Better Health For All

The publication of the Scottish Public Health Priorities² in 2018 provides an opportunity to consider the future direction of public health as part of Public Health Reform¹. How can oral and dental health contribute to the wider public health landscape? This is something that I along with the Consultants in Dental Public Health and Chief Administrative Dental Officers Group in Scotland have considered. In this blog post I want to share some of our key findings and messages.

The risk factors for oral diseases are the same as for other non-communicable diseases

If I mentioned poor diet, excess sugar intake, alcohol and tobacco use as risk factors for non-communicable diseases, what conditions immediately spring to mind? Type 2 Diabetes? Coronary Heart Disease? Cancer? Well in the mind of a dental professional those same risk factors might lead them to consider dental caries, periodontal disease and oral cancer. There is a high degree of overlap in the risk factors for oral disease and other non-communicable and chronic conditions which affect our population. Therefore we can use a common risk factor approach³ to ensure we have consistent messages and exert the greatest influence in our prevention activities.

Dentists are well placed to routinely see a “well” population

In a recent survey⁴, 73% of adults reported they had attended their dentist in the last year. Many of these patients will be attending for routine check-up appointments with no specific problems or symptoms. Therefore, the dentist might be the only healthcare professional a “well” patient sees for a while, why you ask is this important? Well, this provides a unique prevention opportunity, with dental professionals able to identify risk factors, such as smoking, alcohol intake or diet at an early opportunity and provide evidence based behaviour change advice and support such as referral to stop smoking services. As outlined in the Scottish Government’s Oral Health Improvement Plan⁵ there might also be the opportunity to explore the possibility of dental teams providing general health checks to aid the early detection of non-communicable diseases such as diabetes.

We have shown that investment in prevention pays

Childsmile the National Oral Health Improvement Programme for children in Scotland was first established in 2006. Every child in Scotland has the opportunity to benefit from Childsmile, from the toothbrushing packs and free flow drinking cups handed out by Health Visitors to all children and the universal supervised toothbrushing programme being offered in nursery schools. There is also targeted provision of fluoride varnish in priority nurseries and schools, and the extension of toothbrushing into some primary schools. Research⁶ has been able to demonstrate cost savings associated with spending on prevention activities. Within three years the nursery tooth brushing programme was shown to have recouped its annual expenditure through savings on actual and anticipated dental treatments. Indeed the programme was recently recognised by the EU Commission as an example of public health best practice⁷.

We still have a long way to go

Over the past 10 years, oral and dental health professionals, along with our varied range of collaborators have made huge improvements in the oral health of the Scottish population. We have high seen significant increases in the percentage of the population registered with a dental practice⁸ and have decreased the percentage of the Primary 1 child population suffering from dental disease by around 25%⁹.

However, we still have much left to do. By the start of primary school nearly a third (29%) of children will have dental decay at a level where treatment is required. We still see a huge inequity in the oral health of our population, with those living in areas of deprivation experiencing significantly poorer oral health as well as marginalised groups such as those experiencing homelessness.

Action can, and must be taken to harness existing momentum and build new and innovative actions to address the inequalities we see. Using a common risk factor approach, and recognising the clear cross cutting issues which affect dentistry, oral health and general health will be key. Action on oral health will result in improved health and wellbeing for our population. Indeed, we cannot strive to have good health for our population without improving oral health.

1. https://publichealthreform.scot/
2. https://www.gov.scot/publications/scotlands-public-health-priorities/
3. https://www.ncbi.nlm.nih.gov/pubmed/11106011
4. https://www.gov.scot/binaries/content/documents/govscot/publications/statistics/2018/09/scottish-health-survey-2017-volume-1-main-report/documents/scottish-health-survey-2017-main-report/scottish-health-survey-2017-main-report/govscot%3Adocument/00540654.pdf
5. https://www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2018/01/oral-health-improvement-plan/documents/00530479-pdf/00530479-pdf/govscot%3Adocument/00530479.pdf
6. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136211
7. https://twitter.com/CDO_Scotland/status/1141375479309639680?s=19
8. https://www.isdscotland.org/Health-Topics/Dental-Care/Publications/2019-01-22/2019-01-22-Dental-Report.pdf
9. https://www.isdscotland.org/Health-Topics/Dental-Care/Publications/2018-10-23/2018-10-23-NDIP-Report.pdf

Written by Jacky Burns, Specialty Registrar in Dental Public Health NHS Fife. You can follow Jacky on Twitter.