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Hidden Heroes Day: Rewarding work in secure settings

This Hidden Heroes Day, we celebrate all dentists and dental teams working in secure settings, which offer an incredibly rewarding career path with the opportunity to work in a multidisciplinary team.

Ellie Heidari
Ellie Heidari Senior Specialist Clinical Teacher

Many prisoners would be considered vulnerable. Some have undiagnosed learning difficulties, and others troubled backgrounds. We work collaboratively to gain an understanding of the population's current situation, the lessons learnt from the past, and what support we can offer to individuals after discharge back into the community.

Working in a secure setting is enjoyable, and you learn to improve your communication, time management skills, and adopt behaviour management techniques to address patients' anxiety levels. It is rewarding to see the impact you and your team can make on patients that might not have seen a dentist in a long time, especially when they present with pain during the detoxification phase.

A career in a secure setting

My career in secure facilities began when I was working at a homeless centre as a young dentist. The homeless patient group often felt like a revolving door, where individuals would become homeless, enter a secure facility, and then exit to become homeless again. Sensing my enthusiasm to support better pathways for these patient groups, my head of department offered me an opportunity to work in a young offender's institute in Feltham, and a local prison in London. It meant a lot of early morning train journeys, but it was also where my passion for dentistry in secure settings began.

There are different categories within a secure setting system, mainly due to security levels. My latest role was within a category B local prison, with a high turnover of prisoners, especially those on remand. Remand patients can move settings swiftly, making the continuation of care more challenging. Convicted patients, especially the ones hosted in higher security settings, such as Belmarsh, might not be transferred as frequently, enabling the dental care team to carry on with longer term treatment.

In the beginning of my career, I was keen to learn as much as possible, conducting research to contribute to practising evidence-based dentistry. Dentists and oral health teams in all settings investigate patients' general health to provide the right treatment. When there is a history of drug abuse, we offer dental health support without judgement, and plan for the patients' long-term care.

A day in a secure setting

The oral health care team works with a wide range of colleagues to make sure that all aspects of patient care are considered. This includes collaborating with prison officers for the timely transfer of prisoners to the health care wing and speaking to health care mangers to promote healthy living. The number of individuals you treat per day can vary depending on patient needs, and the contracted sessions. Many settings have a triage system for prisoners to be assessed for any pain or acute problems at reception, before being referred on for further health care treatment. The many suggested care pathways such as the urgent care, prevention and anxiety pathway that colleagues will soon have access to, enable the team to provide and advertise the standard of care.

Many patients experience oral health symptoms and pain after entering a detox programme. The period of rehabilitation is important, and as an oral healthcare team, we play an important part in patients' appearance, function and general quality of life. We work with pharmacies, the kitchen, and procurement staff to highlight the importance of reducing sugar, due to its impact on oral health and ensure that prisoners receive oral healthcare kits, including fluoride toothpaste and a toothbrush, and can engage with prevention advice. The older population within secure settings is increasing, along with a rise in systematic diseases.

To provide holistic care, you need time to collaborate with other professionals, especially on conditions such as diabetes. Poor oral health can exacerbate medical conditions, especially if patients have missing teeth and discontinue food intake as a result.

Building a respectful relationship with your patients and colleagues is important. Other staff can help build a bigger picture of the people you are treating. It is a huge team effort between commissioners, the prison service, providers and healthcare professionals to ensure that everyone's wellbeing is taken into consideration. It is vital we all work collaboratively, particularly in cases where patients have learning difficulties or dental anxieties and require extra support and time. Our role as a healthcare team is to highlight vulnerable groups and provide care in a timely fashion.

Challenges of secure settings

As a specialist in special care dentistry my passion is to provide high quality care to everyone, equally. We are currently working with stakeholders on producing pathways to support this vision for patients, especially during the discharge process. Once back in the community, many individuals might not inform dental teams about the past. We must continue to reduce the stigma attached to vulnerable patients and offer additional support, such as making medical history sheets and forms more accessible to anyone with literacy issues.

There can be systematic challenges facing dentists in secure settings if the workflow does not operate smoothly. Prisons run on complex systems, and it can take a long time to get access to facilities and patients. Many dentists wish to be able to do more for patients, but there are over 85,000 prisoners in the UK, many of them vulnerable.

It is important to give early career dentists and dental care professionals opportunities to work in a secure setting. It is a great way to develop a career and broaden horizons. In the future I would like to see more collaboration between all stakeholders, which will only build on the care provided to patients. I will continue to marry together research, education, and the high quality of care these patients deserve to strive for the best result.