Ben Flewett discusses dentistry’s important role in helping prevent a healthcare crisis.
The evidence of the impact of oral health on the general health of the nation was already strong and growing before the negative impact of Covid-19. Now faced with a huge backlog of appointments, exacerbated by the need to observe social distancing, fallow time and enhanced infection control, the long-term effects of poor or neglected oral health are likely to be felt for many years to come.
It's been reported that during the 10-week shutdown of UK dental practices earlier this year, 13m appointments were ‘lost’ – either cancelled or postponed. But this figure only tells part of the story. What is not yet known is the effect of these missed appointments and the subsequent neglect of oral health issues on the general health of the nation. Thankfully, in the latest lockdown dental practices have remained open as ‘essential services’, but I believe it will take years to recover the ground we have lost from the enforced closures earlier in the year and the ongoing limitations in general practice.
It is no surprise that there is now a growing body of evidence that oral health is plausibly linked to general health and wellbeing at every stage of life. The connection between poor oral health and conditions such as cardiovascular disease, diabetes, obesity, oral cancer, complications in pregnancy and even mental health problems is made worse by a lack of awareness and education about the importance of dental health and the consequences of inadequate oral healthcare. And now of course, the Covid-19 pandemic has created a whole series of new challenges.
Sara Hurley, chief dental officer for England, has spearheaded the concept of making dentistry part of a ‘whole body’ approach to improving the general health of the nation. In an event at the end of last year, she explained her thoughts, “There is a growing body of evidence that supports the benefits and return on investment to be derived from integrating oral health into the wider health, educational and social care agenda i.e. ‘putting the mouth back in the body’. This approach is essential if we are to address the enduring issue of health and oral health inequality in England.”
This message was an important one then but is critical now. The idea that oral health should not be an afterthought, and that it actually plays an important role in providing a preventive approach to health and wellbeing is crucial. On the positive side, there are encouraging examples of exactly how the dental profession can contribute to the nation’s health. New research suggests that intensively treating gingivitis can help some people with type 2 diabetes, by lowering their blood glucose level and reducing chronic inflammation – both of which, if left untreated, can lead to cardiovascular and kidney problems.
Dentists, dental hygienists and therapists also play a vital role in the early detection of mouth cancer. The incidence of mouth cancer was on the rise even before the pandemic, but fears are now that there may be an explosion of cases in the coming months, due to missed screening opportunities. Mouth cancer claims more lives in the UK than cervical and testicular cancer combined. Visual examination of the mouth by a front-line health professional is the single most effective method of diagnosing such cancers.
Of course, it is also important to recognise the specific impact that oral health has on the general health of children. Tooth decay is the most common oral disease affecting children and young people in England, yet it is largely preventable. Despite NHS dental care for children being free, it is still necessary to educate parents and carers about the preventive treatment available for children and young people and the simple things that can be done to protect teeth at an early age.
Smoothing the way
As the dental profession becomes increasingly aware of the possible links between oral health and systemic disease, it is obvious that tackling patients’ problems around oral health can only be achieved by routine attendance, monitoring and prevention. In 2019, statistics from NHS Digital showed that half of the UK’s population had not seen a dentist in the previous two years. In the current climate, it is even more important that the whole dental community takes responsibility and puts in place processes that further encourage regular attendance and improve patient experience as a first step in disease prevention.
Some of the dental software tools now available not only contribute to patient safety but are also a good fit with the guidance issued to practices in the light of the coronavirus pandemic. Reducing the time that patients are in the practice and minimising face-to-face contact can be aided by a remote patient portal through which patients can complete and submit forms from the comfort and safety of their own homes. Once patients reach the practice, they can check-in remotely through the portal from outside the practice and wait to be called for their appointment. All these advances are helping to streamline the patient journey but are also able to instil confidence in the safety measures you have put in place.
Meeting the challenge
In the midst of the current climate, it is difficult to put in place strategies for the future as we struggle to cope with constantly changing guidance and regulations. However, one objective remains constant and that is the need to shift the mindset from one of pure treatment to prevention. Only by moving the emphasis across the whole healthcare sector can we create an enduring organisation that has a chance of lasting for decades to come.
References available on request.