Targeting vulnerable families, the collaborative programme empowers parents with personalised insights and clear, prioritised guidance for their children’s oral care
SINGAPORE — For many families, dental care decisions tend to be reactive, made only when a child experiences pain or visible dental problems, by which time treatment can be more complex. Addressing childhood dental risk early not only improves health outcomes but also supports better use of healthcare resources by ensuring children receive the right level of care at the right time.
Past studies on children’s dental health in Singapore have highlighted the prevalence of early childhood caries and gaps in dental care access and follow‑through among young children. One study1 showed an increase in early childhood caries with age, with prevalence rising from 17.8 per cent among two‑year‑old children to 42.9 per cent by age three.
Another study2 conducted between 2018 and 2019 by institutions under the National University Health System (NUHS), examined the differences in health habits and health-related quality of life of preschool children from lower-income families3 compared with their peers. In relation to dental health, it found that fewer than half had ever visited a dentist, compared with 75.4 per cent of their peers from higher-income families. Of particular concern was the low follow‑through on recommended care. Among children identified with active dental decay and advised to seek follow‑up, only 13.3 per cent of those from lower‑income families accessed specialist care within the three- to four-month follow-up period. Amongst those followed up till 12 months, 28.9 per cent followed through with regular dental care (including primary care dental clinics) at least once a year.
Enabling early, right‑sited dental care through tele‑dentistry
In January 2023, a multi-modal tele-dentistry programme which combined behavioural risk assessment with image-based assessment, was launched as part of the HEAlth and Development SUpport in Preschool Partnerships (HEADS-UPP) initiative (refer to Annex A). HEADS-UPP is a community-based preventive health programme delivered in partnership with Care Corner Singapore and PAP Community Foundation (PCF) Sparkletots Preschool, providing health and developmental screenings, targeted health and parenting education, and support to children from lower-income families4.
The tele-dentistry programme brings together the clinical, academic and public health expertise from the National University Hospital (NUH), the Faculty of Dentistry, National University of Singapore (NUS Dentistry), the National University Centre for Oral Health, Singapore (NUCOHS) and the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine) to support early identification of caries risk and timely parental action. Through this cross‑institutional collaboration, the programme aims to enable earlier intervention and, over the longer term, help narrow oral health disparities among preschool children from vulnerable families.
As of 20 January 2026, a total of 355 children aged 18 months to six years from 17 PCF Sparkletots preschools in western Singapore had benefitted from the programme. Nurses and case management officers from NUH visit preschools to capture intraoral images of the children’s teeth, while parents complete a questionnaire adapted from the American Academy of Pediatric Dentistry’s Caries Risk Assessment tool, covering factors such as oral hygiene, dietary habits, family history of caries, and frequency of dental visits.
A paediatric dentist from NUS Dentistry then remotely reviews the questionnaire responses and assesses the intraoral photographs for signs of dental plaque, gingival inflammation, and dental decay. These assessments culminate in a personalised dental report for each child, which includes annotated intraoral images highlighting areas of concern, alongside the child’s caries risk level and recommended individualised and prioritised follow‑up actions. The programme incorporates a tiered referral pathway based on individual risk assessment, ensuring right‑siting of care, with high-risk children referred directly to NUCOHS for specialist management, while those of lower risk are referred to appropriate primary care. Members of the HEADS-UPP team will also engage parents to walk through the report, reinforcing key recommendations and providing coaching on preventive practices.
The same questionnaire is administered approximately six to nine months after the individualised report is shared with families, providing the programme team with insights into whether parents have acted on the recommended preventive measures, such as arranging dental visits or making changes to their child’s oral health habits.
Preliminary findings show improved parental follow‑through and reduced caries risk
Based on responses from the questionnaires administered at the start of the tele-dentistry programme, 93.3 per cent of children were identified as being at moderate to high risk of dental caries. A review of intraoral images from the 355 participating children further found that 27.3 per cent showed signs of dental caries, 30.7 per cent had inflamed gums, and 54.9 per cent demonstrated poor oral hygiene.
Among children identified with dental caries, the tele‑dentistry programme was associated with improved follow‑through on recommended care. While only 13.3 per cent of children from lower-income families received further specialist treatment within the three to four-month follow-up period in the 2018/19 NUHS study despite being recommended to do so, 57.5 per cent of children in the HEADS-UPP tele-dentistry programme subsequently received such follow‑up care four to six months later, suggesting stronger parental follow‑through and earlier intervention. More parents also followed recommendations to seek regular dental care at primary care dental clinics (51.3 per cent), as compared with the 2018/19 NUHS study (28.9 per cent).
Feedback from parents participating in the tele‑dentistry programme indicated that the personalised approach helped strengthen their child’s toothbrushing routines, reduce practices associated with caries risk, and build greater confidence in managing their child’s oral health. These perceptions were supported by preliminary findings from the follow‑up questionnaire administered six to nine months after parents received the personalised dental report, which showed a reduction in caries risk, with the proportion of children classified as moderate to high risk decreasing from 93.3 per cent to 75.6 per cent.
“What we are seeing from this tele-dentistry programme is encouraging,” said Associate Professor Catherine Hong, Vice Dean (Research, Innovation and Enterprise), NUS Dentistry and Senior Consultant, Division of Paediatric Dentistry, NUCOHS. “By bringing dental assessment and clinical advice closer to where children are, we are able to identify risks earlier and support lower‑income families who might otherwise face barriers to timely care. This helps address gaps in early detection during a critical stage of a child’s development.”
Adjunct Associate Professor Chong Shang Chee, Head of Division and Senior Consultant, Division of Developmental and Behavioural Paediatrics, Department of Paediatrics, Khoo Teck Puat – National University Children's Medical Institute, NUH, and programme lead of HEADS-UPP, added: “Looking ahead, we see tele‑dentistry as an important part of how HEADS‑UPP encourages families to take proactive action through structured guidance, such as individualised reports that clearly prioritise next steps so parents are not overwhelmed.”
“Going forward, we aim to enhance the dental screening process through the integration of artificial intelligence (AI). AI can help review the intraoral images, evaluate responses from the Caries Risk Assessment questionnaire and integrate these data to generate oral health reports. These reports contain customised oral health recommendations that allow parents to intervene early, reducing the risk of progression of dental caries and gum inflammation. These enhancements will streamline the dental screening process, enabling the programme to reach more children and expand to additional preschools, while reducing reliance on manual processes. "
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1Hu S, Sim YF, Toh JY, Saw SM, Godfrey KM, Chong YS, Yap F, Lee YS, Shek LP, Tan KH, Chong MF, Hsu CS. Infant dietary patterns and early childhood caries in a multi-ethnic Asian cohort. Sci Rep. 2019 Jan 29;9(1):852. doi: 10.1038/s41598-018-37183-5. PMID: 30696871; PMCID: PMC6351619.
2Chong SC, Aishworiya R, Seo WL, Chiong YK, Koh GC, Lin JB, Heng L, Habib Mohd T, Saw YE, Chan YH, Chua JS, Shorey S. Health practices, behaviours and quality of life of low-income preschoolers: A community-based cross-sectional comparison study in Singapore. Ann Acad Med Singap. 2024 Mar 27;53(3):142-151. doi: 10.47102/annals-acadmedsg.2023168. PMID: 38920242.
3Those with a household income below SGD3000 or per capita income below SGD750.
4Families who meet the criteria of household income below SGD4500 or per capita income below SGD1125.
