Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by the British Dental Association (PH 28)


  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 health organisations:

    —  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 cancer—which 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 role.

  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.

June 2000

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