Oral health improvement strategy for priority groups

Executive Summary

1. Introduction

Preventing oral diseases helps keep treatment simple, prevents pain and suffering and helps people to stay healthy.

The National Oral Health Improvement Strategy for Priority Groups sets out the means by which the 2005 Dental Action Plan commitment, to develop preventive programmes for adults vulnerable to oral diseases, is to be achieved.

The new core national preventive programme Smile, will build on the well-established national preventive programme for children, Childsmile.

Smile Core, will encourage and support toothbrushing and preventive care across the priority groups identified in the Strategy, bringing together a number of key principles which are applicable to all the groups. These include; needs assessment, evidence-based prevention of oral disease, accessible information, staff training and appropriate services.

However, we know that the circumstances in which prevention of oral disease is carried out in each setting are slightly different, and there will be additional elements to the basic programme which address the specific needs of each of the priority groups:

Smile: Older People and those with Special Care Needs and Smile: Homeless will build on the excellent work which is already taking place in NHS boards across Scotland to improve oral health for adults who are more vulnerable to oral disease.

2. Key Issues Impacting on the Oral Health of Dental Priority Groups

Older People and those with Special Care Needs

As the number of older people rises and their complexity of care increases, there will be an associated rise in demands on the service and a change in the nature of care required.

Homeless People

Homeless people have a variety of challenges facing them. Many are affected by poor general health, low self-esteem and poorer than average dental health. They may have problems accessing facilities to carry out oral self-care and often have difficulty in accessing dental services.

3. Recommendations

The Smile Programme should encompass the following activities for each of the Dental Priority Groups categories identified above:

Older People and those with Special Care Needs

• An oral care plan should be developed according to the assessed needs of the individual. This should incorporate oral hygiene, care and treatment needs.
• Referral and throughcare protocols should be developed to assist those with special care needs. These should be documented. Such protocols should facilitate the smooth transition from child to adult services for young people with special care needs.
• Managers of care establishments should ensure that the diet and standard of oral hygiene assistance available to clients meets the necessary standard to promote and maintain good oral health and should ensure documentation of daily oral care.
• Brushing with a fluoride toothpaste containing at least 1,350 ppm fluoride should be encouraged, together with the use of fluoride mouthwash where there is a special need for this.
• Those at high risk of caries should have fluoride varnish professionally applied twice yearly (2.2% F).
• Those with active crown or root decay should have the opportunity to have 2,800 or 5,000 ppm fluoride toothpaste prescribed professionally. Prophylactic use should be considered for those at very high risk of dental decay.
• Toothbrushes and interdental cleaning aids should be available to care home residents.
• Educational material and training should be made available to carers and care home managers. Managers should implement the NHS Quality Improvement Scotland (QIS) best practice statement and identify an oral heath champion within the facility.
• Supporting resources for other adults with additional care needs should be developed to take account of the specific needs of younger dependent people.
• Carers and care home staff should be aware of the potential role of the whole team within the Salaried and General Dental Services in meeting client treatment needs and work with them to develop clear patient care pathways.
• Care home managers should raise client awareness of the National Care Standards and collaborate with key organisations such as Healthcare Improvement Scotland, Scottish Care and corporate care providers to implement them. Any future revisions of the standards should highlight the role of the Community Dental Service in the provision of oral healthcare to those with special care needs.
• NHS boards should collaborate with the salaried dental service in highlighting the role of non-dental staff can play in achieving good oral health for those with special care needs.
• Dental Health Support Workers should be fully supported to provide oral health education within care homes and to at act as the key link between public health nurses and dental professionals for those being cared for at home.

Homeless People

• All homeless people should have the opportunity to have their oral health needs assessed by referral to an appropriate dental team member^A and provision made for ongoing care according to their needs, in association with other staff members.
• Homeless people should have the opportunity to brush twice daily with a fluoride toothpaste containing at least 1,350 ppm fluoride and dental packs containing toothbrushes and paste should be distributed at key facilities such as hostels and night shelters. Drinking water should be made available to clients.
• Oral health education materials and information on dental services should be available to homeless people at key locations and oral health champions identified. Staff working in hostels and outreach teams should play a facilitating role in disseminating information and helping with the making of dental appointments for clients who need assistance.
• The Salaried Dental Services should continue to play a lead role in services for people who are homeless, including the training of oral health champions in collaboration with oral health promotion teams.
• Drop-in dental care services, which offer a staged approach to care and are closely aligned to other services for homeless people, should be available. An individualised basic care plan should be offered to clients.
• NHS boards should maintain a list of contact details for dedicated drop-in dental care facilities for the homeless and disseminate these to key services for the homeless.
• NHS boards should maintain a list of NHS dentists willing to accept homeless clients.