March 2014

Initial impetus for action Bradford District is an area of approximately 400 square kilometres, in the Yorkshire and Humber region of Northern England, The population estimate for Bradford District for 2009 was 506,800 people and it is one of a few metropolitan districts experiencing population growth. The population is younger relative to England, and is more deprived. The district is ethnically diverse with 74% of the population white, 21% Asian, and 5% mixed race, black or other ethnicities (Office for National Statistics, 2009). Regular National Dental Epidemiology Programme surveys demonstrate that five-year-old children living in Bradford District have disease levels significantly greater than the average for England, with very little improvement over the past ten years (Bradford and Airedale NHS, 2012). Results from the oral health survey of five-year-old children carried out in 2007/08 showed a mean number of decayed, missing and filled teeth (d3mft) of 2.42 (Rooney et al., 2009). In 2007/08 Primary Care Trusts (PCT) in England were responsible for assessing the oral health needs of their population, and for commissioning appropriate oral health programmes and dental services to meet those needs. A package of care aimed at improving oral health of young children in Bradford, had previously been commissioned by the former Bradford and Airedale teaching PCT under the name of ‘Building Brighter Smiles’ which was based on the principles of proportionate universalism with population-wide and targeted elements. The package followed an early life course approach and included breastfeeding advice, partnership working with health visitors to provide oral health advice, free toothpaste, toothbrush and trainer cups to under two-years-olds, a dental health award promoting healthy snacks in pre-school settings, toothbrushing programmes in schools and mosques, and providing oral-health based educational resources for pre-school and primary school children. This package of care provided by Bradford District Care Trust Community Dental Service (CDS) had been in place for over seven years commencing in 2000. Despite this intensive and proactive approach, dental disease at a population level in Bradford District remained high.