Recently I attended an interesting presentation by Professor Peter Mossey, Dundee University on""Oral Health Inequalities"" at the Scottish Dental Show, 2016 Glasgow 13-14 May http://goo.gl/AxxejL

As a Glasgow based dentist, I am interested in oral health inequalities and its impact on oral and general health. I witness the Glasgow Effect everyday http://goo.gl/2NF3Ci, it refers to unexplained poor health and low life expectancy in Glasgow, compared with the rest of the United Kingdom and Europe.

Professor Mossey spoke about his experience regarding cleft lip and palate in the developing world - outlining three factors relating to inequality.

- Invisibility - There are no registration, data collection, publications and so a total lack of awareness about the global toll of inequality 

- Access to Care - Countries in greatest need of care are the ones with the least resources and poor infrastructure. 

- Infanticide - Recent evidence highlight that Orofacial Cleft results in high rates of infanticide. 

A combination of these factors led to a significant difference in morbidity in children as compared to the developed world. 

Across Europe, the inequality gap is highlighted with these figures: 12.5 deaths occur in every 1000 live births in high mortality regions vs 1.7 every 1000 live births in the lowest regions.These inequalities can be extrapolated to oral health and inequalities in Scotland, who share the problem of access to care with developing countries.

In 2012, 10 out of 14 of Scotland’s regional health boards recorded the lowest rates of registrations to an NHS dentist in the most deprived areas. 
Children in Scotland attending primary school in socially deprived areas of UK, have higher rate of tooth decay than those in non deprived areas. 60% of 5 year olds and 70% of 8 year olds have tooth decay compared to 40% of 5 year olds and 55% of 8 year olds in non deprived areas. 

In response to Scotland's poor record in dental health and inequalities, Childsmile Programme http://www.child-smile.co.uk was created in 2009 by NHS Scotland, to improve the oral health of children in Scotland, with all children receiving a minimum level of care and those in the most deprived areas receiving targeted levels of care - including twice - yearly fluoride varnish application and enhanced support to vulnerable families via dental practices and support workers. Proportionate universalism - raise the standard of care universally for everyone but putting more resource to those in greatest need. 
The Primary 7 age group met the target of 60% across the age group without obvious decay! 

The Childsmile  Programme has been a success story, and an excellent example of an intervention designed to simultaneously deliver dental health improvement and reduce health inequality. 

Rather than compromising the gold standard of care by removing resources from the affluent areas and relocating these resources to the most deprived. Proportionate universalism as indicated in the child smile programme appears to be a very effective method of intervention.

The Childsmile programme helped to create new work patterns and behavior for health care teams. There is more joined up/integrated oral care with the involvement of  health visitors, community dental nurses and even primary school teachers, delivering effective oral health across Scotland.  Prof Lorna Macpherson, Director of  Evaluation & Research Team of the Childsmile  programme, Glasgow University http://goo.gl/o15II9 recommend that  ""dentistry integrated into the health visiting &child health system"".

Strategic health planners & oral health product manufacturers should be alerted to these emerging patterns of  work/behavior and their implications for oral and general health across Scotland.

As a practicing dentist,  I am interested to learn if a programme such as Childsmile can be extrapolated to other geographical locations/countries to improve dental health and close health inequality? also is it possible to adapt it to close not only oral health inequalities but health inequalities across the world? 

These are questions for all key health players and interested parties.