Redesigning services to improve children’s oral health

Four coloured toothbrushes

As part of the ARC Inequalities and Prevention National Symposium 2022 members of our Innovation and Evaluation Theme will present the ‘Tip Top Teeth: Hospital-based Oral Health Prevention Programme’. The collaborative programme bought together Chelsea and Westminster Hospital (CW), the Bi-borough Department of Public Health: City of Westminster; Royal Borough of Kensington and Chelsea, and Public Health England (London) to maximise the opportunities for children and their families to receive interventions and information to improve oral health while attending hospital.

The ARC National Priority Consortium in Prevention with Behavioural Risk Factor is led by NIHR ARC North East and North Cumbria and NIHR ARC West Midlands and the programme involves all 15 ARCs from across England. With the aim of reducing ill health and preventing premature mortality, the consortium brings together experts that identify and prioritise evidence-based interventions and support multi-site implementation and evaluation. The conference gives researchers from across to country to come together and share their work and learn from each another.

Addressing tooth decay

Almost 9 out of 10 hospital tooth extractions among children aged 0 to 5 years are due to preventable tooth decay and tooth extraction is still the most common hospital procedure in 6 to 10-year-olds, according to data up to 2019. Tooth decay is almost entirely preventable and is inequitably distributed across the population with 3 in 10 young children in CWFT’s catchment area have signs of visible tooth decay, compared to 1 in 4 nationally. The three-year, collaborative oral health programme was designed, commissioned and delivered using a targeted universalism approach to provide health improvement information and relevant signposting to paediatric patients and their carers in three ways.

1. Universal health promotion activities, including: animated videos playing in waiting areas including A&E; poster displays in public areas; bedside information; discharge information packs

2. Evidence-based targeted supervised toothbrushing (STB), individual bedside sessions for paediatric inpatients and carers covering how and how often to brush teeth, need for fluoride, sugar intake information including sugar swaps

3. Tailored oral health training for staff

To raise awareness 93 posters and animated videos, featuring practical advice such as how to reduce sugar intake, hands-on advice about toothbrushing with fluoride toothpaste, and continuing care with local dentists were deployed across the hospital site. Despite the impact of the COVID-19 pandemic on services 737 children received supervised tooth brushing. Following this 96% of children/carers stated they learned something, and 94% committed to behaviour change.

Dr Grazia Antonacci, Deputy Theme Lead for Innovation and Evaluation for ARC NW London, is presenting the programme at the conference and said:

“We will share our evaluation results of Tip Top Teeth, which demonstrate that a hospital-based OHP is potentially an effective and equitable way to improve patient, family and staff knowledge of good oral health practices and encourages participants to consider positive behaviour change. This experience also demonstrates how NIHR ARCs can support the sector to bridge the evidence-practice gap and meet the needs of local populations and health and care systems”.

Making every contact count

Working to address the specific health needs of our local population is key to how we operate and projects like this can prevent poor health by promoting the conditions for good health at an earlier stage in life, so more people can live healthier lives. Implementation of the novel oral health programme in a “non-traditional” health promotion and prevention setting reached an estimated 1,680 children and families through STB alone.

Dr Sophie Coronini-Cronberg, Programme SRO and Consultant in Public Health at CWFT, and Implementation Lead for ARC NW London, said:

“Hospital visits and stays can be good moments for positive health behaviour change. The ambition of the programme is for every child attending Chelsea and Westminster Hospital to receive an oral health message. We have shown we are reaching some of the most vulnerable groups, and all this at a time when COVID has significantly reduced community dental capacity.”

“In addition to supporting families, I am particularly proud of how Tip Top Teeth has supported capacity-building and knowledge transfer: not only did 73 staff receive oral health training, but the programme also provided research skills-building opportunities for Public Health Clinical Fellows, Registrars and Oral Health Programme Coordinators. Similarly, it gave research colleagues the opportunity to work directly with frontline clinical services and evaluate a real-time programme.”

An ‘extraordinary’ project

Laraib Ahmed, former Oral Health Programme Coordinator at Chelsea and Westminster Hospital said:

"The NIHR ARC NW London support on the Oral Health Project has been extraordinary. I did not expect the immense amount of support I received from the team. Both Laura and Grazia [ARC colleagues] went well out of their way to not only teach me the fundamentals of evaluating a project, but also health improvement strategies in preparation for writing an academic paper and the roll-out of our project to a new site. The team have been consistent and thorough throughout the project. I have learnt so much over the last two years and the project would not have achieved as much as it has without the support from ARC."

Sharing knowledge and experience across the NIHR ARC network is key to how we work, conferences like this allows us to come together and focus on joining up regional work and projects to enable us to have national impact.


The programme was shortlisted for the HSJ Public and Preventative Health Service Redesign Initiative (2021)

Explore more work from our Implementation Theme and Innovation and Evaluation Theme.