Dental public health in action: ‘First Dental Steps’ - An oral health improvement intervention embedded in the healthy child programme

Dental caries remains a significant public health problem with almost a quarter of children in England having experience of caries by the time they are five. This implementation focused paper presents an overview of the local dental public health team working collaboratively with health visiting teams in the South West of England to deliver a multistranded oral health improvement programme embedded into the Healthy Child Programme. At aged nine to 12 months children receive a mandated health check conducted by health visitors which provides an opportunity to deliver an oral health intervention. The intervention, First Dental Steps, includes oral health training, distribution of oral health packs, a referral pathway for high-risk children and a data capture template. Health visiting teams have shown high levels of engagement with the initiative, which has also included the innovative recording of oral health information as part of clinical notes taken by health visiting teams. Implementation of First Dental Steps varied across local teams, with fidelity of programme delivery, such as distribution of oral health packs and appointment of oral health champions, differing between health visiting teams. This evaluation relied primarily on process-based outcomes, which posed challenges for health visitors to collect consistently due to differences in electronic patient record systems and the need for resource-intensive manual extraction in some localities. Future plans for the programme involve adapting the intervention for inclusion health groups and creating a repository of oral health resources for health visiting teams.