Smiling Britain – the state of a nation

The findings of a major report on the State of Oral Health in Europe were debated last week on World Oral Health Day (12 September) in the UK parliament.

MPs and dental experts gathered at the Smiling Britain roundtable convened by Wrigley and GlaxoSmithKline (GSK) Consumer Healthcare to discuss the report, issued by The Platform for Better Oral Health in Europe.

The findings of the State of Oral Health report showed that, although there has been significant improvement over the last decade, more needs to be done to improve oral health and encourage good oral hygiene habits.

The purpose of last week's event was to discuss the results of the State of Oral Health in Europe Report, and present the findings relating to oral health in the UK.

It was hosted by Alison Seabeck MP and Professor Ken Eaton, Dr Nigel Carter and myself and we presented specific areas within the report; the findings, the application of these findings and the action that can be taken.

Professor Ken Eaton highlighted that the aim of the platform was to ensure that oral health is fully integrated into overall health and not isolated as an area of its own, particularly among groups such as children, the elderly and populations with special needs.

He showed that despite significant achievements in the prevention of caries in Europe, a lot remains to be done in a number of areas including: oral health awareness, tackling oral health inequalities and addressing common risk factors.

He also shed light on the key findings of the report that included poor access to services for the socially deprived. The effect oral diseases have on quality of life, the costs of treating oral disease compared to prevention and the lack of policy in this regard.

He stated that 79 billion Euro was spent treating oral disease in Europe and applying an inflation rate of 20% this was likely to rise to 93 billion Euro by 2020. This did not represent value for money as it is more cost effective to prevent disease rather than treat it.

Key policies he outlined were:

  • Develop a coherent European strategy for the promotion of oral health and the prevention of oral diseases
  • Improve the collection of validated oral health data, align methodologies between EU countries and frequently collect reliable and comparable data
  • Guarantee availability and access to high quality and affordable oral health care, including free basic treatment for individuals under 18 years of age          
  • Better integrate oral health into relevant national and EU health programs and policies

Dr Nigel Carter, chief executive of the British Dental Health Foundation, focused his discussion on three main areas.

He stated that the new contract represents a real opportunity and it is important not to lose outcome rather than output measures; this is the first time prevention has been rewarded.

He stressed it was important to recognise that the needs of the 'heavy metal' generation will have different needs and expectations from the under 40s with much less decay experience and that it is important that this initiative remains a priority for government in these economic times.

He also highlighted that, in terms of water fluoridation, it is important not to lose impetus and get the consultation mechanism with local authorities right. He stressed that is was important for dental public health to remain the key in the new local authority environment. Water fluoridation has a key role to play in reducing inequalities and the recently announced initiative on locally organised consultations on the extension of fluoridation is to be welcomed.

Finally he summed up his presentation by pointing out that dental disease is totally preventable and yet still affects the majority of the UK population either through dental decay or gum disease.

He also presented some statistics about oral cancer stating that over the last 12 years the prevalence rate has seen a 48% increase.

With the increasing role of HPV, now everyone not just smokers and drinkers appear to be at risk.

The survival rate from oral cancer can be vastly increased with early detection and he highlighted the danger in extended recall intervals. He also reminded us of the continued need to raise awareness of this potentially fatal oral disease amongst all sectors of the population.

As the final speaker, I focused on the oral hygiene and nutrition elements of the report. She highlighted how general health, oral health and nutrition were fundamentally related to one another and that many oral diseases  their complications and impact on general health and systemic disease are largely preventable. 

In addition to oral health disparities among socio economic groups, there are also disparities in diet and nutrition with evidence of adolescents from higher social backgrounds having a better diet and better oral hygiene routines than those of poorer economic backgrounds.

Regular toothbrushing among 11 year olds in the EU is associated with a higher family income and good parent child communication is associated with more regular tooth brushing in adolescents.

The report presented evidence that fruit and vegetable intake decreases with lower economic status and that soft drink consumption is higher amongst adolescents with patents of lower occupational status. This demonstrates oral health, nutrition and quality of life disparities among lower socio economic groups, which is reflected across all EU Member States.

I finished my presentation by highlighting the fact that, as clinicians, we can collect data, monitor patient health, take part in health surveillance programs and support and implement preventive strategies.

Clinicians cannot, however, create the level of policy needed to cause a paradigm shift from treatment to prevention. The help of government is needed to do that. Finally I encouraged the ministers present to read the report and its recommendations and to help the European Platform for Oral Health to take the key strategies forward.

The guests invited included the BDA, representatives from the BSDHT and BADN in addition to the dental press, relevant Government Ministers and Shadow Ministers, members of the All-Party Parliamentary Group for Dentistry and members of the Health Select Committee. A lively and constructive discussion was had following the presentations and attendees were sent home with oral health goody bags and copies of the full report and key findings.

Juliette Reeves is an expanded duties hygienist and nutritionist. She qualified from Birmingham Dental Hospital in 1981. Her main areas of interest are nutritonal influences in periodontal disease, stress, bone density and female hormones.



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