Childsmile Evaluation

Lead Contact:  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 methodology 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.

Key Publications

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) 

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)

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)

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)

McMahon, A. D, Elliott L, Macpherson LM, 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)

Clark, D, King A, Sharpe K, Connelly G, Elliott L, Macpherson LMD, McMahon AD, 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)

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)

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)