Fluoride Action Network



Dental decay is one of the most common diseases of childhood. In the 1990s Scottish children had among the worst rates of dental decay in the UK and Europe. We aimed to assess the association between the roll-out of nursery toothbrushing within the national Childsmile programme and a reduction in dental decay in 5-year-old children and to assess cost savings.


The intervention was supervised toothbrushing in nurseries measured as the percentage of nurseries participating in all Scottish health boards. The endpoint was mean d3 mft (number of teeth decayed into the dentine, missing, or filled) in 99?071 children aged 5 years, covering 7–25% of the population, who participated in multiple cross-sectional dental epidemiology surveys in 1987–2009 (conducted every 2 years in every health board). Estimated costs of the nursery toothbrushing programme in 2011 were requested from all health boards. Unit costs of filled, extracted, and decayed teeth were calculated. The total costs associated with actual and anticipated dental treatments were estimated for 1999–2009. These costs were based on the unit costs and on data from the dental epidemiology surveys and then extrapolated to the population level. Savings were calculated for the subsequent years in comparison with the reference 2001 dental treatment costs.


Mean d3mft in years ?2 to 0 (relative to that in toothbrushing start-up year 0) was 3·06, reducing to 2·07 in years 10 to 12 (mean difference ?0·99, 95% CI ?1·08 to ?0·90; p<0·0001). This improvement was greater for children in the most deprived areas (?1·71, ?1·93 to ?1·49; p<0·0001) than for children in the most affluent areas (?0·43, ?0·60 to ?0·25; p<0·0001). The uptake of toothbrushing correlated with the decline in d3mft (correlation ?0·64, p=0·011). The estimated cost of the nursery toothbrushing programme in Scotland was £1?762?621 per year. The estimated savings ranged from £1?217?255 in 2003 (13·9% of costs in 2001) to £4?731?097 in 2009 (54·0%).


An improvement and reduction in inequalities in the dental health of 5-year-old children was detected and was associated with the uptake of nursery toothbrushing. The costs associated with the actual and anticipated dental treatments for 5-year-old children decreased over time. In the eighth year of the toothbrushing programme the savings were more than two and a half times the costs of the programme implementation.


Childsmile is funded by the Scottish Government. Dental epidemiology surveys data collections were funded by the National Health Service.

*Abstract online at https://www.sciencedirect.com/science/article/pii/S0140673614621449