Professor Jenny Gallagher discusses Caring for Children – the Future Oral Health Workforce
During her talk at the Saving Kids’ Teeth Conference 2017 Professor Jenny Gallagher (above left with Dr Linda Greenwall) began by explaining the King’s College London vision for oral care by 2029, which called for a more global perspective and asked dental academia to take more responsibility worldwide for population-based prevention and individual oral care.
Good health and wellbeing is just one of the 17 UN goals set for the year 2030, which means improving care on a national, regional, and global level. In order to achieve this, finding the right shape for the dental workforce is vital in order to help ensure their skills and commitment are sufficient to meet the future needs of the world’s population. Mid-level providers, such as therapists, could prove essential in meeting those needs
Better data is needed to shape the workforce and better access to care; ultimately leading to improved delivery of high quality care and better health outcomes. There are many drivers for change, including changes in demography and disease, and also developments in technology and science.
However, the projected population growth curve for 2100 is highest in the poorest and most vulnerable areas of the world, which will lead to crisis unless the people’s needs are met. There are currently 244 million migrants worldwide, some economic, some escaping warfare and strife. Many of these people are bringing exotic health problems to the developed western world that must be addressed, but even so, untreated caries in adult teeth is still the number one disease in the world.
NEED – SUPPLY – DEMAND
Healthcare, said Professor Gallagher, must be about more than just dealing with teeth, it must also recognise factors affecting oral and systemic health. To be effective it needs the flexibility and leadership to make the skill mix more effective, and in the UK that means dentists must be willing to delegate. A balance must be found between the areas of NEED – SUPPLY – DEMAND and that can’t happen without more flexibility in the skill mix. In studies 90% of young dentists were happy to delegate fissure sealants to hygienists and 51% delegated minor restorations to therapists. Why can’t we adopt this model straight away?
However, things aren’t that easy. Creating an effective skill mix to include delegation means delivering inter-professional training, and that takes time. Plus there is a need to look at case complexity and the cost-effectiveness of the new team model. Financial models must also be explored and a new system of payment established, the current NHS contract will not support an effective skill mix that includes delegation.
Issues facing the dental workforce in areas of greatest need
Elsewhere in the world the problems are different. China has carried out a comprehensive study of 12-year-olds. It has the largest population in the world (which might be debated by India) and its oral health needs are met by dentists and assistant dentists (another type of mid-range provider).
The study asked how to lower the risk of dental disease in 12-year-olds and decided on a needs-led approach. Those with the lowest risk of DMFT scored 0, the highest scored 1. The most at risk received applications of fluoride varnish twice a year. The study calculated that caring for China’s 12-year-olds would take up 1% of its dental workforce while 93% of the effort would go into education about effective preventive measures, and they didn’t need dentists to deliver that.
Even so, it is estimated that the current number of dentists in China can only meet some 5% of the population’s needs, and China has no hygienists to fall back on. It is an interesting situation and worth watching.
The Global Health Network is working with the Connaught Hospital in Freetown, Sierra Leon in an attempt to meet the needs of a population of seven million people living in significant poverty. They have suffered wars, economic crisis and an ebola epidemic which has left them with a very young demographic.
Half the indigenous workforce was educated abroad and returned to support their homeland. Internationals are welcomed with open arms and UK dental professionals looking for a challenge might consider the opportunity. Many migrants are working there.
For the children of Sierra Leon dental disease, including caries etc., is seen as the silent epidemic. Part of the reason for this is that sugary foods and drinks are not considered as sweets but as the easy option for meals. They are easy to transport, store, and prepare, and children love them. They eat and the teeth rot out of their gums, leading to further health issues in the future. Somehow this situation must be addressed, and that will require co-operation on a global scale.
The number of student places in UK has dropped from 1100 to 1000, and although the number of dentists working in practice has risen overall it is important to decide who delivers what care to which demographic, 0-4-year-olds to the 65+. By 2030 up to 24% of the population will be 65+.
Care of children has to start with the parents, pre-school children 0-4-years-old must start attending dental appointments to help them become accustomed to the surgery. The dental check by one (DCby1) initiative is an excellent start. From there the child can be supported to better oral health throughout their school years. Teenagers and the 18+ are another matter and perhaps a discussion for another day.
Professor Jenny Gallagher MBE is currently leading a review of the links between general and oral health for Public Health England. Her research interests focus on shaping the healthcare workforce to meet the needs of the population, with a strong emphasis on promoting oral health and preventing disease, particularly amongst vulnerable groups.
Next: Mr Mike Harrison – Doctors need to care about children’s teeth.