Friday, 12 April 2013

Protecting Welsh smiles - National Oral Health Plan

The Chief Dental Officer's 5-year plan for oral health in Wales
hopes to take good local practice national.
(Pic : NHS Wales)
I realise this has been a "dull week" , but someone needs to go through the various strategies and keep you up to date with what the Welsh Government are actually doing. I suppose it's part of my public service remit - if bloggers have such a thing. This is the last one for now, I swear.

Just before the Easter recess, the Chief Dental Officer, David Thomas, introduced a new five year plan for oral health which will last until 2018. I suppose this was the last major policy initiatives Lesley Griffiths will have overseen as Health Minister.

Obviously, this plan is so brilliant they decided to publish it twice, as the version I downloaded seems to be an accidentally repeated 40-page report. There's a useful summary of the plan though in the first few pages.

The state of oral health in Wales

Firstly, the number of children with dental decay has decreased by 6% - a clear improvement – to stand at around 41% of children. There have also been improvements across social classes, so there's no widening inequality gap, however it's said that these rates still – as you might expect – "lag behind the rest of the UK." There's still an overall gap in children's oral health between the well-off and least well-off too.

Dental decay is caused by bacterial plaque acids from sugary foods and drinks. The Chief Dental Officer says that "the most proven" way to prevent tooth decay is through applying fluoride to teeth. Most toothpastes have fluoride anyway, but another method is to put fluoride in water supplies, however the Welsh Government "has no plans" to fluoridate water supplies and it might be beyond their scope too. It's said that this should probably remain the case due to the complexity involved.

In adults, oral health has "improved dramatically" over the last half a century. In 2009, only 10% of Welsh adults had no natural teeth compared to 37% in 1978. Though this is still higher than England.

In terms of gum disease – which can be a primary cause of tooth lose – 56% of Welsh adults with teeth had bleeding gums, while 50% had "pocketing" (gap between the edge of the tooth and the gum line). There's a link between deprivation levels and poor oral health, as well as smoking.

Smoking is a leading cause of oral cancer, though there are no clear overall trends in Wales, with peaks and troughs in the number of cases. 385 Welsh people were diagnosed with oral cancer in 2007. Again, it's more common amongst deprived populations, with Merthyr Tydfil apparently standing out in particular.

Dental Services

Community and hospital dental services are currently provided by local health boards (LHBs), while primary dental services are contracted to individual practices.

In 2011, Wales had 1,800 dentists and around 2,800 registered dental care professionals (dental nurses, oral hygienists etc.). The good news is that half of Welsh dentists are under the age of 40, and the gender ratio amongst recent dental school graduates is near enough 50:50, though dentistry as a whole remains just about male-dominated. However, 91% of dental care professionals are women.

The good news is that, unlike other parts of the NHS, it looks as though Wales will meet the right balance between supply and demand in terms of dentistry staff, and the number of dentists being produced in Wales is currently growing at a faster rate than the population.

In the two years to September 2012, 55% of the Welsh population visited an NHS dentist, travelling an average of 4.3miles. There's roughly a third-third-third split in terms of patients being treated completely privately, charged NHS rates or funded completely by the NHS.

The plan wants the general dental services (GDS) budget to be provided on an all-Wales basis. It also outlines a desire for LHBs to include dentistry in their reporting on primary care (which would presumably include things like GP services).

There are highlighted problems with dental pilot schemes in local communities, which leave "patients feeling disempowered and dentists disengaged." They instead want a universal dental service that's available to anyone who needs it, and pilot schemes that are more innovative. School dental screening will be reviewed, as it remains to be seen whether it's actually effective or not as deprived children may not attend school often enough to be assessed.

In terms of hospital dental services, most of that will be surgical specialities like Oral & Maxillofacial Surgery. They praise Abertawe Bro Morgannwg for moving some of their consultant dental speciality services from Morriston to the Port Talbot primary care resource centre. It's a shame the whole hospital reorganisation thing is doing the complete opposite, then?

Ensuring Standards

There are various measures being taken to improve, or continue to improve, the standards of dental care. Most of this is very technical, so I don't think I need to go into too much detail.

Some of the proposed improvements include more integrated IT systems for things like data transfer, improved occupational health programmes for dentists and more opportunities for dentists to take part in academic research (which is an issue in medicine too).


There's actually quite a bit of good news in here.

I'm pleasantly surprised firstly, as it seems there's been a big turn around in terms of the number of dentists in Wales – which was one of the Assembly's original health crises. Although attendance rates still appear to remain lower in rural Wales (with the exception of Powys) and there remain chronic problems with waiting lists.

The Chief Dental Officer seems keen to promote good practice in some LHBs, and take those good practices across the country. So, this might be one area where local health boards deserve some praise, whilst deserving nothing but criticism for their handling of hospital reorganisations. It's worth pointing out that dental services (except hospital services like maxillofacial surgery) will be unaffected by those said reorganisations.

Like all health issues though, the best cure is prevention. That's down to all of us taking better care of our teeth, better oral health education – especially for children - and reductions in smoking. You've got to question what possible effect changes to Community Dentistry and school dental services will have there, but I'll trust dentist's judgement on that.


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