Challenges associated with implementation of a school-based tooth-brushing and fluoride varnish programme in a diverse and transient urban population.

Public health competencies being illustrated; Planning, delivery and evaluation of health improvement programmes, addressing health inequalities, awareness of cultural impacts on health and wellbeing. Smile4Life, a schools-based, evidence informed oral health promotion programme, was designed to address high levels of oral health need and inequality within a UK City. The aims of the pilot described were to test the feasibility of delivering the programme (supervised tooth-brushing, take home kits, educational resources and application of fluoride varnish) in six culturally diverse schools in disadvantaged neighbourhoods, and evaluate its impact on caries prevalence. High levels of participation were achieved (98% positive consent) however only 44% received more than one application of fluoride varnish. A reduction in decay prevalence and improved oral hygiene was observed. This paper examines the challenges faced in working with transient and culturally diverse population groups, working effectively with schools to deliver an effective intervention for this population, and in responding effectively across agencies to address safeguarding concerns.