Sir, we have read with a particular interest the Upfront segment in January's edition regarding a new programme in Greater Manchester aimed to tackle tooth decay in under five-year olds.

The programme aims to introduce daily tooth brushing in schools, distributing dental aids through health visitor checks, encouraging dental visits and improving access to dental care for children under five.

In 2015, the Oral Health Survey identified that 24.7% of participants experienced dental decay, with 88% of this decay left untreated.1

Not only can we consider this from a health perspective, but financially - the NHS spends £7.8 million every year on tooth extractions among the under-fives.

Public Health England (PHE) has also predicted that supervised tooth brushing will produce a return of investment of £3.06 for every £1 spent at five years and can result in an extra 2,666 school days gained per 5000.2

Wales implemented the £3.7 million Design to Smile Community Dental Service Programme in 2009. Its programme, in addition to the aims of the Greater Manchester initiative, provides fluoride varnish applications and fissure sealants.

It was set up with the aim of reducing the socio-economic inequalities which have an impact of decay development and to implement changes in order to halve the prevalence of decay by 2020.

Oral health surveys of five-year-olds conducted within Wales have shown a decrease of 38% in decay prevalence between 2007-8 and 2015-163 which would assume this intervention has created positive improvements in oral health.

It will be interesting to see whether the Greater Manchester initiative will have similar success rates even in the absence of dental treatment.

Having been actively involved in the data collection for the epidemiology of decay in five-year olds for PHE, it has been an eye-opening experience and one highlighting that many children are still not receiving the dental care they need.

The results will be published as part of the Oral Health Survey for five-year-olds in 2018-19 and we look forward to seeing what the results reveal.

It is with hope that initiatives, such as those in Greater Manchester and Wales, reduce the prevalence of childhood decay significantly.

To further aid the improvement in oral health promotion, I urge general dental practitioners to support these initiatives. We all have a role in ensuring early intervention and management of decay whether that is in primary or secondary care.