The dental sector in England is undergoing systemic transformation driven by an acute need to expand preventive care for children and adolescents. Caries remains the leading cause of hospitalizations among children aged 5–9 years, exacerbating the crisis of access to NHS dentistry and requiring new organizational solutions.
In the current circumstances, the key factor for progress is not only increasing the number of dentists, but also the strategic integration of competency distribution among members of the clinical team — dentists, therapists/hygienists and nurses with expanded responsibilities. A modeling study that examined six «skill‑mix» scenarios, ranging from a single‑profile dentist to a scenario of maximal delegation, demonstrates a range of opportunities for the diffusion of evidence‑based preventive interventions across the entire child population; moreover, in optimized scenarios the dentist retains responsibility for diagnosis, clinical assessment and treatment planning, while preventive procedures and measures for fluoride prophylaxis, individually‑oriented counseling and care are implemented by staff within documented and clinically validated protocols.
The distribution of roles should be seen as a component of comprehensive clinical cooperation — not a mere redistribution of tasks, but the creation of a multi‑level system where standards of practice, clinical protocols and patient routing algorithms ensure predictability and quality of care; this includes standardized criteria for referral to a dentist, training in motivational interviewing skills and clinical supervision to maintain the quality of interventions.
The authors emphasize that the model is based on assumptions of ideal access and efficient patient flow, which limits the external transferability of the results to real practice, where implementation barriers include funding, administrative complexity and incomplete patient attendance. The relevance of the approach requires alignment of educational standards, national certification and mechanisms of clinical accountability, ensuring reproducibility and safety of the delegation of duties.
Key operational questions include assessing the actual availability of practitioners with expanded competencies, modeling staffing needs under varying workloads, integrating vaccination and screening programs into primary dental care — all these parameters are necessary for planning implementation and scaling; preserving dentists’ time for diagnosis, complex treatment and planning remains one of the main expected effects, while simultaneously increasing coverage of preventive programs.
The model does not demonstrate direct improvement in clinical outcomes — empirical validation is required in the form of prospective studies, cluster randomized controlled trials or real‑world studies with assessment of clinical outcomes, patient‑oriented measures and economic effect. An economic analysis is needed taking into account NHS costs, payment models for prevention, the impact on hospitalizations and the child’s quality of life, as well as an analysis of resilience given variability in patient attendance and regional differences in workforce capacity.
Risks include insufficient staff training, blurring of the boundaries of clinical responsibility, variability in protocol adherence and potential legal/regulatory constraints; to minimize risks clear frameworks of clinical oversight, quality audit, standards of continuing professional development and mechanisms of clinical supervision are required.
From the perspective of evidence‑based medicine and workforce organization the proposed concept of «prevention‑first» has a logical basis and the potential to increase coverage of prevention and rationalize patient pathways — provided mandatory validation of the model in real clinical settings, adaptation of educational programs and development of sustainable financial incentives. Expert attention should be paid to integrating caries risk assessment protocols, unified referral criteria and outcome metrics, including hospitalization frequency, the need for winter fillings in children and quality of life indicators; it is also critical to conduct pilot projects with economic evaluation and subsequent scaling upon confirmed effectiveness.
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