1.1 In presenting this document we recognise the enormous progress made over the last decade, particularly the improvement in children's oral health. The Scottish Government's Childsmile Programme has made significant progress in improving the oral health of young children. This programme is delivered by health visitors, oral health teams, staff in nurseries and schools, and dental practices. It concentrates on preventive actions such as toothbrushing and fluoride varnish application.
1.2 We have also seen substantial improvements in the numbers of dentists providing NHS dental services. Access to NHS dental services is at its highest ever level, with approximately 90 per cent of the population registered with a NHS dentist in Scotland.
1.3 Looking forward we have to maintain the progress that has been made but also recognise the significant challenges which remain. The recent public health review noted that there are many challenges which 'cannot be addressed solely through treatment' and rightly highlights the importance of prevention.  In dentistry the opportunities to address these problems are clear; diseases of the mouth are almost totally preventable, we know the causes of most of them and we have shown that prevention works.
1.4 Prevention has to be at the forefront of any plans we have, recognising that stakeholders - individuals, carers, parents, teachers at all levels, health and social care staff and the dental team - all need to contribute to good oral health outcomes. NHS dental services have to change, not only to encourage prevention, but also to continue to deliver a high quality service in line with the vision of a sustainable health service outlined in the National Clinical Strategy. 
1.5 The numbers of older people supported in their own homes or resident in care homes is increasing. The health and social care agenda provides an opportunity to apply the same team effort to addressing disease found in the older generation shown to be so effective for children. Increasingly oral health care requires the involvement of a range of professionals beyond the dental team.
1.6 The Scottish Government considers this the ideal opportunity to provide NHS dentistry with a new overarching approach to take it forward from this point. This is about meeting new challenges so that patients and service providers have confidence there is strategic leadership and direction from the Scottish Government for the future of NHS dental provision.
1.7 In the first instance we need to identify some of the key oral health challenges facing Scotland and the implications for dental patients. We should acknowledge that some of the proposals, which we wish to explore as part of the consultation, are medium to longer-term in nature.
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