Child oral Health Improvement utiLising Data LINKage (CHILD-LINK): Identifying the effect of social determinants on childhood tooth decay to improve the utilisation and inclusivity of community-level oral health interventions.

Research Title CHILD-LINK: Child oral Health Improvement utiLising Data LINKage Background In England, approximately one in five children has dental caries (tooth decay). Caries can cause pain, dental infection, school absence, and a poorer quality of life. There are also marked inequalities in oral health across England. Treatment of caries is the most common reason for a 5-9-year-old to be admitted to hospital and costs the NHS £50 million every year. The Social Determinants of Health (SDH) framework is crucial to our understanding of oral health inequalities. However, there is limited research within this area. To improve oral health, community-level interventions are recommended by national bodies, including toothbrushing schemes and fluoride varnish programmes. Little is known about the effect of the SDH on these interventions. In Bradford, one in three children has caries, significantly higher than the national average. Several birth cohorts have been set up to tackle the levels of childhood disease in the city, referred to as the Born in Bradford (BiB) cohorts. BiB holds rich epidemiological data for the SDH. For the first time, dental records, including caries data, have been linked to 13,856 BiB participants. Aim Identify the causal effect of SDH on childhood caries, dental access, and community-level oral health interventions, to improve intervention inclusivity and utilisation in Bradford. Objectives Summarise the current evidence for the SDH on the uptake and utilisation of community-level interventions designed for children under the age of 6 years (Work-Package 1). Estimate the causal effect of the SDH on childhood caries, access to dental care, and the utilisation of community-level interventions in Bradford (Work-Package 2) Co-produce recommendations for commissioning bodies to improve the inclusivity and utilisation of community-level oral health interventions (Work-Package 3). Methods Work-Package 1: Scoping review A scoping review will be undertaken using the Joanna Briggs Institute methodology. Current evidence on how SDH affects the uptake and utilisation of community-level interventions in children will be summarised, mapped, and reported using the PRISMA-Scoping Review checklist. Work-Package 2: Causal inference analysis Directed acyclic graphs will be developed to encode causal social determinants identified from the SDH framework and Work-Package 1. The data will be analysed with respect to missingness, consistency, and representativeness using appropriate statistical techniques. The causal effect sizes of SDH on caries, dental access, and utilisation of interventions will be estimated using causal inference statistical analyses. Work-Package 3: Co-produced recommendations to adapt community-level interventions An Appreciative Inquiry approach will be employed through a series of workshops. Co-produced recommendations to adapt community-level interventions for local authorities and commissioners will be created with comprehensive multistakeholder involvement. Impact and dissemination The co-produced recommendations will improve the inclusivity and utilisation of community-level interventions. The causal effect of key social determinants will be estimated, contributing to the evidence-base for oral health inequalities. Tailored dissemination, supported by BiB, includes regular e-communications, a dissemination event, professionally created resources, peer-reviewed papers, and international conferences. Findings will inform future post-doctoral research estimating the effectiveness of the recommendations and testing in other populations.