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Designed to Smile (D2S) is a national oral health improvement programme, aimed to reduce the prevalence of dental caries in young children in Wales. D2S has a responsibility to consider the environmental impact of the service it provides and demonstrate adherence to the sustainable development principle legislated within the Wellbeing of Future Generations (Wales) Act. To review the environmental impact of D2S by estimating the carbon footprint of the programme and identify carbon hotspots for future targeted action. Process mapping iden