Oral Health Improvement and Dental Services in Scottish Prisons

2. Oral health improvement

2.1 Oral health is determined by diet, hygiene, smoking, alcohol use, stress and trauma. As these causes are common to a number of other chronic diseases, adopting a common risk factor approach addresses risk factors common to many chronic conditions is more rational than one that is disease specific. Most oral diseases can be prevented, through healthy dietary choices which limit sugar consumption, good oral hygiene, abstinence from smoking and moderation in alcohol intake.^[12]

2.2 Core preventive messages, which should be adapted to take account of specific patient needs and the patient's medical and social history, are listed below. These include:^[13]

• Brushing twice daily with a fluoride toothpaste containing at least 1,350 ppm fluoride.
• Reducing the amount and frequency of consumption of sugary foods and drinks, and restricting sugary foods to mealtimes.
• Regular check-ups with a dentist to provide an opportunity to diagnose and treat oral diseases early.

2.3 For adults with obvious, current and active dental decay consideration should be given to additional measures to prevent decay.^[12]

• Using a fluoride mouthwash (0.05% Na F) in addition to toothbrushing if appropriate.
• Having fluoride varnish (2.2% F) professionally applied twice yearly.
• Using a professionally prescribed 2,800 or 5,000 ppm fluoride toothpaste.

2.4 All adults should have the support they require to prevent gum disease. The following measures are effective:^[13]

• Cessation of smoking.
• Brushing teeth twice daily.
• Cleaning between the teeth using interdental brushes or floss.

2.5 The risk of developing oral cancer is linked to smoking and alcohol misuse. Alcohol acts together with smoking to multiply the risk of developing the disease.^[12] Groups such as prisoners, where a history of alcohol consumption and smoking is more common, are at particularly increased risk of developing oral cancer.

2.6 Oral cancer or pre-cancerous oral conditions may be difficult for patients to detect and are often painless in the early stages, resulting in late presentation to health professionals. Having an examination by a dental professional is important, both to receive advice which will help to prevent the disease, and to help detect any signs of disease as early as possible.^[14] Any ulcer which has no other obvious cause and which has not healed after three weeks should be referred for specialist investigation.

2.7 Health professionals also have an opportunity to provide advice on smoking cessation and have a valuable role in signposting clients to smoking cessation services.^[15] A number of resources are available, for example, "A Guide to Smoking Cessation in Scotland".^[16]

2.8 Achieving and maintaining oral health requires effective partnerships between the prisoner and the prison staff, the dental team and the NHS Board. All staff have an important role to play in supporting prisoners in health-behaviour change such as smoking cessation, drug substitution programmes and therapeutic substance abuse care programmes. Prison staff can play an important role in co-ordinating access to services and are normally the first point of contact when requesting dental appointments.

2.9 A number of oral health promotion initiatives, have already been put in place in locations across Scotland. These have been largely NHS Board-led, and supported by the Scottish Prison Service staff within prisons. These have highlighted the importance of a "whole prison" commitment to implementing actions that improve oral health through improved dietary regimes, better access to toothbrushing with fluoride toothpaste and increased staff and prisoner awareness of what is needed to maintain good oral health.^[17] The key learning points from these pilots were brought together in NHS Health Scotland's "Mouth Matters"^[13] training guide and are detailed below. These reinforce the recommendations contained within; "Better health, better lives for prisoners: A framework for improving the lives of Scotland's prisoners".^[18]

Leadership:

Senior prison staff commitment to the programme.

Dedicated oral health promoter involvement.

Needs assessment:

Early assessment of prisoners' dental needs - clinical and information.

Create a health-promoting environment:

Plumbed-in drinking water across the prison.

Increase range of sugar-free products on canteen sheet.

Increase access to fresh fruit and vegetables.

Affordable artificial sweetener and sugar-free drinks on canteen sheet.

Distribution of an oral health pack, containing a toothbrush and fluoride toothpaste on remand and on release.

Information and skills:

Increase awareness of the oral health benefits of fruit and vegetables.

Oral health promotion at induction, within purposeful activities and integrated into other health improvement activities, such as smoking-cessation courses.

Development of oral health champions.

Signposting to NHS dental services on liberation.

Prison staff support:

Improve oral health awareness in all NHS and SPS staff.

Joint oral health improvement initiatives by NHS and SPS staff.