BDJ Model Finds Dental Team Skill Mix Improves Child Caries Prevention in England

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Posted: May 22, 2026

BDJ Model Finds Dental Team Skill Mix Improves Child Caries Prevention in England

Edited by Dentaltown staff

A new operational research model published in the British Dental Journal indicates that using the full dental team — dentists, dental hygienists and therapists, and extended-duties dental nurses — would deliver evidence-informed, risk-based caries prevention to children in England more efficiently than relying on any single workforce role, especially under realistic NHS staffing constraints.

The linear programming optimisation model tested six dental skill mix scenarios against a status-quo caries risk rate of 31.02% across the under-18 population. Researchers drew inputs from Office for National Statistics demographic data, the National Dental Epidemiology Programme for England oral health surveys of three- and five-year-olds, the 2013 Child Dental Health Survey, and the U.K. government’s Delivering Better Oral Health Version 4 evidence-based toolkit.

The model found that a single-discipline workforce of dentists alone could in theory deliver universal preventive care to children in England using 7,991 whole-time-equivalent dentists, the lowest raw headcount among the scenarios tested. However, the authors noted this would require roughly one-third of England’s registered dentist workforce to dedicate 100% of their NHS clinical time exclusively to children, which the paper described as an unrealistic baseline given current NHS commitment levels.

Among scenarios incorporating skill mix, the most efficient was a maximum-delegation model in which extended-duties dental nurses delivered most preventive interventions under prescription, dental hygienists and therapists provided fissure sealants and restorations following dentist assessment, and dentists carried out only the initial oral health review. That configuration required 1,602 dentists, 6,002 dental hygienists and therapists, and 4,083 extended-duties dental nurses, for a combined whole-time-equivalent workforce of 11,687.

A proportional combination scenario in which dentists provided full preventive care for the highest-risk 10% of children and the rest of the workload was shared by other team members required 409 dentists, 7,902 hygienists and therapists, and 3,940 extended-duties dental nurses. The intermediate skill mix scenario required the largest total workforce, at 17,750.

The authors noted that just over 52% of children in England attended an NHS dentist within the recommended one-year interval in 2023, meaning current workforce demand falls well below the modeled ideal of 100% population coverage. They argued that effective deployment of the broader dental team could help address the country’s child oral health access gap as the proportion of dentists providing NHS care has continued to decline.

The study was led by Victoria Niven of King’s College London, with co-authors at Cardiff University. Funding was provided by NHS England Workforce, Training and Education and the National Institute for Health and Care Research. The authors said the modeling framework could be adapted to project workforce requirements for adult care, target population groups, and regional service planning, though they cautioned that several timing assumptions for extended-duties dental nurses could be refined as additional evidence becomes available.

Sources:
British Dental Journal, “Prevention first — modelling evidence-based prevention with the dental team for children in England,” by Victoria Niven, Immanuel Sakkilian, Paul R. Harper and Jennifer E. Gallagher, May 22, 2026: nature.com/articles/s41415-026-9626-6
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