Adult Oral Health

Strategic Context

Consider the national strategic context for prioritising improvement action in this area (in conjunction with your health board’s annual plan and regional partnership board’s area plan). The strategic importance of a given topic is key to thinking about how our actions align with local or national initiatives and policies to deliver collective and measurable impacts on population health.

• Oral health is a key part of a person's overall health and wellbeing.
• Evidence from the Dental Epidemiology programme for Wales demonstrates that oral health inequalities exist from early childhood.
• Tooth decay has a lifelong impact as poor childhood dental health is a predictor of poor adult dental health.
• People living in areas that are described as socially and economically disadvantaged are often at highest risk of poor oral health.
• Prevention of tooth decay, periodontal disease and oral cancer are fundamental cornerstones to a healthy mouth (UK Government, 2021)
• The Welsh Government set out strategic direction for oral health improvement in A healthier Wales: the oral health and dental services response (WG 2018).
• A multi-faceted approach is required to improve population oral health, with a strategy which influences the wider determinants of health and addresses oral health inequalities. Clusters will benefit from specialist dental public health advice when formulating plans to improve oral health of their local population.

Data analyses

Consider statistical indicators and other evidence on population needs to compare your own position to that of others, both within and without your health board (where possible). If relevant, consider any additional local data requirements that might contribute to an informed decision on action.

• Indicator: Description of a recommended indicator relating to this topic, which would inform population needs assessment.
• Data source and link: Who produces the analysis and where to find the most current analysis on their website (NB the most current analysis may not utilise the most recent data).
• Documentation link: Where to find general advice on interpreting the analysis e.g. what is/ is not included, any caveats, etc.

Indicator:	Prevalence of decayed, missing or filled teeth (%)
Data source and link:	Dental Epidemiology Programme for Wales
Documentation link:	This data source includes reports that provide context

Improvement actions

Identifying priority actions involves seeking and appraising evidence on effective and cost-effective improvement options. The below options are a starting point for considering interventions at practice, cluster/ professional collaborative or pan-cluster level. The make-up of your cluster and the stakeholders you work with is likely to influence the type of actions you take.

Improve access to NHS dental services

1) In keeping with the General Dental Services (GDS) Reform Programme, support local commissioning that improves access and equity of access in areas of deprivation. Work with the Local Health Board and dental services to improve equity in access to dental care.

2) Support primary care dental services to have a prevention and outcome focussed ethos.

3) Provide accessible public information about local urgent care dental access (via 111 or a local helpline).

4) Encourage and facilitate routine attendance after emergency care; NICE guidance Oral health promotion in the community (QS139) recommends that dental services providing emergency care to people who do not have a regular dental team should give information about the benefits of attending for routine care and how a local dental practice can be found.

Ensure oral health is a key health and wellbeing priority

NICE Public Health Guidance 55: Oral Health: local authorities and partners recommends that:

1) oral health should be a core component of strategic health needs assessments and health and wellbeing strategies

2) all health and wellbeing and disease prevention policies for adults (including local government, health, and social care strategies) include advice and information about oral health, including:

• Health and social care assessments
• Care delivered at home and within adult care services
• Local adult safeguarding
• Nutrition and health and wellbeing
• Local food, drink and snacks policies in a range of settings

Create oral health strategies based on oral health needs assessments to identify groups at high risk of poor oral health

NICE Public Health Guidance 55: Oral Health: local authorities and partners recommends that:

1) oral health needs data should be collected from a range of data sources to identify groups at high risk of poor oral health and ensure inclusion in oral health needs assessments

2) oral health needs assessments should be conducted as part of cyclical planning processes, and geared towards improving oral health and reducing health inequalities

3) oral health strategies should be developed which:

• set out how to address the oral health needs of the local population as a whole (universal approaches) and groups identified at high risk of poor oral health (targeted approaches)
• identify and work in partnership with people who are in a position to improve oral health in their communities
• include proposals and provision for monitoring and evaluation, including what works for whom, when and in what circumstances

Ensure public service environments promote oral health

NICE Public Health Guidance 55: Oral Health: local authorities and partners recommends that:

1) all public services promote oral health by:

• Making plain drinking water available for free
• Providing a choice of sugar-free food, drinks (water or milk) and snacks (including fresh fruit), including from any vending machines on site
• Encouraging and supporting breastfeeding

This includes public sector services such as: leisure centres; community or drop-in centres; nurseries and children's centres; other early years services (including services provided during pregnancy and for new parents); schools; and food banks.

2) other local authority 'levers' are used to address oral health and the wider social determinants of health, for example, local planning decisions for fast food outlets.

3) links with local organisations in other sectors (for example, local shops and supermarkets) are used to promote oral health. This could be part of a broader approach to promoting healthier lifestyles including helping people to reduce their tobacco and alcohol consumption.

Ensure frontline health and social care staff can give advice on the important of oral health

NICE Public Health Guidance 55: Oral Health: local authorities and partners recommends that:

1) service specifications include the requirement for frontline health and social care staff to receive training in promoting oral health.

2) training for frontline health and social care staff is regularly commissioned

3) frontline health and social care staff understand the links between health inequalities and oral health and the needs of groups at high risk of poor oral health.

4) frontline health and social care staff can advise carers on how to protect and improve the oral health and hygiene of those they care for.

Oral health training of health and social care students and staff are core elements of the Designed to Smile and Gwên Am Byth national oral health improvement programmes (delivered by NHS Wales Community Dental Services).

Incorporate oral health promotion in existing services for all adults at high risk of poor oral health

NICE Public Health Guidance 55: Oral Health: local authorities and partners recommends that community health and social care service specifications (including substance misuse services and those supporting people living independently in the community) are reviewed to ensure inclusion of:

• the requirement to promote and protect oral health in the context of overall health and wellbeing

• oral health assessment within care plans, in line with safeguarding policies, and including a referral, or advice to go to a dentist or other clinical services
• oral health care as an integral part of care planning
• support to help people maintain good oral hygiene (including advice about diet)
• staff training in how to promote oral health, during inductions and then updated on a regular basis

These are the aims and activities of Gwên Am Byth, for dependent older people.

Commission tailored oral health promotion services for adults at high risk of poor oral health

NICE Public Health Guidance 55: Oral Health: local authorities and partners recommends:

1) Providing tailored interventions to help people at high risk of poor oral health who live independently in the community. This could include outreach services, for example, for people who are homeless or who frequently change location, such as traveller communities.

2) Ensuring services deliver evidence-based advice and interventions to promote and protect oral health, in line with Delivering Better Oral Health.

3) Ensuring local care pathways encourage people to use dental services.

Include oral health in care plans of people who are receiving health or social care support and are at high risk of poor oral health

NICE Quality Standard [QS139]: Oral health promotion in the community (QS139) recommends including oral health in care plans for people receiving health or social care support and at high risk of poor oral health to help ensure that relevant needs are addressed. This may include day-to-day support to help people maintain good oral hygiene and referring to dental services if needed.

This is an aim and activity of Gwên Am Byth, for dependent older people.

Promote oral health in the workplace

NICE Public Health Guidance 55: Oral Health: local authorities and partners recommends:

1) Working with occupational health and human resource services to promote and protect oral health using Delivering Better Oral Health. This should be part of efforts to improve general health and wellbeing at work and should be tailored to local needs.

2) Considering ways to raise awareness of evidence-based oral health information and advice and ways to improve access to dental services.

3) Considering allowing people time off work to go to the dentist without losing pay.

4) Making information available to staff about local dental services and about national guidelines on oral health.

5) Ensuring the workplace environment promotes oral health.

The Healthy Working Wales programme aims to support and encourage employers to create healthy working environments, and take action to improve the health and wellbeing of their staff.

Last updated 15/06/24