Blackpool A Better Start’s Oral Health Strategy sees 10% reduction in the number of children with decayed teeth

Michelle O’Neil

Michelle O’Neil, Development Support Officer at Blackpool Better Start, tells us about the partnership’s Early Years Oral Health Improvement Plan devised to address the oral health inequalities in Blackpool and improve the oral health of the youngest children and their families.

Access to an NHS dentist has been one of the most significant issues raised with Healthwatch by the public over the last eighteen months. Despite tooth decay being preventable, in 2019/20, a quarter of five-year-olds in England had tooth decay affecting three or four of their teeth.

The Scope of the problem

  • In 2019/20, 20% of three-year-olds in Blackpool were affected by tooth decay, compared to 11% nationally. 
  • 31% of five-year old children in Blackpool had missing or decayed teeth against the national average of 23%.
  • In 2019/20, 79% of children in Blackpool admitted to hospital for tooth extractions were under the age of 11, and 32% were under the age of five.
  • In 2021, NHS dental statistics data showed that only 29% of Blackpool’s children had seen an NHS dentist in the previous 12 months compared to 43% of children across England.
  • In addition to a lack of access to dentists, families also face further socio-economic barriers such as location, cost, and fear. 

How we tackled these issues 

Our strategy focusses predominantly on behavioural changes to prevent poor oral health. It includes: 

  • Working in conjunction with Blackpool Public Health and NHS England to deliver innovative approaches to preventative oral health work.
  • Distributing toothpaste and toothbrushes and ‘sippy cups’ through Health Visitors and Community Connectors, via Family Hubs, and at community events.
  • The launch of the Henry Infant Feeding Service which offers universal support to expectant and new parents about infant feeding and early oral health support. 
  • The supervised tooth brushing scheme which has been implemented across 86 nurseries, childminder settings and reception classes, benefiting over 4000 children between the ages of three and four.
  • Training the workforce to use consistent language around oral health messaging and developing a targeted communications campaign to promote good oral health. 
  • Developing an ‘Oral Health Peer Support role’ to deliver co-designed and clear public health messages to the community. 

One of the most successful approaches has been the use of new flexible commissioning arrangements which have enabled NHS England partners to work more innovatively by redirecting funding. This has allowed us to work with a local practice which has committed half a day per week to see and treat children under five years of age who are not currently registered with a dentist.

Referrals come through professionals or self-referral with the ‘Text Teeth’ scheme, which is promoted through social media and in the community, including through the Oral Health Urgent Care Team. The scheme enables parents to contact the Community Connector team who then liaise with both families and the practice. They provide a crucial link to support relationships and improve and maximise take up of appointments. As well as this, Community Connectors attend the half-day session to support parents who may be anxious about attending and to provide further advice and signposting.  There have been over 650 requests for support to date.


There has been a significant improvement in the oral health of under fives in Blackpool since 2015 and the beginning of A Better Start funding. In 2015, 42.5% of under-fives in the town had missing or decayed teeth. In 2021, this figure dropped to 31.2% - a decrease of over 10%.

Since November 2022, 669 families have been referred to the funded dentist. We are currently developing processes which will help Community Connectors to gain a better understanding of the challenges and barriers families are facing. It will also help us to better measure the impact of this work on children and their families.

It is anticipated that our combined work to support behaviour change and prevent issues from occurring in the first place will continue to impact children and families in Blackpool positively. The aim is to demonstrate a significant and permanent shift in their oral health from the very start of life, leading to a reduction in rates of dental decay across communities over time. To achieve this, it will require delivery at scale over the next 12 months, to ensure that in three to five years’ time, babies being born in Blackpool will have happier, healthier lives.

About A Better Start

A Better Start is a ten-year (2015-2025), £215 million programme set-up by The National Lottery Community Fund, the largest funder of community activity in the UK.

Five A Better Start partnerships based in Blackpool, Bradford, Lambeth, Nottingham and Southend are supporting families to give their babies and very young children the best possible start in life. Working with local parents, the A Better Start partnerships are developing and testing ways to improve their children’s diet and nutrition, social and emotional development, and speech, language and communication.

The work of the programme is grounded in scientific evidence and research. A Better Start is place-based and enabling systems change. It aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life. It is one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aim to make people’s lives healthier and happier

The National Children’s Bureau is coordinating an ambitious programme of shared learning for A Better Start, disseminating the partnerships’ experiences in creating innovative services far and wide, so that others working in early childhood development or place-based systems change can benefit.

Sign-up to join our mailing list

Visit the A Better Start website to find out more.