"[We need to focus on] How dentists and dental care professionals can work together within their local communities to become advocates and lobbyists to help reduce oral health inequalities" - BDA oral health inequalities survey respondent
We were pleased to see that the Mayor of London has said he committed to tackling the shocking health inequalities in the capital, and the recent launch of a draft strategy on 'Better health for all Londoners'.
But we were not entirely surprised to read it and learn that oral health gets only a cursory mention in the draft strategy, and no mention in the proposed indicators.
On behalf of the profession, we have made a response to the draft strategy and we have made the case that oral health must be considered as an essential part of any strategy.
We'd like thank all the London dentists who responded to our survey, helping us to provide information on what the situation is like on the ground, and who helped us paint a picture of the inequalities in oral health that exist in London.
The mouth needs to be part of health planning
"I am only in favour of initiatives when they are joined-up. We received free toothbrushes for children but then no-one came to ask for them, as nothing was publicised locally. I am not in favour on wasting money like that. We should have oral health messages by a professional going to schools or nurseries. We should encourage all children to have at least six-monthly check-ups so that we can reinforce the prevention message." - BDA oral health inequalities survey respondent
The message from you seems clear: the mouth is an important part of overall health planning, and health and social care services need to be more joined-up for effective prevention.
As health professionals, you know that health inequalities cannot be tackled through health service alone and strategies need to be implemented with social care agencies, as well as in other policies such as town planning, for the problem to really be addressed.
Dentists from two thirds of the 33 London boroughs responded to our survey and nearly half of these (48 per cent) are doing over 80% NHS dentistry. Community and hospital dentists responded and told us what they think, as well as GDPs.
A whopping 72 per cent of you said that oral health inequalities are a problem in your area. Those of us who live in the capital know that are major pockets of deprivation right across London, but it's still a shocking stat.
Government evidence tells us that is an established link between deprivation and dental decay, and children in London continue to have poorer oral health than those amongst the rest England. And within London itself, there are big divides: 39 per cent of five-year olds in Ealing experience decay, compared to 16 per cent of kids in Bromley (almost a 2.5 fold difference).
What can be done to tackle oral health inequalities in London?
"Increase the number of UDAs available for NHS dentistry by providing additional funding. We have closed our practice to new patients. The population of our borough has increased by 20 per cent since the inception of the new contract, and no additional UDAs have been awarded" - BDA oral health inequalities survey respondent
In our response to the draft strategy, we've pointed out that England has no national children's oral health improvement programme and therefore seems to be lagging behind. Innovative schemes like Childsmile in Scotland have helped achieve significant advances in oral health for kids, and we believe schemes like this should be given a chance in England. In response to our survey, 93 per cent of our London dentists said the capital would benefit from a city-wide programme on oral health support to school-aged children.
Only 17 per cent of you were aware of any borough-wide oral health promotion schemes in your area.
Funding is always the elephant in the room. We've been campaigning for reform to the discredited 2006 contract, it just doesn't work for patients or practitioners. A real strategy for prevention needs to be backed up with adequate funding.
Most of you (81 per cent), agreed that money from the sugar levy (tax) when implemented in 2018 should be used to fund oral health promotion schemes.
Sixty-eight per cent of you said the current NHS contract is limiting capacity to treat high-needs patients and 58% said it is limiting capacity to provide effective preventative care
In our response, we've said that there must be a long-term view taken and the cost-effectiveness of prevention must be considered.
We've flagged up PHE's Return on Investment tool, which enables Local Authorities to enter local population data and calculate the savings that may be made by investing in a range of oral health improvement measures for children.
For us it's a no-brainer. Surely investing in prevention makes much more financial sense, rather than the NHS spending £30 million on hospital-based tooth extractions for children aged 18 years and under?
The Federation of London Local Dental Committees has also included detailed information about the 2006 dental contract and its flaws, in their response to the Mayor's draft strategy.
What are dentists already doing?
"Cut down on 'red tape' and let primary care workers to get on with providing the care the public deserve." BDA oral health inequalities survey respondent
"Increasing funding for the public health service in local authorities and making sure that the CDS does not suffer from the cuts which are affecting pure NHS services." - BDA oral health inequalities survey respondent
We're proud that our dentists are already very pro-active: 70% of you said that you already do some type of unfunded oral health promotion in their practice.
Activities flagged up include visits to local schools and nurseries, providing information and leaflets, taking part in national campaigns, like National Smile Month, Mouth Cancer Action Month, Sugar Awareness week, Sugar Swaps, and displaying posters in their practice, as well as talking to their patients about their oral health: 98% of you said you give advice on diet to patients.
Nearly all of our respondents (98 per cent) said they agreed that oral health promotion advice should be included in the Red Book (the personal child health record given to all parents of new-borns). We are currently working with the Officer of the Chief Dental Officer for England to getting oral health reminders included in the digital version of the Red Book.
But it's not just about kids; in our response, we've made the case for integrating oral health care plans for patients with mental health conditions, and for older people, as provision for these groups is patchy, at best, and we don't think this is right.
One respondent even said that as local support is so inadequate, they were considering setting up their own mobile dental unit to treat the homeless in his area. This year, we've worked with the London homeless charity, Groundswell, to highlight the gaps in promoting oral health provision for homeless people, and the strain this can put on hospital emergency departments.
So, you know that it can be better for dental patients in London, and we've told the London mayor this.
The final strategy is due to be published in 2018, we'll keep you posted on developments.
Head of Health and Science Policy
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