Sir, I have read with great interest the opinion article Child dental neglect: is it a neglected area in the UK? (BDJ 2012; 213: 103–104) and the subsequent letter Taking prevention to the child (BDJ 2012; 213: 376). Both highlight the challenges involved with the diagnosis and treatment of child dental neglect. While I do agree that community fluoride varnishing schemes are very effective and that school based intervention programmes also have a place, they do not reach all of these vulnerable children. Some of the most vulnerable children in society are those from families who refuse to engage with all services whether those are health services, social services or education. For example, in school or nursery based intervention or screening programmes, the children may have poor attendance rates and not be present on the screening or intervention day. How can we as dentists then help these children to access dental services?

One model that has been effective is that recently set up in NHS Greater Glasgow and Clyde. In this model children with welfare concerns are referred to the child protection unit based at the Royal Hospital for Sick Children in Glasgow and can be appointed for a comprehensive medical assessment. This assessment includes a comprehensive oral assessment by a dentist. The assessments normally take place in a local health centre or child development centre. When children attend they are accompanied by a parent/carer and also a social worker. In this way we are able to ensure multi-disciplinary working. The dental appendix to the medical report can also highlight the oral needs of the children to their health visitor (for the under fives) and many of the health visitors will have a dental health support worker as part of their team who can support families to access the care. Importantly this has also raised the profile of oral health with both our medical colleagues and colleagues in social services who are now more aware of the important input dentistry can have to the overall assessment of children's welfare, especially in this most vulnerable group.

1. Glasgow