Preventing tooth decay in children
With a focus on preventing tooth decay in children, our research underpins the Welsh Government's approach to improving oral health and delivering better dental care throughout Wales.
Tooth decay in children is a major health concern. This is particularly true for children in deprived communities, where levels of decay are three times higher than in more affluent areas. It is one of the main reasons for young children being admitted to hospital, due to the need for tooth extractions under general anaesthesia.
Our research is supporting Welsh government efforts to tackle the issue and helping to reduce levels of tooth decay in children.
Exploring the success of Designed to Smile
In 2009, Welsh Government implemented ‘Designed to Smile,’ a national oral health improvement programme. Cardiff University research, led by Professor Ivor Chestnut, found a 12% decrease in rates of tooth decay in 5 year olds since its launch.
The study also provided evidence that early prevention is likely to be most effective at preventing future tooth decay. Children who are decay free by 5 will have less decay throughout their lifetime.
Based on the evidence that early prevention is most likely to minimise tooth decay, the Welsh Government re-focused Designed to Smile to target children under the age of five.
Designed to Smile
'Designed to Smile' was introduced in 2009 as a way of improving children’s oral health. Community Dental Service teams give advice to families, provide toothbrushes and fluoride toothpaste, and encourage visits to the dentist.
Each year over 90,000 children in 1,200 schools and nurseries take part in the Designed to Smile tooth brushing scheme, which includes daily tooth-brushing and twice yearly fluoride varnish application.
Cardiff’s ‘Seal or Varnish?’ trial
The majority of tooth decay is located on the biting surface of the first molars which erupt at age six. To prevent this, it is common practice for dentists to apply either a dental sealant or a fluoride varnish directly onto the back teeth.
Fissure sealants are plastic coatings applied to teeth to stop food and bacteria from getting stuck. Applied once, they last for several years. Fluoride varnish is a sticky paste, containing high levels of fluoride, that is painted onto the teeth for added protection. Varnish needs to be reapplied by a dental professional at least twice a year.
Before 2011, there was no conclusive evidence about which treatment was better at preventing tooth decay, or which was more cost-effective.
To address this lack of evidence, Cardiff University researchers undertook one of the largest clinical trials in dentistry. Known as the 'Seal or Varnish?' trial, the study followed over 1,000 six-year-olds for four years in deprived communities in South Wales. Varnish was proved to be just as effective as fissure sealants, but the cost per child of varnish as a treatment proved to be significantly less.
As a result of this, the Welsh Government announced that varnish, rather than fissure sealants, would be routinely offered.
The financial savings made are re-invested in the Designed to Smile programme, increasing the amount of children that benefit from the scheme.
Meet the team
- Chestnutt, I. G. et al. 2017. Fissure seal or fluoride varnish? A randomised trial of their relative effectiveness. Journal of Dental Research 96 (7), pp.754-761. (10.1177/0022034517702094)
- Jones, C. M. et al., 2017. The caries experience of 5 year-old children in Scotland in 2013-2014, and in England and Wales in 2014-2015. Reports of cross-sectional dental surveys using BASCD criteria. Community Dental Health 34 (3), pp.157-162. (10.1922/CDH_4085Jones06)
- Chestnutt, I. G. et al. 2012. Protocol for 'Seal or Varnish' (SoV) trial: A randomised controlled trial to measure the relative cost and effectiveness of pit and fissure sealants and fluoride varnish in preventing dental decay. BMC Oral Health 12 (1), pp.51-62. (10.1186/1472-6831-12-51)