This new normal gives us a unique opportunity to address inequalities in oral health in Northern Ireland.
Way back in October 2019, BDA NI held a summit at Stormont, calling time on the importance of a new strategy for oral health provision in Northern Ireland. That was the culmination of a lot of campaigning and, with the subsequent announcement by the Department of Health to establish two new Oral Health Options groups - one to review child oral health provision, and the other for older people, this was a major step forward in the process of updating our 2007 oral health strategy for Northern Ireland.
“The pandemic put this vital work on hold but it has now restarted”
The pandemic put this vital work on hold, but I’m pleased to say it has now restarted. I have the privilege of representing CDS on the Older Persons' Group. While our current focus is naturally on reinstating suspended services, going back to the old normal is not enough. We must build on the work we’d started before the pandemic to create a new, and sustainable oral health vision for Northern Ireland, and the improved outcomes this will deliver.
Here’s an outline of where we stand on these important issues:
Oral health in care homes
We don’t yet know what the impact of a year of suspended routine care in care homes will be. Normal disease has continued alongside COVID-19, and we expect to see a backlog of oral health issues in care settings. As the Dental Director for community dental service in one of the five health trusts in Northern Ireland, my team and I are in frequent contact with 110 care homes. The number of visits allowed to care homes is increasing at present, but it’s early days.
“We're making the case that oral health visits should be prioritised”
With the vaccination programme going well and community transmission dropping, I believe it makes sense to begin resuming oral health visits. It is completely understandable that care homes are reticent to open up to visitors. But we’re working closely with our local providers and are making the case that oral health visits should be prioritised. It’s a case of risk management, and the risk to oral health must be taken into account.
If diseases go undetected and we miss out on opportunities for early interventions, the health of older people in care homes could be seriously affected. We need to plan for the short and long term right now. Every opportunity to improve services where possible is valuable. For example, I’m working with a multidisciplinary group to draft new guidance on dysphagia, which we hope will go on to support care home providers and benefit residents.
Children’s oral health and prevention
Children’s oral health has also been impacted by the crisis. With schools closing and key routine dental check-ups being put on hold, pre-existing inequalities in oral health have likely been exacerbated. We know that money is tight for many and unhealthy food is cheaper, so lockdown diets may also have impacted children’s oral health.
“We’re likely accumulating a debt of oral health problems among children”
With opportunities for early intervention being missed, we’re likely accumulating a debt of oral health problems among children. GA waiting lists, which were already long before the crisis, will get longer now due to the suspension and missed opportunities for prevention and early intervention. Getting these lists back up and running is dependent on theatre staff being available, and prevention is the only solution to the length of these lists in the long term.
Initiatives like Happy Smiles, a pre-school and early years’ oral health programme in Northern Ireland, must get back up and running to support prevention. Providing oral health advice in these pre-school settings teaches children about oral health and helps to motivate the household. With P1, P2 and P3 now back in school, it’s important that we promote the adoption of all aspects of this programme, tooth-brushing, healthy snacking and oral health education. This evidence-based prevention-first approach is exactly what’s needed to improve children’s oral health.
Multidisciplinary teams are the future
One of the very few positive impacts of the COVID crisis on oral health is opportunities to work in multidisciplinary teams. I believe this has the potential to transform the kind of care provided to older people and children. In the past, dentistry has been quite siloed. I hope after this crisis, we continue to work with others such as care home health visitors and school nurses; this will help us to play a more important role in the overall health of our patients.
These relationships make health visitors and school nurses more likely to refer children for dental check-ups, when they report them for being under-nourished or for failure to thrive, for example. Working closely with them, as we have done during COVID, will help us integrate dental care into the wider definition of healthcare, helping us prevent the child’s oral health worsening and landing them on future GA lists.
Rebooting the oral health strategy
At the tail-end of this crisis, I believe there is an appetite for change and opportunity for innovation. The General Dental Services (GDS) contract must be rewritten to make provision for prevention. We’ve gathered momentum behind the message that drill and fill is not enough. Prevention is essential to oral health and the contract must reflect and reward it. NHS Wales is looking at integrating prevention into their contract, we now have the opportunity to do the same.
“NHS Wales is looking at integrating prevention into their contract, we now have the opportunity to do the same”
We’ve kept dentistry on the agenda throughout the pandemic. Having worked to ensure political interest in these issues is at an historic high, we’re pleased to see some encouraging signs. The Options Group focusing on older people is meeting in earnest and work is also underway to progress the children’s oral health review, thanks to the commitment of the acting CDO. As well as feeding into both groups, BDA NI is also sitting on NI’s obesity prevention steering group, making sure oral health is represented in important wider public health discussions.
Funding will undoubtedly remain the crucial question going forward. But we have at last secured a vehicle to highlight the gaps in oral health provision of our two most vulnerable cohorts, and we have some significant backing from political and other stakeholders who also want to see oral health prioritised.
We will be working to ensure oral health provision is given the priority that it deserves after years of neglect, and a fresh vision/policy context for oral health is absolutely key to this.
Caroline Lappin
Chair of NI Council, Clinical Director for the community dental service (CDS) in the South Eastern Trust
