
focussed on sustained behaviour change, supported across the health and social care systems in
Cumbria and Lancashire, with interventions informed by nationally agreed evidence-based guidance.
The strategy for implementation involved developing the wider workforce to effectively and consistently
support and deliver the programme. These included staff working in settings where children and
families use services in addition to dental practices.
This is evidenced through completion of a
standardised workbook, and through an
award system. Training is provided by
existing experienced NHS oral health
improvement practitioners, using a
standardised training pack and a suite of
supportive web-based resources (Fig 3).
Taking into account the facilities and services
available in the more rural parts of the
counties, to increase NHS support capacity,
dental nurses from practices in areas of
Cumbria were also trained in the promotion of
oral health and the clinical skills relating to the
application of fluoride varnish. Success in
training is measured through an assessment
of clinical skills and viva voce examination.
The positive effects of this training are
assessed by measuring the reported
occurrences of fluoride varnish application
delivered through dental practices.www.smile4life.org.uk
Figure.4 and Figure.5 – Smile4Life in settings
Staff in Children’s Centres and nurseries were identified and trained as Oral Health Champions. Their
role is to effectively share and support the delivery of four groups of evidence-based oral and general
health messages within their setting (Fig 2).
* For the year 2008 the requirement for positive consent introduced bias into these data which means that they
cannot be used for backwards comparison.
Fifty four Dental Nurses in
Cumbria have successfully
completed the Practice-
based Prevention and
Fluoride Varnish Application
Course. Fig 6
Fluoride varnish application
rates in Cumbria have
increased by 66% between
2010/11 and 2011/12.
Figure.6 – Dental Nurses trained in prevention and fluoride varnish application
Figure.3 - Web-based resources
For further information contact: eric.rooney@phe.gov.uk