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Challenging oral health inequalities

Man with bad teeth, smoking

14 December 2014

UCL research on oral health inequalities suggests an urgent need for a more evidence-based, integrated public health approach to this major problem. This has influenced both local and national policies and the development of clinical practice guidelines to reduce inequalities and allow dental professionals to prevent oral and systemic disease.

Work by the UCL Dental Public Health Group has explored the nature and causes of oral health inequalities, the overlap between oral and general health inequalities more broadly, and ways in which those inequalities might most effectively be reduced. This pioneering work has exercised an important influence on national and international oral health policy and professional practice, particularly promoting a more integrated public health approach and supporting a shift in the focus of NHS dentistry from treatment and repair to prevention.

In 1999 the UCL research team produced the first review synthesising evidence for widening inequalities in oral health between social classes, across regions of England, and among certain minority ethnic groups in pre-school children. Further analyses of national data from a range of EU countries (including the UK), as well as the US, Brazil, Japan and South Korea, identified correlations between socioeconomic status and oral health. The work highlighted the complexity of the social, economic and psychosocial factors influencing oral health inequalities and demonstrated the limitations of dental health education and clinical preventive interventions that fail to address the underlying social determinants.

Responding to the urgent need to identify more integrated ways of promoting oral health and reducing oral health inequalities, the UCL group developed a common risk factor approach emphasising and facilitating the coincidental and complementary development and implementation of oral health and other health programmes. Since oral health shares many of the same risk factors - notably diet, hygiene, tobacco and alcohol use, stress and trauma - as many other chronic diseases, they proposed taking a collaborative, rather than a disease-specific, approach to tackling these. This emphasis on the need for a common risk factor approach in tackling shared risks for a range of chronic conditions, including oral diseases, has been highly influential in supporting the development by UK Primary Care Trusts and Local Authorities of local oral health strategies.

Two particularly common risk factors highlighted by the research are diet and smoking. Findings from the UCL team's work on the link between oral health and diet and nutrition have supported efforts to improve infant feeding practices and promote preventive dietary interventions - including those delivered in the primary dental care setting - to reduce obesity in young people. The work has also informed key public health policy and guidelines set up to help tackle health inequalities linked to socioeconomic status. The head of the UCL Dental Public Health Group, Professor Richard Watt, has, for example, contributed to National Institute for Health and Clinical Excellence guidance on maternal and child nutrition, issued "to improve the nutrition of pregnant and breastfeeding mothers and children in low-income households".

The Group has also played an important role in supporting UK government attempts to reduce smoking, particularly by investigating ways in which dentists and their teams can contribute to these efforts. Here, their research focussed particularly on ways to support the inclusion of smoking cessation in dental hygiene and dental therapy curricula and to help dental teams provide smoking cessation services. This work underpinned the co-production by Professor Watt of influential Department of Health guidance for dental professionals, as well as of training materials designed to equip dental teams to provide effective smoking cessation support. Their distribution to all undergraduate dental and oral hygiene and therapy schools in England has ensured the contribution of those training resources to an ever-clearer move among dentists toward the routine provision of cessation advice or patient referrals for specialist support.

More broadly, Professor Watt has advised on and authored a number of key oral health policies informing national oral health policy, as well as contributing to the development of the Department of Health toolkit Delivering Better Oral Health: An evidence-based toolkit for prevention. This toolkit, which was distributed to all general dental practitioners in England in 2009, helps dentists work in a more preventive manner, including by providing diet advice, smoking cessation support and interventions to reduce harmful alcohol intake. An updated version of the toolkit has just been published by Public Health England. In addition, Professor Watt had made a major contribution to a new Public Health England policy, Commissioning Better Oral Health, on how Local Authorities can implement evidence based dental public health programmes across the country.

Further afield, the research has informed the development and content of both national and local policies in Australia.

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