Oral Health Improvement and Dental Services in Scottish Prisons

1. Background

1.1 The 2005 Action Plan for improving oral health and modernising NHS dental services in Scotland^[1] recommended that NHS boards develop oral health promotion programmes for prisoners.

1.2 Additionally, the Scottish Government recognised the importance of addressing the health of prisoners in Equally Well, report of the ministerial taskforce on health inequalities, 2008;^[2] which also included a specific recommendation that measures should be put in place to improve the oral health of prisoners.

1.3 In July 2008, Scottish Ministers approved the transfer of responsibility^[3] for the health care of prisoners from the Scottish Prison Service to NHSScotland. As a result, responsibility for healthcare services, including dental services, transferred to NHS Boards on November 1, 2011. This Framework sets out a range of measures to improve the oral health of prisoners and describes how dental services for prisoners should be delivered in future.

1.4 There are currently fifteen prison facilities in Scotland,^[4] thirteen of which are directly managed by the Scottish Prison Service. A further two establishments, HMP Kilmarnock and HMP Addiewell are operated by private companies.

1.5 The prison population of Scotland has increased steadily over the last decade reaching an average daily population of 8,178 during 2011/12. Male prisoners accounted for 7,710 of the prison population, and there were a further 468 women prisoners. It is projected that the average daily prison population will reach 9,500 by 2020/21.^[5]

1.6 Mirroring the general population the prison population is ageing with a significant increase in the number of prisoners now aged 60 years or more.^[6]

1.7 Additionally, many prisoners have complex health and social care needs.^[7],[8] An assessment of the health needs of the prison population in Scotland identified a number of underlying health and social problems which affect many of those in prison and which are of direct or indirect importance to improving oral health:^[9]

• Drug and alcohol abuse
• High levels of tobacco use
• High incidence of blood-borne virus infection
• Low levels of literacy
• Mental health concerns
• High levels of dental disease
• Poor nutritional status

1.8 Frequently, oral health problems are more severe in prisoners than those seen in the general population. Indeed, the Scottish Prisons' Dental Health Survey^[10] in 2002 and revisited in 2011,^[11] found a number of issues amongst prisoners. One of the principal findings being that the Care Index (the amount of treated decay) had remained at a low level (30%) over the period. Other key oral health findings are detailed below:

Tooth decay

• Prisoners had significantly more decayed teeth, fewer filled teeth and fewer standing teeth than the general population.
• Severe decay was three times higher in the male prison population than the general population, and was fourteen times more prevalent in female prisoners than in women in the general population.
• Overall, 60% of adult males examined were found to have decayed teeth

Tooth Loss

• An estimated 6.2% of those examined were found to have no natural teeth remaining.
• Of those who had lost all their own teeth, 88% wore full dentures.

Oral Cancer

The prison population is one with a history of behaviours which increase the risk of oral cancer, with higher levels of smoking and alcohol consumption than is found in the adult population as a whole.

1.9 The quantity and level of decay experience was associated with the demography of the prisoner group, the frequency of remands and the length of sentence. Prisoners with longer sentences tended to have received more dental care than those serving shorter sentences and had improved oral hygiene.