Memorandum by the British Dental Association
The British Dental Association (BDA) is pleased
to be able to submit this evidence to the Committee's inquiry
into public health.
The Association notes that the inquiry is intended
to focus upon the co-ordination between central government, local
government, health authorities and PCGs/PCTs in promoting and
delivering public health. The comments below reflect this focus.
Oral health is an essential part of the nations'
general health, in terms of pain, discomfort and disfigurement
for the individual and the loss of productive working time for
the economy. It is, therefore, essential that the structures that
are in place to ensure delivery of the best possible oral health
for the people of the United Kingdom function effectively.
The following are observations and comments
the BDA would make about the inter-operation of local and national
the BDA has consistently called for
dental public health to be considered as an equal partner with
other healthcare professionals and disciplines, and has sought
the kind of inter-operation described above, including working
in partnership with others within the NHS and outside bodies,
including voluntary organisations;
the BDA has called for dental advice
to central government to be strengthened. With a positive steer
from the centre we believe it would be easier for dentists to
become involved locally and participate in national initiatives
such as the strategy on mental health;
the BDA has actively encouraged health
authorities to establish Oral Health Advisory Groups, which have
helped improve co-operation within different branches of the profession
and provided a local source of dental advice to Health Authorities
and PCGs/PCTs. It is also an important source of advice for local
health Improvement Programmes. We also consider that there should
be dental representation on PCT Boards;
collaboration on oral health already
exists in many areas between the Community Dental Service (CDS)
and social services, education services, community health councils,
other health care professionals and the voluntary sector. This
collaboration should be encouraged and built upon to ensure the
delivery of the best possible oral health for the population,
especially those in socially deprived areas;
the BDA has called for recognition
of oral diseases as diseases of poverty. Local councils clearly
have a role to play in eradicating such poverty, in particular
social services departments and other initiatives, such as Health
Action Zones. Once identified, services can be targeted through
the CDS. The BDA has also called for local authority members to
be educated about their responsibilities in oral health;
there are many examples of local
initiatives to improve oral health, such as the use of mobile
clinics, initiatives amongst ethnic minority communities and with
carers. Schools have been involved in healthy eating initiatives
and the use of mouth guards in sport. These initiatives should
be encouraged and funded where they exist and disseminated to
other areas. Other examples of integration of services should
also be more widely publicised;
the BDA has consistently called for
more resources for oral health promotion and has called for Trusts
to give this increased priority in their plans;
the effective inter-operation of
the various agencies is also important for the prevention and
treatment of oral cancer. Survival rates are high if oral cancer
is detected early, In the UK over 3,500 people are diagnosed with
oral cancer each year, with 1,076 deaths occurring in 1998, about
the same number that die each year from cervical cancerwhich
represents around four people in the UK per day;
oral cancer is strongly related to
social and economic deprivation, with the highest rates occurring
in the most disadvantaged sections of society. The causes of oral
cancer are mainly smoking and alcohol abuse. It is essential,
therefore, that those most at risk are made aware of the dangers
of such activities through properly funded health education and
that the population is encouraged to attend their dentist regularly
so that these cancers can be detected early enough to prevent
death or serious illness; and
the BDA has also commented on the
Interim Report of a project to strengthen public health function
for England in 1998, issued by the then Chief Medical Officer,
which was a pre-cursor to "Our Healthier Nation". In
that response the BDA again called for improvements in joint working
across organisational boundaries and better co-ordination of services
locally. The Association also called for each Health Authority
to have a Consultant in Dental Public Health; a recurring theme.
The White Paper Saving Lives: Our Healthier
Nation listed the functions of the Health Development Agency.
These included maintaining an up-to-date map of the evidence base
for public health and health improvement, providing advice on
targeting health promotion most effectively on the worst-off and
narrowing the health gap, and advising on the capacity and capability
of the public health workforce to deliver the Minister's strategy.
It is important that specialists in Dental Public Health are involved
in these processes so that oral health is included along with
all other aspects of public health.
The Chairman of BDA Council wrote to the Parliamentary
Under Secretary of State for Public Health seeking assurance that
the expertise of the Health Education Authority in the area of
oral health would not be lost or dissipated by its replacement
by the Agency. The Minister assured the BDA that oral health promotion
was essential in improving general health and expected the Agency
to continue to play a key role in this area. We do have concerns
however, about the reduction in funding (by some 66 per cent)
faced by the Agency in terms of their ability to meet the new
The Agency will also have a key role to play
in educating the public on how lifestyles impact on oral health.
For example, oral cancer is closely associated with both smoking
and alcohol abuse. Smoking also exacerbates gum disease.
As in Public Health, expert Dental Public Health
advice that is independent and unbiased is needed at PCG/PCT level,
as well as in the Health Authorities and the Regional Offices
of the NHS Executive. The current Dental Public Health workforce
will be severely stretched in fulfilling these objectives.
The Association is concerned that the Community
Dental Service, which provides dental care to many of the most
vulnerable groups in the community, should not be diminished within
the new structure, and that the employment arrangements for dentists
transferred from Community Trusts should be protected.
The BDA has recommended that the flexibility
which the CDS needs to respond to the changing needs and demands
of the local population will, in most places, best be met by providing
the service on a health authority wide basis. A lead PCT for an
area where CDS services could be managed on behalf of a number
of PCTs, or siting the Service within an acute or specialist Trust,
which could also manage the Service for a suitably large area,
is most likely to provide this flexibility. The Committee has
argued that these arrangements are the most efficient for the
Service, and the client groups that they service, and are also
necessary in terms of clinical governance arrangements for the
continuing management of clinicians working within the Service.
The BDA believes that the Minister for Public
Health needs to have a wide-ranging role across Departmental boundaries
to ensure that government policies promote and improve the health
of the public. Within the field of oral health there exists one
of the most cost-effective community health promotion measures,
namely the fluoridation of the water supply (see below). The Minister
for Public Health must ensure that, where it has local support,
water fluoridation is extended so that those living in deprived
communities may benefit.
The BDA has consistently argued that it is important
that a consultant in Dental Public Health supports each Director
of Public Health. These consultants have a key role in bringing
together the local dental community and liaising with other local
healthcare professionals. As consultants in Dental Public Health
are in short supply, differing models of provision, such as consortium
arrangements, may be necessary.
The most effective way of reducing inequalities
in dental health is by the fluoridation of the water supplies.
In the White Paper Saving Lives: Our Healthier Nation the
Government announced that they had commissioned the Centre for
Reviews and Dissemination at the University of York to undertake
a systematic review of the effectiveness and safety of water fluoridation.
The draft report has recently been published on the Internet.
This prestigious report, in which all of the hard evidence on
fluoridation is reviewed, has confirmed the scientific view that
the measure is both effective and safe. Furthermore, it affirms
that fluoridation reduces inequalities in dental health as it
has a greater effect in socially deprived communities in which
the population suffers higher rates of tooth decay.
The White Paper stated that if the Review "confirms
that there are benefits to dental health from fluoridation and
that there are no significant risks, we intend to introduce a
legal obligation on water companies to fluoridate where there
is strong local support for doing so". Ministers have thus
given a commitment to acting on evidence-based policy in general,
and on the results of the review of the evidence on fluoridation
in particular. They must now be asked to introduce the promised
legislation, to ensure that the proportion of the population receiving
fluoridated water is extended. This provides an early opportunity
for the government to address inequalities in health in an evidence-based
way. The beneficial results of implementing this policy will be
able to be demonstrated within three to five years of its introduction.
A failure to take the appropriate action would cast serious doubts
on the commitment of the government to adopt evidence-based policies
to reduce inequalities in health.
The identification of common risk factors, eg
diet and lifestyle, when including references to oral health,
are ideal examples of "joined up" thinking and working
and are to be encouraged.
It is clear from the above that oral health
has a key role to play in the public health strategies of the
country. It is essential, therefore, that the co-ordination between
the agencies charged with delivering that public health is effective
and that they ensure that they place the delivery of good oral
health as one of their key objectives. Authorities should also
ensure that they receive the best possible oral health advice
from those qualified to provide it, both locally and nationally.