Childsmile links prevention to lower carbon use across Scotland
Over the last two decades, Childsmile has become one of Scotland’s most visible public health programmes, and its sustainability work now sits alongside its oral health mission rather than beside it. The programme’s central logic is straightforward: preventing dental disease avoids treatment, travel, materials, and repeated appointments later on. In a system trying to cut emissions, that matters because the cleanest episode of care is often the one never needed.
Childsmile has framed sustainability as an extension of prevention, not a separate add-on. Healthcare delivery contributes to climate change, and the NHS accounts for approximately 5% of the UK’s total greenhouse gas emissions, so even routine service design carries environmental consequences. For a child who avoids caries through supervised toothbrushing, fluoride varnish, and family support, the benefit is not only clinical. It also means fewer restorative visits, less staff travel, lower use of disposable materials, and less downstream demand on services that are already stretched.
This programme has therefore treated sustainability as a practical health systems issue. Public Health Scotland has recognised the model as a case study in prevention and sustainability, and the experience has been particularly relevant in remote and rural areas where travel burdens can quickly multiply. In a national programme spanning broad geography, even modest changes in workflow can produce measurable effects.
Digital meetings cut thousands of kilometres from travel
One of the earliest and clearest gains came from replacing many national and regional meetings with Microsoft Teams. Strategic planning no longer depended so heavily on staff travelling to central locations, and the reduction in travel was substantial. In one year, Childsmile cut distance travelled by just under 18,000 kilometres. The carbon saving was 3,600 kg CO2e, roughly equivalent to the weight of seven adult polar bears.
The numbers are eye-catching, but the operational gain is just as important. Staff spent less time on the road, costs fell, and participation became easier for teams spread across Scotland. For programmes built on collaboration, digital working can strengthen access as well as reduce emissions. It also reduces the hidden clinical cost of geography, where long journeys can discourage attendance at meetings, slow decision-making, and add friction to national coordination.
A single structural change produced a direct emissions reduction and improved reach across the service.
Paper reduction delivered a steady annual saving
Childsmile also reviewed its nationally produced print materials, with subject experts assessing whether documents could be digitised or withdrawn. The result was a sustained reduction in paper use year after year. That shift saves around 2,600 kg CO2e annually, an amount compared with the weight of six adult Highland cows.
The environmental benefit is only one part of the story. Fewer printed resources mean less storage, less distribution, and less waste across a programme that reaches children and families across Scotland. Digital publication also allows updates to be made more quickly when guidance changes, which matters in a prevention programme where accuracy and consistency shape behaviour at home, in nurseries, and in supervised toothbrushing settings.
Single-use mirrors are being used less often
Childsmile teams have also examined the routine use of disposable mirrors during fluoride varnish application. By the end of 2024, the programme was using around 71,000 fewer single-use mirrors than before the sustainability strategy began. In a large national programme, that kind of reduction is not trivial. It shows how one item, multiplied across repeated encounters and multiple sites, can become a meaningful source of waste.
The clinical work itself has not changed in its purpose. Fluoride varnish remains a preventive intervention, and the shift has focused on reducing avoidable disposable use around it. In practice, small procurement and workflow changes can produce a cumulative environmental effect without compromising delivery.
Procurement is now part of the prevention model
Sustainability has also moved into purchasing decisions. Childsmile has worked with National Procurement and suppliers to explore more sustainable equipment, including a locally sourced free-flow drinking cup intended to replace tens of thousands of imported items. The programme has also worked on a cost-effective, single-mould, fully recyclable toothpaste tube.
This matters because oral care products are often designed around function first and recyclability second. Traditional toothpaste tubes are difficult to recycle because they contain mixed materials and laminated structures. By contrast, a single-mould recyclable tube can enter kerbside recycling or NHS plastic recycling waste streams. The tubes were introduced in 2026 and will be used in supervised toothbrushing programmes and oral health packs sent into family homes.
The shift moves the sustainability question upstream. Product design, manufacturing, packaging, transport, and disposal all affect the carbon and waste burden before the item ever reaches a child’s toothbrush cup.
Prevention itself is the strongest sustainability measure
The clearest environmental argument for Childsmile may be the simplest one: preventing disease avoids emissions tied to treatment. Evidence shows that supervised toothbrushing and other Childsmile interventions improve oral health outcomes and reduce dental disease. Research also indicates that the carbon savings from preventing treatment exceed the emissions created by running the supervised toothbrushing programme, with emissions savings more than four times greater than programme emissions.
That relationship is clinically and environmentally important. Dental decay can lead to restorative care, extractions, repeat appointments, and wider resource use across the service. Preventing those outcomes preserves oral health while reducing the footprint of avoidable care. In sustainability terms, prevention is not a softer option. It is often the most efficient one.
Toothbrush recycling remains unresolved
Not every part of the programme has been easy to decarbonise. Recycling used toothbrushes remains a major challenge. Although toothbrushes are recyclable in principle, mixed materials in the head make them difficult to process at home, and industrial recycling has not yet proved economically sustainable at scale.
Childsmile has experimented with recycling services through Terracycle and later through a supplier to NHS Scotland, but both arrangements ended when recycling oral care products became unworkable. The fallback is disposal in black bag waste for incineration, ideally with energy recovery. Even that option is constrained by limited incineration capacity in Scotland and by higher charges when recyclable material is mixed into the waste stream.
The result is a familiar problem in healthcare sustainability: the most desirable environmental option is not always the most feasible one within current budgets and infrastructure. Childsmile continues to work with national waste management colleagues in PSDS to find a longer-term solution.
The programme’s experience shows that sustainability in dentistry is not a separate moral project. It is tied to how prevention is delivered, how products are sourced, and how services are organised across a national network. In Childsmile’s case, the challenge now is not whether prevention can reduce emissions. The remaining task is finding durable, affordable ways to make every part of that prevention pathway match the same standard.