Tag Archives: ChildSmile

Fluoridation: Open letter to Democrats for Social Credit

The only New Zealand political party opposing community water fluoridation relies on false information

The only political party in New Zealand campaigning against community water fluoridation is the Democrats for Social Credit. It is a minor party, nor represented in Parliament and of little influence. However, it does have connections with Fluoride Free NZ, the main anti-fluoride activist group, and its members have imposed anti-fluoridation policies on some groups they belong to. Two examples are Grey Power and the Hamilton Residents & Ratepayers Association – both of which presented anti-fluoride submissions to the recent parliamentary health committee hearings.

I wish to promote an open discussion with the Democrats for Social Credit about their anti-fluoridation policy so have sent them this Open Letter. If they are open to a good-faith discussion I am happy to provide space on this blog for an exchange of views on their policy.


David Trantor, Health Spokesperson for Democrats for Social Credit

Dear David Tranter,
Health Spokesman,
Democrats for Social Credit

You wrote an open letter to the Minister of Health critiquing the government’s policy on community water fluoridation (CWF) and posing some questions about dental health programmes, documented evidence relating to CWF and human rights aspects you consider relevant.

Here I take issue with some of your claims – particularly about dental health in Denmark and the scientific evidence supporting CWF. I believe the evidence does not support the anti-fluoridation policy of your party and your party should reconsider that policy.

If you believe my arguments here are mistaken or otherwise wish to defend the current anti-fluoride policy of your party I am open to a good-faith exchange of opinions and offer you the right of reply and the opportunity for a further discussion on this blog.

Natural fluoridation in Denmark

You point to the good dental health in Denmark and assert “they have never fluoridated their water.” This is true – but you ignore the fact that much of the Danish population benefits from natural levels of fluoride in their drinking water.

Unlike New Zealand parts of Denmark have drinking water fluoride concentrations similar to the optimum concentrations recommended for CWF. Map 1 from Kirkeskov et al., (2010) shows the distribution of different drinking water fluoride concentration ranges.  Map 2 shows the population distribution. We can see a significant fraction of the Danish population does have access to drinking water containing fluoride.

Map 1: Distribution of natural drinking water fluoride concentrations in Denmark. The town of Nexo is on the Baltic island of Bornholm – shown in the top left-hand rectangle.

Map 2: Population distribution in Denmark.

These natural levels of drinking water fluoride are beneficial to oral health in Denmark. Here is some data from Kirkeskov et al., (2010) illustrating this. The following graph compares the dental decay (numbers with more than 2 decayed, missing or filled teeth surfaces – dmfs) at various drinking water fluoride concentrations for 5 year-olds born in 1989 and 1999.

As we can see, the extent of decay declines with fluoride concentration.

There is a similar pattern for 15-year-olds born in 1979 and 1989. This figure shows the relative numbers with more than 2 decayed missing or filled teeth surfaces, DMFS, for 15-year-olds.

And the same pattern for 15-year-olds with more than 6 decayed, missing or filled tooth surfaces.

Danish dental health programmes

You refer to a “Nexux” programme and argue that this could be an alternative to CWF in New Zealand.

I think you are referring to the programme run in Nexo – a town on the east coast of the Baltic island of Bornholm, Denmark. It is a successful local dental health programme, but only one of several in Denmark. Nexo was in an area of very low socio-economic status and introduced a dental programme at the end of 1987 aimed at improving the dental health fo children.  Ekstrand & Christiansen, (2005) give this description of the programme:

“Since 1992, the program has been offered to children from the age of 8 months. It is based on three closely interrelated principles applied according to the individual child’s needs: (1) education of parents, children and adolescents in understanding dental caries as a localized disease, (2) intensive training in home-based plaque control and (3) early professional, non-operative intervention, including professional plaque removal, local application of 2% NaF and application of sealants. In the period when the children have erupting permanent first or second molars, the parents and children are instructed in using a tooth brushing technique specially designed for erupting molar teeth.”

As you can see it is a rather intensive programme and is not a Denmark-wide programme. It has been successful in Nexo, where 15-year-olds had DMFS (decayed, missing and filled tooth surfaces) values in 1986 (before introduction of the programme)  slightly higher than the Danish average. The equivalent values of DMFS for Nexo were the third lowest for all municipalities in 1993 and the lowest in 1999 (Ekstrand & Christiansen, 2005).

Elements of the Nexo programme will be used in other parts of Denmark, and in other countries. Especially where school-based programmes exist.

Incidentally, Map 1 indicates the concentration of natural fluoride in the drinking water on the island where Nexo is situated is similar to that recommended for community water fluoridation. Ekstrand et al., (2005) reports that the fluoride concentration in the Nexo drinking water is 0.8 mg/L.

Nexo is a complement to, not a substitute for, CWF

Each country and region adopt health programmes appropriate to their circumstance. In New Zealand, we have programmes which include some aspect of the Nexo programme or similar programmes like the ChildSmile programme in Scotland (see ChildSmile dental health – its pros and cons and ChildSmile – a complement, not an alternative, to fluoridation). For example the use of fluoride varnish treatments, especially in non-fluoridated areas.

New Zealand can learn from the experience of other countries and in practice, we may introduce some aspects of other programmes. But blanket transfer of full programmes is rare.

The important aspect, though, is none of these programmes is considered an alternative to fluoridation. They are considered as complementary to CWF, and not substitutes for CWF.  The Danish Dental Association has supported fluoridation for areas of low natural fluoride concentrations. Similarly, the British Dental Association in Scotland supports both ChildSmile and CWF and has publicly called for communities to move towards introducing water fluoridation.

In fact, we can consider that the programme used in Nexo (where the drinking water contains fluoride at 0.8 mg/L) actually complements the effect of natural community water fluoridation.

“Documented evidence”

You ask the Minister:

“Why do you ignore all the documented evidence against fluoridation instead of applying positive dental health policies such as the Denmark example?”

The “Denmark example” is dealt with above and it is not what you suggest. Similarly, I suggest the “documented evidence” you refer to really doesn’t give the viable argument “against fluoridation” you imply.

Unfortunately, you do not present any of this “documented evidence” for discussion. Perhaps, if you respond positively to my suggestion of a right of reply and an ongoing discussion, you can give this evidence.

“Informed consent”

You refer to the “H&D Commissioner’s Code of Rights” asserting that:

“no-one can be medicated without giving their informed consent” and “people have the right to give – or refuse – their INFORMED consent when fluoridation is applied to public water supplies?”

Well, I am all for people being properly informed and providing consent to the treatments used for their water supply. I see this as a democratic issue and I support democracy.

But you destroy your argument by suggesting fluoridation is a “medication” when it clearly is not – either legally or rationally. The legal argument was surely settled by the High Court decision in 2014 (see Corporate backers of anti-fluoride movement lose in NZ High Court) where Justice Rodney Hansen concluded:

“[80] In my view, fluoridation cannot be relevantly distinguished from the addition of chlorine or any other substance for the purpose of disinfecting drinking water, a process which itself may lead to the addition of contaminants as the water standards themselves assume. Both processes involve adding a chemical compound to the water. Both are undertaken for the prevention of disease. It is not material that one works by adding something to the water while the other achieves its purpose by taking unwanted organisms out.

[81] The addition of iodine to salt, folic acid to bread and the pasteurisation of milk are, in my view, equivalent interventions made to achieve public health benefits by means which could not be achieved nearly as effectively by medicating the populace individually. . . . All are intended to improve the health of the populace. But they do not, in my view, constitute medical treatment for the purpose of s 11″ [the relevant section of the NZBORA].”

Is scientific knowledge  really “one-sided” propaganda

You also weaken your argument by claiming:

“the one-sided propaganda used to support fluoridation is not informing people”

Describing objective scientific research and findings as “one-sided” simply displays your own bias – and willingness to discredit or ignore the science. Again, you do not give specific examples of the science you consider “one-sided propaganda” – hopefully, you will do so if you take up my offer of a right of reply and a continued discussion.

Democratic rights

You assert:

“when fluoridation is forced upon people it is nothing less than mass medication concerning which people have no opportunity to give – or refuse – their consent.”

The common anti-fluoride claim that people are having fluoridated water forced upon them always raises the picture in my mind of a person being held down and water being forced down their throat as in force-feeding.

Of course, that is ridiculous – for a number of reasons.

  • In New Zealand, there has usually been a democratic public consultation of some sort before the introduction of CWF – or even after its introduction. Local bodies have surveyed residents or used referenda. They have also used a consultation procedure relying on submissions from the public.The opportunity “to give – or refuse – their consent” has in most cases been far greater than for most decisions made by our representatives in this democracy of ours. Some voters find it annoying when asked for such consent (preferring their representatives decide) but I firmly believe it important to include the public in controversial decisions – even where the controversy results from scaremongering rather than facts (as it does with CWF).
  • There are alternatives for the minority. This means that democratic decisions made by a community can actually be a win-win situation. The majority get the social policy they want and have voted for. the minority have access to alternatives. In fact, most anti-fluoride activists already use alternatives – they filter their tap water or source a different supply. Some cities already provide “fluoride-free” water sources to help this. Sometimes I think the real motivation of these ideologically driven activists is to deny this social health policy to others rather than any real concern they have for their own access to water.
  • Some activists will acknowledge there is no evidence of any harmful side effects from CWF but invoke a “precautionary principle” to argue against it. They should be mollified by the fact that CWF is one of the most extensively researched topics. In a sense, we must thank the ideologically and commercially motivated anti-fluoride campaigners for this. Their activity is rarely successful in preventing CWF or fooling most of the public. But it does mean that researcher keep an eye on the arguments and are continually checking them out.

Conclusion

David, I believe you are mistaken, or misinformed, about the dental health programmes in Denmark. You ignore completely the availability of effective natural levels of fluoride in much of Denmark’s drinking water and seem unaware of the nature of the Nexo programme or its limited area of operation.

Expert opinion considers programmes like Nexo and the Scottish ChildSmile are effective complements to CWF – not substitutes for, or alternatives to, CWF. I support our health officials considering use of similar programmes in New Zealand but it is misleading for the Democrats for Social Credit to advocate for such programmes simply as a way of preventing or opposing CWF – which is  an effective, beneficial and safe social health measure.

I appreciate you may not accept my arguments or the facts I have presented here. If that is the case I urge you to accept my offer of a right of reply and ongoing good-faith discussion and am happy to help this by making space available on this blog.

I look forward to your response.

References

Ekstrand, K. R., & Christiansen, M. E. C. (2005). Outcomes of a non-operative caries treatment programme for children and adolescents. Caries Research, 39(6), 455–467.

Kirkeskov, L., Kristiansen, E., Bøggild, H., Von Platen-Hallermund, F., Sckerl, H., Carlsen, A., … Poulsen, S. (2010). The association between fluoride in drinking water and dental caries in Danish children. Linking data from health registers, environmental registers and administrative registers. Community Dentistry and Oral Epidemiology, 38(3), 206–212.

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ChildSmile – a complement, not an alternative, to fluoridation

Childsmile-Hebrides-Today

New Zealand Health Boards already run elements of the Scottish ChildSmile dental health programme and do not see it as an alternative to community water fluoridation


I am currently dealing with family issues so am reposting this article,ChildSmile dental health – its pros and consfrom September 2015.  Local antifluoride activists are busy presenting ChildSmile and similar programmes as alternatives to fluoridation. They aren’t – and New Zealand District health Boards alreeayd operate elements of these programmes where they consider them effective.


There is some local interest in the Scottish ChildSmile dental health programme. Partly because anti-fluoride campaigners are promoting it to local bodies as an alternative to community water fluoridation (CWF). Their interest is possibly due to the opt-in nature of the programme which they see as satisfying their demands for “freedom of choice” (in this case the choice means excluding their own children from the programme which, after all, does include fluoride treatments).

However, health professionals in the UK are more balanced in their opinions. While welcoming ChildSmile they do not see it as an argument against CWF – rather as “the next best thing – a rather expensive substitute for the fluoridation schemes that have never been introduced.”

I have written about the ChildSmile programme before (see Fluoride debate: Ken Perrott’s closing response to Paul Connett?). But here is some more detail I have picked up from discussion online with health professionals.

What is the ChildSmile programme?

quote-3-1a
On the surface, the ChildSmile programme supplies children with toothbrushes and toothpaste:

“The core programme involves supervised daily toothbrushing for all Scottish three and four year olds attending nursery schools (but not those who don’t attend nurseries). This has been extended to five and six year olds in primary schools in those areas (not necessarily across entire local authorities) counted as being among the 20% most deprived in Scotland.”

Data suggest that about 82% of three and four-year-olds are participating. The children who do not take part do not benefit.

ChildSmile also includes twice-yearly application of fluoride varnish to children’s teeth.  The programme 2013/2014 targets included this:

“At least 60% of 3 and 4 year old children in each SIMD quintile to receive at least two applications of fluoride varnish per year by March 2014.”

In addition to toothbrushing and varnishing, Childsmile involves health education initiatives based principally on public health nurses and health visitors attaching themselves to particular schools in order to give oral health advice to children and parents. Subject to parental consent, they also arrange for children who are not registered with a dentist to undergo check-ups and, if necessary, treatment.

Is it a substitute for CWF?

Not really, but health professionals see it as the “next best thing.” Appropriate for situations where there is no CWF. But it only covers children – and then only those children whose parents give consent (many don’t). In contrast, CWF benefits adolescents and adults, as well as children. Families can, of course, “opt out” od CWF (by using water filters or different sources), but numbers will be lower than those excluded by “opt-in” procedures.

It is wrong to see such programmes as alternatives to, or separate from, CWF. Elements of the ChildSmile programme were already present before ChildSmile was introduced. Similar elements will also be common in countries like New Zealand.

Is it effective?

Childsmile was introduced in 2008 so it is a little early to judge its effectiveness. Scottish children’s dental health has improved and the programme most likely has assisted that.

For example, 58% of five-year-olds were free of decay in 2008, compared with 68% in 2014. The average decayed, missing and filled teeth (dmft) score for this age group has fallen over that period from 1.86 to 1.27.

CS-1

However, there does not seem to have been a reduction in dental health inequalities between children from different social groups in Scotland. In 2008, 42% of children from the most socially deprived quintile of Scottish five-year-olds were free of decay compared with 73% of those from the least deprived quintile. In 2014, 53% of five-year-olds in the most deprived quintile were free of decay compared with 83% of those from the least deprived quintile.

CS-2

According to the Scottish National Dental Inspection programme the absolute inequality between the most and least deprived children remains at 30% (comparing percentages of children without tooth decay), according to surveys conducted in 2008, 2010, 2012 and 2014.

Another concern is that children in the most deprived quintile of five-year-olds have not reached the national target set in 2010 that 60% of them should be free of decay.

Of course, the ChildSmile programme has no effect on the oral health of  current adolescents and adults.

What about the cost?

ChildSmile is far less cost-effective than CWF. Let’s compare the cost of CWF in England with the costs for the ChildSmile programme in Scotland

CWF serves 6 million people in England, costs around £2.1 million a year and is benefiting everyone with natural teeth, regardless of age, education or socioeconomic status. It benefits all children. So the cost per person of is around 35 pence per annum, although if we exclude people with no natural teeth it is likely to be a little higher than that – an average cost of about 40 pence per person benefiting.

If we take a narrow view and assume only children and adolescents aged 0 to 17 (21% of the population in England ) benefitted from CWF the cost would apply to around 1.26 million out of the 6 million supplied with fluoridated water. On that basis, the cost of CWF would be £1.67 per year for each child benefitting.

In contrast:

The total national ChildSmile budget for 2013/14 was £14,956,000, according to a statement by the Minister responsible to the Scottish Parliament in July 2013. This covers everything attributable to Childsmile – the toothbrushing programme, plus targeted varnish applications and associated oral health education initiatives.  Assuming that around 120,000 Scottish children aged between three and six are benefiting, it works out at a cost of around £125 per child per annum.

Compare the Childsmile costs of around £125 per child per annum with the CWF costs of about 40 pence per person per annum or even £1.67 per year for each child benefitting. CWF is obviously many times less expensive that ChildSmile.

What is the attitude of Scottish dentists?

The British Dental Association supports CWF and in Scotland has come out publicly to call for communities to move towards introducing water fluoridation. That position undermines the arguments of New Zealand anti-fluoridation groups claiming that Childsmile is an adequate substitute for water fluoridation. The professional body representing dentists in Scotland does not see it that way.

The BDA in Scotland points out that CWF would be beneficial to children and elderly people. It argues that water fluoridation “would complement the Childsmile programme” by helping cut the overall burden of tooth decay and reducing dental health inequalities in the elderly. We could look at it another way and see that a Childsmile programme could complement water fluoridation. After all, we must remember that initiatives such as Childsmile rely on personal compliance and that they benefit only those taking part. They give no benefit for the rest of the population, unlike CWF.

CWF and ChildSmile are are not mutually exclusive. Children in fluoridated areas should be encouraged to brush their teeth regularly with a fluoride toothpaste and to receive dental check-ups. Bear in mind, also, that components of a ChildSmile programme, such as supervised toothbrushing, were in use in parts of Scotland before the introduction of the full programme. Elements of the ChildSmile programme will also be in current use in New Zealand.

Conclusions

Despite claims of anti-fluoride propagandists, the ChildSmile programme is not a simple alternative to CWF. And it is wrong to see it as such in New Zealand.

It is far less cost-effective – the Scottish programme costs around £125 per child per annum compared with 40 pence per person per annum (or £1.67 per year for each child benefitting when benefits to adults are excluded) and therefore far less likely to be put in place as an alternative to CWF.

ChildSmile is an “opt-in” programme so its coverage is far lower than CWF which is an “opt-out.” This is important when social differences in oral health are important.

However, the contact between children and their families on the one hand and public health nurses, health visitors and dentists on the other, is very valuable and may have wider benefits than oral health alone. (I am thinking of problems caused by child neglect and abuse).

I think these sort of programmes are socially very helpful and strongly support them. The cost is, of course, a limiting factor. However, elements of such social programmes may be possible within budget constraints that health authorities face.

Health programmes like ChildSmile, or elements of that programme, can be very effective even in areas where CWF exists. They can give that extra boost to the oral health of children and can, therefore, complement CWF.

There are many areas where CWF is not feasible because of low population density, lack of suitable water reticulation systems or local political opposition to CWF. I believe that programmes like ChildSmile, or parts of that programme, can be very helpful in those situations. Northland and particularly NZ’s Far North are obvious examples.

Finally, let’s not be diverted by the programme name. I am sure that elements of the Scottish ChildSmile programme are already in place in New Zealand, or parts of New Zealand. Given the costs of such programmes, and budget limitations, these programmes do have the advantage that they can be targeted to regions or social groups where the need is the greatest.

Similar articles

ChildSmile dental health – its pros and cons

Childsmile-Hebrides-Today

There is some local interest in the Scottish ChildSmile dental health programme. Partly because anti-fluoride campaigners are promoting it to local bodies as an alternative to community water fluoridation (CWF). Their interest is possibly due to the opt-in nature of the programme which they see as satisfying there demands for “freedom of choice” (in this case the choice means excluding their own children from the programme which, after all, does include fluoride treatments).

However, health professionals in the UK are more balanced in their opinions. While welcoming ChildSmile they do not see it as an argument against CWF – rather as “the next best thing – a rather expensive substitute for the fluoridation schemes that have never been introduced.”

I have written about the ChildSmile programme before (see Fluoride debate: Ken Perrott’s closing response to Paul Connett?). But here is some more detail I have picked up from discussion online with health professionals.

What is the ChildSmile programme?

quote-3-1a
On the surface, the ChildSmile programme supplies children with toothbrushes and toothpaste:

“The core programme involves supervised daily toothbrushing for all Scottish three and four year olds attending nursery schools (but not those who don’t attend nurseries). This has been extended to five and six year olds in primary schools in those areas (not necessarily across entire local authorities) counted as being among the 20% most deprived in Scotland.”

Data suggest that about 82% of three and four-year-olds are participating. The children who do not take part do not benefit.

ChildSmile also includes twice-yearly application of fluoride varnish to children’s teeth.  The programme 2013/2014 targets included this:

“At least 60% of 3 and 4 year old children in each SIMD quintile to receive at least two applications of fluoride varnish per year by March 2014.”

In addition to toothbrushing and varnishing, Childsmile involves health education initiatives based principally on public health nurses and health visitors attaching themselves to particular schools in order to give oral health advice to children and parents. Subject to parental consent, they also arrange for children who are not registered with a dentist to undergo check-ups and, if necessary, treatment.

Is it a substitute for CWF?

Not really, but health professionals see it as the “next best thing.” Appropriate for situations where there is no CWF. But it only covers children – and then only those children whose parents give consent (many don’t). In contrast, CWF benefits adolescents and adults, as well as children. Families can, of course, “opt out” od CWF (by using water filters or different sources), but numbers will be lower than those excluded by “opt-in” procedures.

It is wrong to see such programmes as alternatives to, or separate from, CWF. Elements of the ChildSmile programme were already present before ChildSmile was introduced. Similar elements will also be common in countries like New Zealand.

Is it effective?

Childsmile was introduced in 2008 so it is a little early to judge its effectiveness. Scottish children’s dental health has improved and the programme most likely has assisted that.

For example, 58% of five-year-olds were free of decay in 2008, compared with 68% in 2014. The average decayed, missing and filled teeth (dmft) score for this age group has fallen over that period from 1.86 to 1.27.

CS-1

However, there does not seem to have been a reduction in dental health inequalities between children from different social groups in Scotland. In 2008, 42% of children from the most socially deprived quintile of Scottish five-year-olds were free of decay compared with 73% of those from the least deprived quintile. In 2014, 53% of five-year-olds in the most deprived quintile were free of decay compared with 83% of those from the least deprived quintile.

CS-2

According to the Scottish National Dental Inspection programme the absolute inequality between the most and least deprived children remains at 30% (comparing percentages of children without tooth decay), according to surveys conducted in 2008, 2010, 2012 and 2014.

Another concern is that children in the most deprived quintile of five-year-olds have not reached the national target set in 2010 that 60% of them should be free of decay.

Of course, the ChildSmile programme has no effect on the oral health of  current adolescents and adults.

What about the cost?

ChildSmile is far less cost-effective than CWF. Let’s compare the cost of CWF in England with the costs for the ChildSmile programme in Scotland

CWF serves 6 million people in England, costs around £2.1 million a year and is benefiting everyone with natural teeth, regardless of age, education or socioeconomic status. It benefits all children. So the cost per person of is around 35 pence per annum, although if we exclude people with no natural teeth it is likely to be a little higher than that – an average cost of about 40 pence per person benefiting.

If we take a narrow view and assume only children and adolescents aged 0 to 17 (21% of the population in England ) benefitted from CWF the cost would apply to around 1.26 million out of the 6 million supplied with fluoridated water. On that basis, the cost of CWF would be £1.67 per year for each child benefitting.

In contrast:

The total national ChildSmile budget for 2013/14 was £14,956,000, according to a statement by the Minister responsible to the Scottish Parliament in July 2013. This covers  everything attributable to Childsmile – the toothbrushing programme, plus targeted varnish applications and associated oral health education initiatives.  Assuming that around 120,000 Scottish children aged between three and six are benefiting, it works out at a cost of around £125 per child per annum.

Compare the Childsmile costs of around £125 per child per annum with the CWF costs of about 40 pence per person per annum or even £1.67 per year for each child benefitting. CWF is obviously many times less expensive that ChildSmile.

What is the attitude of Scottish dentists?

The British Dental Association supports CWF and in Scotland has come out publicly to call for communities to move towards introducing water fluoridation. That position undermines the arguments of New Zealand anti-fluoridation groups claiming that Childsmile is an adequate substitute for water fluoridation. The professional body representing dentists in Scotland does not see it that way.

The BDA in Scotland points out that CWF would be beneficial to children and elderly people. It argues that water fluoridation “would complement the Childsmile programme” by helping cut the overall burden of tooth decay and reducing dental health inequalities in the elderly. We could look at it another way and see that a Childsmile programme could complement water fluoridation. After all, we must remember that initiatives such as Childsmile rely on personal compliance and that they benefit only those taking part. They give no benefit for the rest of the population, unlike CWF.

CWF and ChildSmile are are not mutually exclusive. Children in fluoridated areas should be encouraged to brush their teeth regularly with a fluoride toothpaste and to receive dental check-ups. Bear in mind, also, that components of a ChildSmile programme, such as supervised toothbrushing, were in use in parts of Scotland before the introduction of the full programme. Elements of the ChildSmile programme will also be in current use in New Zealand.

Conclusions

Despite claims of anti-fluoride propagandists, the ChildSmile programme is not a simple alternative to CWF. And it is wrong to see it as such in New Zealand.

It is far less cost-effective – the Scottish programme costs around £125 per child per annum compared with 40 pence per person per annum (or £1.67 per year for each child benefitting when benefits to adults are excluded) and therefore far less likely to be put in place as an alternative to CWF.

ChildSmile is an “opt-in” programme so its coverage is far lower than CWF which is an “opt-out.” This is important when social differences in oral health are important.

However, the contact between children and their families on the one hand and public health nurses, health visitors and dentists on the other, is very valuable and may have wider benefits than oral health alone. (I am thinking of problems caused by child neglect and abuse).

I think these sort of programmes are socially very helpful and strongly support them. The cost is, of course, a limiting factor. However, elements of such social programmes may be possible within budget constraints that health authorities face.

Health programmes like ChildSmile, or elements of that programme, can be very effective even in areas where CWF exists. They can give that extra boost to the oral health of children and can, therefore, complement CWF.

There are many areas where CWF is not feasible because of low population density, lack of suitable water reticulation systems or local political opposition to CWF. I believe that programmes like ChildSmile, or parts of that programme, can be very helpful in those situations. Northland and particularly NZ’s Far North are obvious examples.

Finally, let’s not be diverted by the programme name. I am sure that elements of the Scottish ChildSmile programme are already in place in New Zealand, or parts of New Zealand. Given the costs of such programmes, and budget limitations, these programmes do have the advantage that they can be targeted to regions or social groups where the need is the greatest.

Similar articles