Healthy Living Dentistry

The Wigan Borough already has a strong base within local General Dental Practices and the majority are already providing an excellent service, including a number of prevention and enhanced services. The primary aim of the Healthy Living Dentistry (HLD) Programme is to demonstrate the quality and effectiveness of community dentistry services, and to show how they contribute to better health and wellbeing services overall.

To date 18 dental services and practices have signed up and committed to undertaking the minimum level 1 of the HLD Programme. Level 2 can take up to 2 years to achieve due to the timings of the campaigns the practices promote. Practices are expected to start achieving level 2 accreditation early 2016.

Wigan Borough has a population of 320,975. There remain marked inequalities in the life expectancy between the most deprived and most affluent parts of Wigan. On average, men in the most affluent ward will live almost 11 years longer than those in the most deprived ward and for women, there is an 8 year difference. Much of that inequality is caused by potentially avoidable risks, especially smoking and obesity. The modern lifestyle threatens to reverse the advances in health achieved. Alcohol consumption is rising to harmful levels; smoking rates remain high along with intakes of both sugar and salt.

Whilst the headline statistics present a positive picture, inequalities in health have been widening and not everyone has been taking advantage of opportunities available to prevent illness, or understand how their current lifestyle choices may affect their longer term health. Here at Wigan Council the principles are to target programmes and services effectively across the whole life course to maximise health gain and improve outcomes for Wigan residents. Council strategy and policy identifies three groups, within the life course: ‘Start Well’, ‘Live Well’ and ‘Age Well’ with services designed around these groups.

In the coming months and years the whole health economy will have to deal with perhaps the toughest financial climate it has ever faced, meaning that greater partnership working will be necessary to ensure that we can continue to improve the quality of services and care the public receives.

The challenges we face require a new approach if we are to maintain the reductions in death rates from the main killer diseases (heart, cancer and respiratory diseases).

Healthy Living Dentistry helps us meet the challenge to continue to increase life expectancy and to respond to a rapidly growing and elderly population. This prospectus sets out the way we can develop a group of highly motivated healthcare professionals to move to centre stage in the emerging public health delivery system for the 21st century.

Prior to implementing Healthy Living Dentistry (HLD), buy in was gained from the Local Dental Committee (LDC) who recognised that HLD will help Dental Practices recognise the general health messages that are delivered and provide opportunities to take the service to another level. A prospectus was developed to promote the HLD programme.

Level 1:

• A minimum of one staff member and the lead dentist must complete Royal Society of Public Health (RSPH) Understanding Health Improvement qualification (level 2). The cost of an RSPH examination is £19, funded by Public Health.

• Health messaging and signposting into ‘preventative lifestyle services’ such as smoking, alcohol, diet, oral screening and fluoride varnish delivery must be in place. • Undertake Baby Teeth Do Matter (BTDM) on-line training.

• Undertake safeguarding training for Awareness of Child Abuse and Neglect – Foundation (level 2) and Safeguarding Adults, and signpost patients where appropriate.

• Commit to promote 3 health campaigns: Stoptober, Mouth Cancer Awareness Action Month and Dry January.

Level 2:

• Commit to promote 6 health campaigns: National Smile Month, National Diabetes Week, Stoptober, Mouth Cancer Awareness Action Month, Dry January and Dementia Awareness.

• Establish health improvement work between Dental Practices, local Early Years settings (EYS) and Children’s Centres. Examples include offering fluoride varnish treatments, prioritising children 5 and under, signposting children and families into dental services. Practices will also nominate a ‘HLD Early Years Champion’ who will develop a relationship with EYS within the practice locality.

• Practices will welcome and offer newly diagnosed cancer patients (who don’t have a Dentist) a dental assessment to support them to be dentally fit. • Additional Voluntary option: Dental practices are encouraged to become Dementia Friends Upon achieving level 1 Dental Practices receive a certificate and a HLD plaque, another certificate is awarded for achieving level 2, all funded by Public Health. Dental practices received a monthly health champion newsletter and an Oral Health newsletter and Forum are to be launched in 2016.

Progress is monitored by staff keeping in touch with the practices and supporting them to collate the evidence required to achieve level 1 / 2. Evidence includes staff and patient feedback, certificates and photographs of health campaign noticeboards / promotion.

To date 60 members of staff have completed the Royal Society of Public Health training, 8 practices have achieved level 1 and are now working towards level 2. The remaining 10 practices are collating the evidence required for the self-assessment for level 1. 5 practices have received dementia awareness sessions and are now ‘dementia friends’.

In December 2014 a feedback survey was completed by all HLD practices to review the programme. Feedback includes:

• ‘Benefits for staff’s personal health and well-being’
• ‘Wider knowledge of local health services and issues’
• ‘Really enjoyed the programme, it has allowed staff to do more than their normal jobs. Patients have enjoyed becoming involved and this has facilitated further discussion within the Practice’

Staff highlighted the RSPH course, Health Champion newsletter and support for campaigns from Public Health as being very helpful, with an average score of 9 out of 10.

A high number of practices achieved higher than the expected promotional campaigns per year (3 per year (level 1), 6 (level 2) with some doing 1 per month. This exceeded our expectations and increased the likelihood of people accessing lifestyle services.

Practices have to have a minimum of one staff member and the lead dentist, undertake the RSPH course, however, many practices asked for more staff to undertake the session, thus building capacity within practices of staff having healthy lifestyle conversations with patients and referring them onto lifestyle services.

Mapping has been undertaken of all the EYS across the Borough and the HLD practices. 16 of the HLD practices have agreed to support links with EYS to increase the number of families/children accessing dental health services, prioritising appointments for under 5’s and increasing the uptake of the (BTDM) Scheme. Each practice will nominate a ‘HLD Early Years Champion’ to develop relationships with the EYS and be the named contact to support work undertaken in these settings. 

Protocols and guidelines have been arranged between staff at The Christie at Wigan, the LDC and HLD practices who have expressed an interest in offering a dental assessment to any newly diagnosed cancer patient as a priority to ensure they are dentally fit before starting treatment. 

• Ensuring that you have engagement from the Local Dental Committee who already have networks and relationships with practices was key to setting up the Healthy Living Dentistry Programme.
• Ensure these representatives and other key partners are involved in setting the criteria for the levels.
• The training was offered at various venues across the Borough and after discussions with dental practices was undertaken over 2 half days on either Wednesday afternoon or Friday morning to allow for staff attendance.
• All practices were visited by a member of public health staff to engage them and promote Healthy Living Dentistry.
• Consider methods of data collection before commencing the pilot. We are currently looking at monitoring the number of signposts each practice makes to evidence the impact of the Healthy Living Dentistry and also liaising with lifestyle services to ensure dental practices are on the list of 'where did you hear about us' for the future.