DENTAL CARIES PREVENTION
BY FIONA SANDOM MSC
I
spend a lot of my time as a dental therapist trying to give preventive advice and trying to influence behaviour change . I am based at the foot of Snowdonia National Park in North Wales and I work in an area of high need .
It is essential that we consider prevention for all our patients and identify those that are at higher risk . It has been reported and highlighted in the dental press , it has been a hot topic of the BDA , Professor J Steel BDJ / BDA ’ s anniversary lecture in 2015 alerted the profession that although there has been a profound reduction in the prevalence of tooth decay , that inequalities still exist and was quoted as saying “ inequality appears to be getting more profound , but we won ’ t be able to treat away the difference .”
The British Society of Paediatric Dentistry is also warning of the importance of reducing caries that we have in our little people . A third of children that started school in 2012 had dental caries . It is a frightening thought that , in this day and age , the most common cause of hospital admissions in our 5 to 9 year olds is a preventable disease that requires a general anaesthetic . There are around 43,000 admissions for dental caries each year . The next most common cause for hospital admissions is for tonsillectomy , with 11,000 admissions a year .
This to me puts the extent of this problem into perspective . In 2014-15 , some £ 35 million was spent on extracting children ’ s teeth . But the problem is not as simple as that . We know that the poor are less likely to attend appointments , that they experience more of the disease , which impacts on their quality of life , more sleepless nights , and unscheduled dental appointments due to pain and missed schools days , than those who are from the more privileged backgrounds . Thus , increasing the inequalities ! We commonly care for those that are already healthy .
Dr Sara Hurley , Chief Dental Officer , England , at NHS Expo in Manchester in September , encouraged the profession to risk assess our patients to ensure that we use our workforce sensibly to increase access and challenge the 6-monthly check up .
Currently we target our prevention in a number of ways , national programmes , like Designed to Smile in Wales , Childsmile in Scotland and Smiles 4 Life in England .
There are local schemes , like the In Practice Prevention Programme ( IPP ), The North Yorkshire and Humber Local Dental Network has been piloting a Prevention Programme called “ In Practice Prevention ”. The Prevention is delivered by trained DCPs through prevention care pathways which implement DBOH evidence based interventions .
The Prevention is “ super targeted ” at children with active caries and all those referred for GA exodontia in socially deprived areas . In simple terms this group of children is examined by GDPs and / or referred for GA and signposted for IPP to the practice team of trained DCPs who deliver the prevention programme over two or three IPP appointments . Each IPP appointment is costed at £ 12 for between 15-17 minutes .
The IPP programme is to be commissioned across a maximum of 74 Practices in areas of social deprivation . The funding will be sourced through Flexible Commissioning or re-targeting of exiting contract values by swapping UDA activity for IPP activity with an associated reduction in the Practice UDA target . The IPP commissioning level is around 2.5 % of existing contract value .
Then there are people like you and I who are busy trying to deliver personal preventive advice and treatment to our patients .
But it is not just the children that we have issues with , what about young adults ,
This graph is a snapshot of 3 year old children in Wales in 2015 from the Picture of Oral Health 2015 ( Dental Epidemiological Survey of 3 year olds in Wales 2013-14 . First release Report of Caries into Dentine , Cardiff University and NHS Public Health Wales .)
it estimated that 50 % of 16 to 24 year olds have untreated dental decay ! Then there is our elderly population , walking around with their heavily restored dentition , partial dentures acting as plaque traps , their multitude of medicines that cause a dry mouth and not forgetting their exposed root surfaces !
So , what do we need to do , we need to deliver evidence based advice and to be fair , we are very lucky to have all that information in Delivering Better Oral Health , allowing us to risk assess our patients and then deliver the most appropriate evidenced based messages and interventions . If you haven ’ t taken a look at it in a while , it is worth a revisit . Not only does it have all the information that you need for tooth brushing information , increasing the fluoride availability , the amount of fluoride in tooth pastes , prescribing protocols for fluoride varnish and high fluoride toothpaste . There is patient friendly advice on healthy eating , sugar-free medicines , improving periodontal health , smoking and tobacco use , Alcohol misuse and oral health , prevention of erosion and most importantly I feel helping patients to change their behaviour .
Keep an eye out for my article on behaviour change .
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22 Dental Practice Magazine