Child Oral Health / Childsmile Evaluation

Lead Contacts:  Professor Andrea Sherriff,  Professor David Conway,


Childsmile is the national child oral health improvement programme for Scotland. 

It was developed as pilot studies from 2006/7, building on an established national supervised toothbrushing programme in nursery schools. By 2011, an integrated programme was in place in all NHS Boards across the country.

An integrated theory-based evaluation led by the University of Glasgow, funded by the Scottish Government, has been an important feature of the programme from its outset.

Since August 2013, the Childsmile approach has been adopted in Chile, England, Israel, Malawi, the Netherlands, countries of Southeastern Europe and Vanuatu.

In 2019, the European Commission recognised the Childsmile methology as public health best practice. 

Evaluation approaches

To understand and tackle the social determinants of childs oral health and reduce child oral health inequalities. 

Process evaluation
The in-depth, mixed-methods process evaluation assesses how closely the programme is operating according to how it was envisioned initially, ie whether the anticipated changes in service provision and behaviours, necessary for child oral health improvement, have occurred. This includes, for example: activity levels for fluoride varnish applications in education and dental practice settings; dental registration and attendance rates; toothbrushing activity; DHSW and other community-based early years’ activity. Where necessary, research is conducted to investigate the barriers and facilitators for the implementation of component parts of the programme. Identification of these factors can facilitate ongoing refinement to enhance programme delivery still further.

Outcomes from the programme are being investigated mainly via a pioneering big data linkage project. This involves linking multiple routine administrative national health and education datasets to create a birth cohort to evaluate the complex multiple interventions of Childsmile with a range of health and education outcomes.
An economic evaluation, investigating the cost-effectiveness of the programme and its components, accompanies this work. Furthermore, an embedded, randomized control trial of the nursery fluoride varnish programme – Protecting Teeth @ 3 trial10 – has recently been completed.

Evaluation is ongoing
The programme is a complex multifaceted programme delivering prevention interventions in multiple settings (through health visitors, in communities with dental health support workers, in nurseries/school settings, and in dental practices). The programme has not been a single fixed model but has been dynamic and evolving since its establishment. Part of its success of Childsmile has been the long- term vision and support from successive Scottish Governments (of differing political make-ups) since its inception in 2005/06. The ongoing evaluation of the programme has also been crucial to programme development and achievements. While there has been considerable success in improvement of child oral health in Scotland over this period, there remains substantial ongoing challenges including persistent inequalities in child oral health; and more recently, the COVID-19 pandemic has had a major impact on the Childsmile programme and stalled the trend of improving child oral health in Scotland. Ongoing monitoring and evaluation of the Childsmile programme is essential to meeting the challenge of child oral health and inequalities both in Scotland and globally.


Monitoring of the Childsmile Programme has key functions: management (including workforce planning and training); feedback of data to inform programme development; and evaluation (in relation to programme reach and effectiveness).

The monitoring data for the Childsmile programme are collated electronically through the University of Dundee Health Informatics Centre (HIC) (external website) hin partnership with Public Health Scotland (PHS), and university of Glasgow Childsmile Evaluation Research Team (CERT). PHS working with colleagues in the Practitioner Services Division (PSD) NSS, process GP17 forms, which, in addition to assisting payment for practitioners, provides data for the monitoring and evaluation of Childsmile Practice. PHS also coordinate data received from NHS Boards, which benchmarks progress with the Childsmile Supervised Toothbrushing component. Data from monitoring sources is used to produce annual headline reports which present longitudinal data for the Integrated Childsmile Programme at a national level. Where appropriate, data are presented by Health Board and Scottish Index of Multiple Deprivation. A principal aim of these documents is to show progress over time for all components of the programme.

Childsmile National Headline Data, Central Evaluation & Research Team, University of Glasgow, January 2023

Childsmile Projects


Additional Support Needs – child oral health

  • Investigating oral health and preventive service access among children with intellectual disabilities and additional educational support needs.
  • Population-based data linkage cohort study
  • Funded by Baily Thomas Foundation (2018-2023)


Preventing Early Childhood Caries

  • Building an international consensus for Early Childhood Caries prevention in education settings.
  • A systematic overview of the literature and Delphi approach
  • Mapping and benchmarking Early Childhood Prevention programmes in South-Eastern European countries
  • Funded by Borrow Foundation (2021-2023)


Early Childhood Caries (ECC) and inequalities- the role of behaviours, social determinants, and the impact of the Childsmile programme: A novel data linkage cohort study

  • Linking social, economic, family, child level data from the Growing up in Scotland Survey to routinely collected population wide caries and Childsmile intervention data from the Child Oral Health Data Lab within the National Safe Haven.
  • Funded by Borrow Foundation (2021-2025)


Poor oral health in childhood as an early predictor of multimorbidity: The Canary in the Mine?

  • Development of a childhood multimorbidity index to identify if poor oral health signals an early risk for multimorbidity, and if the Childsmile programme can offer early interventions to mitigate this.
  • Population wide data linkage using our Child Oral Health Data Lab within the National Safe Haven. 
  • Development of a PPI group for multimorbidity in childhood.
  • Wellcome Trust Doctoral Training programme in multimorbidity for Health professionals 2024-2027

Fluoride Interventions in Early Years Education settings 



Professor David Conway                                                    

Dr Alex McMahon

Professor Andrea Sherriff

Bill Wright

Mariel Goulart

Dr Abodunrin Aminu

Dr Lamis Abuhaloob


Honorary Staff and Affiliates

Honorary Senior Lecturer Dr Alastair Ross                                    

Honorary Professor Lorna Macpherson

Peter King

Dr Leigh Deas

Dr Jamie Kidd

Yulia Anopa

Andres Celis


Childsmile PhDs


Budur Almutairi, Developing and evaluating a Toothbrushing Programme in Saudi Arabia (TOPS) – through a cluster randomized controlled trial in kindergartens in Riyadh, Saudi Arabia.          

Kyle Cousins, Childhood Caries: understanding the role of early life behaviours and social determinants on risk and inequalities: A novel data linkage cohort study. Funded by the Borrow Foundation in collaboration with ScotCen.

Jennifer Eaves, Optimising delivery of the Childsmile nursery supervised toothbrushing programme.

Emma Fletcher, Optimising family toothbrushing behaviours in the home in early years in Scotland: developing and evaluating a community based intervention. Funded by Haleon in collaboration with ACTA.

Aalia Karamat, Enhancing Scotland's Childsmile programme through Community Linking to address child oral health inequalities.

Ahmed Mahmoud, Investigating the role of ethnicity and socioeconomic factors in the oral health of children in Scotland.   

Ryan Stewart, Obesity and dental caries in children in 2 Scotland: trends, inequalities and the reach 3 and impact of the Childsmile programme. Funded by Glasgow Children’s Charity in collaboration with Strathclyde University.



Celis Sersen, Andrés Osvaldo (2022) Evaluation of the impart of national oral health improvement programmes of Chile on the oral health of the child population. PhD thesis, University of Glasgow.

Anopa, Yulia (2020) Economics of primary caries prevention in preschool children. PhD thesis, University of Glasgow.

Kidd, Jamie Brian Rutherford (2019) Developing a population data linkage cohort to investigate the impact on child oral health outcomes following the roll-out of the Childsmile programme in Scotland. PhD thesis, University of Glasgow.

Hodgins, Faith (2017) A mixed methods evaluation of Childsmile's targeted and tailored Dental Health Support Worker intervention. PhD thesis, University of Glasgow.

Young, Mairi Anne (2017) Optimising the role of the dental health support worker in Childsmile Practice: a comparative Realist approach. PhD thesis, University of Glasgow.


Key Publications

Sherriff, A. , Stewart, R.Macpherson, L. M.D. , Kidd, J. B.R.Henderson, A. , Cairns, D.  and Conway, D. I.  (2023) Child oral health and preventive dental service access among children with intellectual disabilities, autism and other educational additional support needs: a population-based record linkage cohort study. Community Dentistry and Oral Epidemiology, (doi: 10.1111/cdoe.12805) (PMID:36354158)

Celis A,  Conway DI,  Macpherson LMD,  McMahon AD.
Data Resource Profile: National Child Oral Health Improvement Programmes for Chile - PubMed (
Int J Epidemiol. 2023 Apr 19;52(2):e110-e115.

Bradford DRR,  Allik M,  McMahon AD,  Brown D.
Assessing the risk of endogeneity bias in health and mortality inequalities research using composite measures of multiple deprivation which include health-related indicators: A case study using the Scottish Index of Multiple Deprivation and population health and mortality data - PubMed (
Health Place. 2023 Mar;80:102998.

Ross AJ, Sherriff A, Kidd J, Deas L, Eaves J, Blokland A, Wright W,  King P, McMahon AD, Conway DI,  Macpherson LMD, 
Evaluating Childsmile, Scotland's National Oral Health Improvement Programme for children - PubMed (
Community Dent Oral Epidemiol. 2023 Feb;51(1):133-138.

Celis, A.Conway, D. I. , Macpherson, L. M.D.  and McMahon, A. D.  (2022) Data resource profile: National Child Oral Health Improvement Programmes for Chile. International Journal of Epidemiology, (doi: 10.1093/ije/dyac191) (PMID:36264249) (Early Online Publication)

Ross, A. J. et al. (2022) Evaluating Childsmile, Scotland’s national oral health improvement programme for children. Community Dentistry and Oral Epidemiology, (Accepted for Publication)

Anopa Y,   Macpherson LMD,  McMahon AD,  Wright W,  Conway DI,  McIntosh E.
Economic Evaluation of the Protecting Teeth @ 3 Randomized Controlled Trial - PubMed (
JDR Clin Trans Res. 2022 Apr 20:23800844221090444.

Bradford DRR,  Allik M,  McMahon AD,  Brown D.
Physical health of care-experienced young children in high-income countries: a scoping review protocol - PubMed (
BMJ Open. 2022 Sep 7;12(9):e063648. doi: 10.1136/bmjopen-2022-063648.

Burns, J., Conway, D. I. Gnich, W. and Macpherson, L. M.D. (2021) A systematic review of interventions to link families with pre-school children from healthcare services to community-based support. Journal of Public Health(doi: 10.1093/pubmed/fdaa242) (PMID:33423052) (Early Online Publication)

Young, M.Ross, A. , Sherriff, A. , Deas, L. and Gnich, W. (2021) Child health interventions delivered by lay health workers to parents: a realist review. Journal of Child Health Care, 25(4), pp. 628-646. (doi: 10.1177/1367493520983124)

Siyang Yuan, S., Humphris, G., Macpherson, L. , Ross, A.  and Freeman, R. (2021) Communicating with parents and preschool children: a qualitative exploration of dental professional-parent-child interactions during paediatric consultations to prevent early childhood caries. Frontiers in Public Health, 9, 669395. (doi: 10.3389/fpubh.2021.669395) (PMID:34055728) (PMCID:PMC8149946)

Yuan, S., Humphris, G., Macpherson, L. , Ross, A.  and Freeman, R. (2021) Communication strategies to encourage child participation in an oral health promotion session: An exemplar video observational study. Health Expectations, 24(2), pp. 700-708. (doi: 10.1111/hex.13219) (PMID:33606905) (PMCID:PMC8077076)

Anopa, Y.Macpherson, L.  and McIntosh, E.  (2020) Systematic review of economic evaluations of primary caries prevention in 2- to 5-year-old preschool children. Value in Health, 23(8), pp. 1109-1118. (doi: 10.1016/j.jval.2020.04.1823)

Anopa, Y. and Conway, D. I.  (2020) Exploring the cost-effectiveness of child dental caries prevention programmes. Are we comparing apples and oranges? Evidence-Based Dentistry, 21(1), pp. 5-7. (doi: 10.1038/s41432-020-0085-7) (PMID:32221482)

Kidd, J. B.R.McMahon, A. D. Sherriff, A. Gnich, W.Mahmoud, A.Macpherson, L. M.D. and Conway, D. I. (2020) Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland. BMJ Open, 10(11), e038116. (doi: 10.1136/bmjopen-2020-038116)

McMahon, A. D. Wright, W.Anopa, Y.McIntosh, E. Turner, S.Conway, D. I. and Macpherson, L. M.D. (2020) Fluoride varnish in nursery schools: a randomised controlled trial – Protecting Teeth @3. Caries Research(doi: 10.1159/000509680) 

Macpherson, L. M.D. , Rodgers, J. and Conway, D. I.  (2019) Childsmile after 10 years part 1: background, theory and principles. Dental Update, 46(2), pp. 113-116. (doi: 10.12968/denu.2019.46.2.113

Macpherson, L. M.D. , Rodgers, J. and Conway, D. I.  (2019) Childsmile after 10 years part 2: programme development, implementation and evaluation. Dental Update, 46(3), pp. 238-246. (doi: 10.12968/denu.2019.46.3.238

Yuan, S., Humphris, G., Ross, A. , Macpherson, L.  and Freeman, R. (2019) Recording communication in primary dental practice: an exploratory study of interactions between dental health professionals, children and parents. British Dental Journal, 227, pp. 887-892. (doi: 10.1038/s41415-019-0890-6) (PMID:31758130)

Gnich, W.Sherriff, A. Bonetti, D.Conway, D. I. and Macpherson, L. M.D. (2018) The effect of introducing a financial incentive to promote application of fluoride varnish in dental practice in Scotland: a natural experiment. Implementation Science, 13, 95. (doi: 10.1186/s13012-018-0775-0) (PMID:29996868) (PMCID:PMC6042272)

Hodgins, F.Sherriff, A. Gnich, W.Ross, A. J. and Macpherson, L. M.D. (2018) The effectiveness of Dental Health Support Workers at linking families with primary care dental practices: a population-wide data linkage cohort study. BMC Oral Health, 18, 191. (doi: 10.1186/s12903-018-0650-z) (PMID:30463549) (PMCID:PMC6249895)

McMahon, A. D., Elliott L, Macpherson, L. , Sharpe KH, Connelly G, Milligan I, Wilson P, Clark D, King A, Wood R, Conway D.I. (2018) Inequalities in the dental health needs and access to dental services among looked after children in Scotland: a population data linkage study. Archives of Disease in Childhood, 103(1), pp. 39-43. (doi: 10.1136/archdischild-2016-312389) (PMID:28855231)

Rhouma, O.Sherriff, A. , Macpherson, L.  and Ross, A.  (2018) Developing a Co-designed Human Factors Toolkit to Support Application of Preventive Treatment to Children Attending General Dental Practice in Scotland. 14th EAPD Congress, Lugano, Switzerland, 20-23 Jun 2018

Ross, A. , Sherriff, A. , Kidd, J.Gnich, W., Anderson, J.E., Deas, L. and Macpherson, L.  (2018) A systems approach using the functional resonance analysis method to support fluoride varnish application for children attending general dental practice. Applied Ergonomics, 68, pp. 294-303. (doi: 10.1016/j.apergo.2017.12.005) (PMID:29409648)

Yuan, S., Humphris, G., Ross, A. , Macpherson, L.  and Freeman, R. (2018) Moderating Parents: Exploring Child-Parent-Dental Professional Communication in Preventive Dental Visits. 96th General Session and Exhibition of the International Association of Dental Research (IADR 2018), London, UK, 25-28 July 2018. 

Clark, D, King A, Sharpe K, Connelly G, Elliott L, Macpherson, L. , McMahon, A. D., Milligan I, Wilson P, Conway D.I, Wood R. (2017) Linking routinely collected social work, education, and health data to enable monitoring of the health and healthcare of school aged children in state care ('looked after children') in Scotland: a national demonstration project. Public Health, 150, pp. 101-111. (doi: 10.1016/j.puhe.2017.05.003) (PMID:28666173)

O'Keefe EJ, McMahon AD, Jones CM, Curnow MM,  Macpherson LMD.
Evaluation of dental therapists undertaking dental examinations in a school setting in Scotland - PubMed (
Community Dent Oral Epidemiol. 2016 Dec;44(6):515-522.

Anopa, Y.McMahon, A. D. Conway, D. I. Ball, G. E.McIntosh, E. and Macpherson, L. M. D. (2015) Improving child oral health: cost analysis of a national nursery toothbrushing programme. PLoS ONE, 10(9), e0136211. (doi: 10.1371/journal.pone.0136211) (PMID:26305577) (PMCID:PMC4549338)

O'Keefe EJ, McMahon AD,  Jones CM, Curnow MM, Macpherson LMD.
Comparison of the caries-protective effect of fluoride varnish with treatment as usual in nursery school attendees receiving preventive oral health support through the Childsmile oral health improvement programme - the Protecting Teeth@3 Study: a randomised controlled trial - PubMed (
BMC Oral Health. 2015 Dec 18;15:160.

Blair YI,  McMahon AD,  Gnich W,  Conway DI,  Macpherson LMD.  
Elimination of 'the Glasgow effect' in levels of dental caries in Scotland's five-year-old children: 10 cross-sectional surveys (1994-2012) - PubMed (
BMC Public Health. 2015 Mar 4;15:212.

Macpherson, L.M.D. Anopa, Y.Conway, D.I. and McMahon, A.D. (2013) National supervised toothbrushing program and dental decay in Scotland. Journal of Dental Research, 92(2), pp. 109-113. (doi: 10.1177/0022034512470690)

Brewster, L.Sherriff, A. and Macpherson, L. (2013) Effectiveness and reach of a directed-population approach to improving dental health and reducing inequalities: a cross sectional study. BMC Public Health, 13(1), p. 778. (doi: 10.1186/1471-2458-13-778)

Eaves, J. and Gnich, W. (2013). Can programme theory be used as a 'translational tool’ to optimise health service delivery in a national early years’ initiative in Scotland: a case study. BMC Health Services Research, 13, 425.

Deas, L., Mattu, L., Gnich, W. (2013) Intelligent policy making? Key actors' perspectives on the development and implementation of an early years' initiative in Scotland's public health arena. Social Science & Medicine, 96, 1-8.

Blair YI,  McMahon AD,  Macpherson LMD.
Comparison and relative utility of inequality measurements: as applied to Scotland's child dental health - PubMed (
PLoS One. 2013;8(3):e58593.

Blair YI, Macpherson LMD,  McCall DR, McMahon AD.
Dental health of 5-year-olds following community-based oral health promotion in Glasgow, UK - PubMed (
International Journal of Paediatric Dentistry 2006; 16; 6: 381-452.

Blair Y, Macpherson LMD, McCall DR, McMahon AD, Stephen KW.
Glasgow nursery-based caries experience, before and after a community development-based oral health programme's implementation - PubMed (
Community Dent Health. 2004 Dec;21(4):291-8.