The Government has issued new guidance to dental operators aimed at ensuring a consistent UK-wide approach to prevention of oral diseases.
This guidance is issued jointly by the Department of Health and Social Care, the Welsh Government, the Department of Health Northern Ireland, and NHS England, and has the support of the British Association for the Study of Community Dentistry.
Delivering Better Oral Health has also been developed with the support of the four UK chief dental officers.
While the guidance seeks to ensure a consistent UK-wide approach to prevention of oral diseases, some differences in operational delivery and organisational responsibilities may apply in Wales, Northern Ireland, and England.
In Scotland the guidance will be used to inform oral health improvement policy.
Dental teams providing frontline care are the principal audience for this evidence-based toolkit.
Since its first edition in 2007, it has been widely used by dental professionals and colleagues across health and social care, both within the UK and beyond.
And it underpins their important role as experts in promoting oral health and preventing oral disease as a fundamental pillar of contemporary healthcare.
This resource was produced to help busy health professionals provide high-quality preventive care, which is patient centred and aligns with wider health advice, thus promoting general and oral health.
As evidence on prevention grows, DBOH guidance makes sense of the growing body of published research evidence.
From the outset there was a commitment to regularly review and update this guidance.
And this fourth edition represents the work of a UK-wide collaboration of well-respected experts and frontline practitioners, including patient representatives.
Guideline Development Groups have come together to review the evidence on specific topics, in line with the published process.
The work has been overseen by a Guideline Working Group, supported by national leaders across health policy and the dental professions through the Dental Oversight Group.
It is intended for use throughout dentistry in the United Kingdom.
The guidance was revised using an agreed, published methodology.
And recommendations are based on the identification of existing high-quality systematic reviews, guidelines and, as appropriate, policy documents or legislation.
Searching focused on the period from 2010 onwards, unless a clear need for a broader or narrower search period was identified by the Guideline Development Groups.
Primary studies were not used unless there was a clear gap in secondary sources of evidence.
To bring version four of this guidance in line with more-recent advances in guideline development, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach has been used to assess the certainty of the evidence and the strength of the subsequent recommendations.
This system rates the quality (or certainty) of evidence for a particular outcome across studies.
All existing evidence has been checked and updated as well as new evidence added, with a greater emphasis placed on risk-based management including monitoring through appropriate dental recall and across the life course, with the first dental attendance within the first year of life.
This is reflected in the summary guidance tables in chapter two, as well as across the narrative chapters.
The content also includes a greater consideration of older people and other vulnerable groups, often based on good practice, rather than available evidence given the paucity of research for these groups.
The importance of supporting behaviour change is acknowledged with this chapter coming immediately after the summary guidance tables.
It includes contemporary behaviour change theory, supported with practical examples found in the clinical case studies appendix.
Regarding the dental disease chapters:
There are also changes which recognise different patterns of living, for example saying ‘toothbrushing last thing at night or before bedtime’ recognises that shift workers may be going to bed in the morning.
Oral and dental diseases are widely prevalent, and while oral health has improved in recent decades, most people are at risk of developing some oral disease during their lifetime.
The most-common diseases are dental caries and periodontal diseases, with oral cancer being the most serious, and tooth wear an increasing concern.
Within healthcare generally, there is a push for greater emphasis on prevention of ill health and reduction of inequalities in health by giving advice, provision of support to change behaviour, and application of evidence-informed actions from birth and across the life course.
Effective self care, together with professional support, is important for good oral health and it is vital that dental team members, as well as other healthcare staff, provide consistent messages that are up to date and based on the best evidence.
Population advice and support on lowering risk
All patients should receive advice and support to lower their risk of oral and general disease and promote health.
This generally involves some element of behaviour change, although there are professional interventions, such as applying fluoride varnish to all teeth, that reduce the risk of dental caries.
This is reflected in the summary guidance tables as advice or professional intervention for all patients.
For those patients about whom there is greater concern, because they are at higher risk of oral disease, there are recommendations on increasing the intensity of general care and additional actions for dental teams and their patients to take.