Background
Tooth decay in children remains a significant public health problem. In 2024, over one in five children, by the age of five, had visible and obvious dental decay on examination. Often that decay can be quite extensive and may result in a child experiencing significant discomfort, pain, loss of sleep and increased self-consciousness. The ramifications of childhood dental decay also reach wider. For example, the whole family may need to make multiple dentist or hospital visits, the child will likely have poorer adult oral health too, and this all adds to the financial burden placed on the NHS.
More positively, we already know that most dental decay is preventable. There is strong evidence of simple and cost-effective interventions (e.g., regular teeth brushing, increased use of fluorides, decreased exposure to sugary drinks and regular dental checks) to both prevent tooth decay and extractions. Despite this knowledge, inequalities across our communities remain. Therefore, the First Dental Steps (FDS) Intervention was created (based on national guidance) to maximise the role of health professionals involved in early years care and aid with improving oral health.
Our research and why it is useful
As part of a child’s one-year health check, a new programme was designed (by NHS England and led by Reena Patel) to provide oral health training for health visiting teams and to aid them with giving families oral care advice. In addition, a giftpack (toothbrush, fluoride toothpaste and a free flow beaker) was given to each child. The research team then asked the 59 families and 21 health visitors, health visiting team leads and health childcare professionals what they thought about the programme, to understand if such an intervention could aid with lessening childhood dental decay.
Following on from the initial project, the research team were also awarded an Impact Accelerator Award (IAA) designed to tailor the intervention to suit the needs of different communities that are at a greater risk of dental caries, such as traveller communities, asylum seekers and refugees, minority ethnic groups such as Asian/Asian British, or families engaging with Family Nurse Partnership.
Together these projects not only aimed to improve dental health from an early age but also better tailor and target their intervention to maximise impact.
Real world impact
Practice
- The First Dental Steps Intervention was built on national guidance around improving oral health for local authorities and is now a regional programme that has been rolled out across all local authorities in South-West England.
- An infographic has been created which outlines the project and what the findings mean for parents and families.
- Initially the FDS programme was targeted at high-risk groups, but it is now a universal offer, so that every child is able to access evidence-based oral health information and advice from their health visiting team.
- Project feasibility feedback highlighted all stakeholders felt that the FDS Intervention fits well into the healthy child programme and all families viewed the dental giftpacks very positively.
- Stakeholders also felt the initial FDS intervention needed to be tailored so the advice is more culturally appropriate or sensitive for different communities. Therefore, the team successfully applied for IAA funding to address this need and have produced a resource. The resource details how best the intervention can be delivered to these communities with specific examples and suggestions. The resources come in a white (print-friendly) and coloured version.
Research and engagement
- This research has increased understanding around some of the barriers to improving oral health in children e.g., health visitor teams can have competing priorities and high workloads leading to capacity issues, and oral health isn’t always a priority for all parents.
- The research has already led to three academic publications – Study protocol for First Dental Steps Intervention: feasibility study of a health visitor led infant oral health improvement programme and Health visiting teams and children’s oral health: a scoping review and First Dental Steps intervention: feasibility study of a health visitor led infant oral health improvement programme.
- The findings have been presented to commissioners around the Southwest.
- The team have also worked with health visiting teams and commissioners in Yorkshire, extending the reach and impact of their research.
- The research was shared as part of the Innovation Zone at the Local Government Authority Conference (online) on the 3rd of April 2025. The FDS Intervention was acknowledged as ‘incredible work’ and there was a clear desire for the findings be shared even more widely.
