Dentists can play a crucial role in the health prevention agenda
25 Apr 2019
Professor Michael Escudier
“Prevention” is one of the most important words in healthcare today. It is at the heart of the NHS Long Term Plan (LTP). Published at the start of January, the LTP sets out the direction for the health service for the next decade and beyond.
From an oral health perspective, we have long known about the importance of prevention in addressing problems such as tooth decay in children. But on a broader level, we also have an opportunity to think about the role that the oral health team – dentists, hygienists, dental therapists and dental nurses - can play in supporting preventive initiatives across the health service. They can contribute to providing a more holistic model of care. These are some of the issues raised in the Faculty of Dental Surgery’s new Position Statement on oral health and general health, which we have published today.
The statement highlights the links between oral health and a range of other health conditions including obesity, diabetes, cardiovascular disease and cancer. In some cases, such as with diabetes and cardiovascular disease, there are well established associations with poor oral health (particularly severe gum disease). Given the role that human papilloma virus (HPV) is known to play in causing some oral and throat cancers, there is also a link between oral health and sexual health. Meanwhile, for other conditions such as obesity, there is research suggesting that dental settings may be an effective environment for delivering preventive advice.
The statement considers some of the opportunities that the oral health profession has to help tackle these wider public health problems. In some circumstances there may be scope for dentists to play more of a role in diagnosis. An article in The British Dental Journal in 2017 suggested that where dental patients present with chronic gum disease, along with other risk factors for cardiovascular disease, dentists can help signpost them towards diagnostic tools such as the NHS Health Check. There may also be similar opportunities to support the diagnosis of diabetes, given that gum disease can be an indicator of that condition.
Many of the causes of poor oral health can also increase patients’ risk of other health problems. High sugar consumption, for example, can cause obesity, while smoking and excessive alcohol consumption can be factors in the development of oral cancer. There are therefore opportunities for dentists to deliver wider public health messages and be involved in preventive campaigns. There are already some interesting local initiatives, such as the Healthy Living Dentistry programme in Greater Manchester, which are taking this approach and provide models of good practice to work from.
It is of course important to be realistic about how dentists should approach this. When it comes to something like HPV for example, these are sensitive conversations that should always be led by need. In instances where a patient presents with oral lesions, which can be a sign of HPV, it is important that dentists are trained to discuss this appropriately and answer any questions that patients have. There may also be a place for dentists to raise HPV as part of a wider conversation about improving oral health and wider wellbeing in this context.
We also realise that these proposals don’t exist in a vacuum, and that the oral health profession is dealing with other challenges such as the need to improve access to dental services, reform of the dental contract and ensure the dental workforce is equipped to meet future need. However, the Government’s current focus on prevention offers an opportunity for the entire health sector to consider how we tackle some of the major public health challenges currently facing us. There is a valuable conversation to be had about how oral health professionals can be involved in that.
Ultimately, we know there are important links between oral health and general health. If we can leverage the oral health professions’ reach and expertise to support wider wellbeing, then it could deliver real benefits for patients. The Position Statement we have published today aims to start the debate about how we achieve that and in the coming months further developments, such as the publication of a Government green paper on prevention, will offer us further opportunities to think about this.