**Background:** Dental decay remains a significant global public health issue, affecting up to 90% of young children in some populations, with disadvantaged groups at particular risk. In England, tooth extraction for dental decay was the most common hospital procedure for children aged 6–10 years in 2019. Dental decay prevalence is almost double among Asian or Asian British children (36.9%) compared with white British children (20.6%), and over one-third (36.3%) of 5-year-olds from the most deprived areas had active tooth decay versus 12.5% in the least deprived areas. In the Royal Borough of Kensington and Chelsea (RBKC), 33.4% of 5-year-olds had visible dental decay in 2014/2015, significantly higher than the national average of 24.8%. The hospital setting was identified as a potential venue to complement traditional community-based oral health promotion activities.
**Methods:** A 2-year (September 2019–September 2021) oral health improvement and disease prevention programme was jointly developed and funded by RBKC Public Health Department, City of Westminster, Public Health England (London), and Chelsea and Westminster Hospital NHS Foundation Trust (CWFT). The programme comprised three intervention components: (1) Health promotion activities — display of videos and posters and distribution of bedside information packs across paediatric settings, with a target of 75% of children/families reporting seeing oral health messaging; (2) Supervised toothbrushing (STB) — one-to-one sessions delivered to paediatric inpatients and their carers using motivational interviewing techniques, with targets of 75% identifying something learned, 75% committing to behaviour change, and 100% signposting of children not regularly seeing a dentist; (3) Staff training — 30-minute sessions for maternity and paediatric staff, with targets of 75% reporting learning and 75% committing to positive change. The intervention was underpinned by the Health Belief Model and COM-B model, following Making Every Contact Count principles. A baseline questionnaire was conducted in November 2019 involving 101 children and parents/carers, showing 55% had not seen any health messaging in the hospital, 22% of children ate sugary foods daily, 9% drank sugary drinks daily, and 18% had both daily. Data were collected between November 2019 and August 2021 using bedside surveys, online booking platforms, and staff feedback surveys. Statistical process control charts (XmR and P-charts) were used to analyse data alongside summary statistics and qualitative analysis.
**Key Results:** Health promotion activities: 93 posters were deployed across the hospital, with 41% (233/565) of families recalling seeing materials (KPI1), though those identifying as Asian or Asian British ethnicity were least likely to report this (29.3%) compared with white or white British ethnicity (46.0%). The 75% target was not met, but recall increased to an average of 63% over the last 12 weeks. Supervised toothbrushing: 737 children received STB (KPI2), averaging 11.5 children/week (50% aged 0–5 years, 21% aged 6–10, 25% aged 11–15, 3% aged 16–18). Including siblings, an estimated 1,683 children were reached. 96% (708/737) of children/families stated they learned something, with the most common theme being toothbrushing frequency/technique (34%) followed by diet and nutrition (29%). 91% (674/737) committed to a positive behaviour change (46% regarding toothbrushing, 30% regarding diet). All 173 children not regularly seeing a dentist were signposted to dental services. Of 229 children brushing less than twice daily, 76% (174/229) committed to brushing twice daily. Of 257 children consuming sugary drinks >3 times/week, 54% (140/257) committed to reducing sugar. Of 317 children consuming sugary foods >3 times/week, 69% (218/317) committed to reducing sugar. 43% of children receiving STB lived in the most deprived areas (IMD quintiles 1 and 2) and 57% identified as minority ethnicity. Staff training: 73 staff members received training (KPI3). All 32 respondents reported learning something new, and 84% (27/32) reported they would do things differently. The programme was significantly impacted by COVID-19, with a 5-month suspension (March–August 2020) and subsequent adaptations including moving training online and reducing STB delivery to a single 'Covid Safe' ward.
**Clinical Implications:** This quality improvement programme demonstrates that a hospital-based opportunistic oral health promotion programme can effectively reach high-risk populations, including children from deprived areas and ethnic minority groups who may not be reached by school-based programmes (50% of STB recipients were under 5 years old). The programme achieved high rates of self-reported learning (96%) and commitment to behaviour change (91%) among families, and all staff respondents reported learning something new. However, the programme faced significant constraints including dependence on a single staff member for frontline delivery, inability to measure actual behaviour change (relying on self-reported intention as a proxy), inability to assess longer-term outcomes due to lack of follow-up after discharge, and challenges with data completeness (23% missing oral health behaviour data). The programme has received a third year of funding and there are plans to roll out to other hospital sites and services. Key learning for future programmes includes the need for flexible delivery mechanisms, wider staff training to reduce single-point-of-failure risks, and securing funding for longitudinal follow-up studies to assess downstream impact on dental decay rates.