Oral health improvement strategy for priority groups

Chapter One Introduction

Access to preventive care, including oral health care, should be central to the health care of all individuals across Scottish society, regardless of life circumstances.

In 2005, the Dental Action Plan¹ set out the commitment of the Scottish Executive to ensuring that the most vulnerable adults in our society should have access to preventive dental programmes which would assist them in maintaining good oral health. This work has had the ongoing support of the current Scottish Government, with significant investment in exploring the oral health needs of the most vulnerable adults, and in planning for how these needs might best be met. This strategy will build on the 2005 Dental Action Plan, bringing together the lessons learned from commissioned work across Scotland, and setting out a core national preventive programme for those with special care needs, including frail older people and those who are homeless.

Key Issues

• Some important risk factors for oral diseases such as poor diet, smoking and inappropriate alcohol consumption, are the same as those for major diseases, including cardiovascular disease, respiratory diseases, diabetes and cancer.² Addressing these common risk factors will help maintain both oral and general health.
• Tooth loss is associated with psychological and social disability:³ Preventing oral diseases will help to reduce this.
• Dental problems are associated with pain and suffering.³ Preventing oral diseases early maintains a healthy functioning dentition and helps to reduce this.
• For older and vulnerable people, treatment can be more complicated, and preventing oral diseases helps keep treatment simple and helps people to stay healthy.⁴
• More people are keeping some natural teeth for life and will need continuing care into older age.^5,6 It is important to plan for how these needs will be met.

The two most common oral diseases, dental decay and gum disease are largely preventable by reducing the frequency of sugar consumption and by carrying out good oral hygiene and using fluoride toothpaste.⁷ The most serious oral disease, oral cancer, is also amenable to prevention.⁷ The development of oral cancer is strongly linked to smoking and excess alcohol consumption, although the risk factors for this disease are more complex, with additional factors such as diet^8,9 and deprivation playing a part.¹⁰

Poverty and challenging life circumstances can often make it more difficult for people to stay healthy.¹¹ Equally Well, report of the Ministerial Taskforce on Health Inequalities¹² has identified the need for specific, personalised programmes to improve the oral health experience of vulnerable groups, with improved access and quality of services.

Oral health services for vulnerable adults should be flexible enough to meet their needs in circumstances where they may not be ready or able to access services through traditional routes such as general dental practice. The Salaried Dental Services have a key role to play in signposting patients to appropriate services, providing special care dentistry where required, and in providing leadership in training. Staff with a remit for oral health improvement such as oral health promoters also have a key role to play in providing training to key staff groups.

The Strategy sets out where we are now and what we are doing to improve the oral health of those adults who are most vulnerable to poor oral health. It will build on the lessons we have learned from local and national pilot projects, and will set out what steps we will take to ensure that NHS boards and local authorities in Scotland play their part in preventing oral diseases and the suffering which flows from these. The voluntary sector also has a valuable role to play.

The Healthcare Quality Strategy for NHSScotland¹³ made a commitment to bringing about measureable improvements to the healthcare experience of patients in Scotland, with a focus on understanding the needs of different communities, eliminating discrimination, reducing inequality, protecting human rights, and building good relations by breaking down barriers which prevent people accessing the care and services they need.

As the National Oral Health Improvement Strategy for Priority Groups is taken forward, it will be fully assessed in terms of its impact on equalities, through a Health Inequalities Impact Assessment (HIIA). This will include a mandatory Equalities Impact Assessment (EQIA), optimising its potential for reducing oral health inequalities across Scotland. These measures will help prevent oral diseases amongst those who are most susceptible to the problem.