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Paediatric dentistry: Dental Check by One

Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS. Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space.

Sir, we were delighted to read the letter from V. Argent (BDJ 2017; 223: 551) in which the importance of a multidisciplinary approach in support of BSPD's Dental Check by One (DCby1) was outlined. As observed, communication of the campaign should be via non-dental as well as dental avenues to reach parents who otherwise would not have knowledge of the campaign. This is indeed our vision. Communication of DCby1 is gaining momentum and we already have a list of supporters from both within and outwith dentistry:

With the support of health visitors, the DCby1 message should reach into homes of new parents. Our aim is that, in due course, 'registering' with a dental practice will be as routine as registration with a medical practice. Our supporters include school nurses, pharmacists and organisations for new parents, such as the National Childbirth Trust. The media has also been supportive and on launch day the DCby1campaign was featured on BBC Breakfast ( England's Chief Dental Officer Sara Hurley was beside me on the sofa championing the campaign.

In our commitment to working with all organisations with an interest in the welfare of children we are mirroring Public Health England's Child Oral Health Improvement Programme Board. The Board comprises a wide range of organisations committed to collaborating in the interests of children, especially the hardest to reach in the most deprived communities. We are also happy to say that DCby1 is an essential part of the Starting Well Programme, a Smile4Life initiative based in the 13 areas of poorest children's oral health in England.

DCby1 is a BSPD campaign, led in partnership with the Office of the Chief Dental Officer of England but also supported by the Chief Dental Officers of Scotland and Wales. With this united and consistent message I expect to see increased attendance of young children, especially from communities with high dental need.

Henrik Overgaard-Nielsen, Chair, General Dental Practice Committee responds: We proudly support the principle of DCby1. Children should receive care when teeth first appear. It's a no brainer. The sooner kids get acclimatised to – and their parents understand the importance of – regular check-ups the better, and we commend BSPD for taking this initiative forward.

Our concern remains the gulf between the principle and the policy. We now have clarity about how dentists should claim for these visits and we want dentists with capacity to encourage all patients to attend with their young children, but there is still the problem of funding. There is no new money to support this important policy goal. And with the cash-limited system we have in England, DCby1 presents real challenges. Under the current GDS contract some colleagues may have spare UDA capacity – but many can do no more than swap one group of patients for another.

We want this scheme to succeed, but for that to happen, the funding situation must change. The worthy sentiment behind the initiative will be lost on parents in West Yorkshire, who are unable to access NHS care for themselves or their children. Sadly in too many areas DCby1 is a promise that simply cannot be kept without additional resource.

This comes as the CDO's Starting Well programme kicks off in 13 locations across England. We all know there are serious problems with health inequalities in many areas, especially for children, but when the response in London is limited to action in just three wards in Ealing it is hard to see this plan making a substantial difference. I remind readers that this initiative is not being billed as a pilot. Lessons are not going to be bottled and shared. This is a limited effort in a handful of sites. A cost-free box tick for government on a manifesto pledge – targeting taken to extremes without the scope for transformative change in health outcomes.

In Scotland ChildSmile has worked because it has sought to deliver the appropriate combination of universal and targeted effort: a basic offer for all, a bit extra for those that need it delivered through practices. Genuine outreach that's shaving millions off treatment bills, made possible by a coherent strategy and dedicated investment.

NHS dentists are used to seeing the 'middle class worried well' and their kids. The risk is that we are not seeing the resources or the will to get genuinely 'hard to reach' patients seen by age one, or indeed by any age. Recycling a fraction of existing budgets will only take us so far. Keeping clawback money in dentistry is a step in the right direction – after all we have £85 million unaccounted for – but the sums are small change compared to the health challenge we face.

Authorities, local and national, in England have not yet woken up to the logic of investment and return in oral health services and we urge them to put resources in so DCby1 and Starting Well can become the seeds of a comprehensive programme. I know our position has led some quarters to accuse us of needless negativity. Nothing could be further from the truth. We believe in the power of health professionals, parents and government to deliver – together – transformative changes to children's health.

We urge practitioners with capacity to get involved in DCby1. We only wish it wasn't a hard choice or a numbers game for any GDP. What we seek is a real, coordinated, resourced, strategic effort to get young hard to reach patients in England receiving the care they desperately need. We are still waiting.

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Stevens, C. Paediatric dentistry: Dental Check by One. Br Dent J 224, 58–59 (2018).

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