|
|
|
||||
Children and Young People Committee
National Assembly for Wales,
Cardiff Bay,
Cardiff,
CF99 1NA.
Dear Colleague,
I am the Clinical Service Manager/Senior Dental Officer (CSM/SDO) of the Abertawe Bro Morgannwg University Health Board (ABMUHB) Community Dental Service (CDS).
I am also a Specialist in Special Care Dentistry.
I am writing to you in response to your letter of 27.7.11 inviting views on the effectiveness of the Welsh Government’s Designed to Smile programme in improving the oral health of children in Wales, particularly in deprived areas and would like to make the following comments.
Introduction
The ABMUHB CDS currently provides dental care for vulnerable people of all ages in the Swansea, Neath and Port Talbot areas in accordance with guidance from the Welsh Assembly government regarding the role of the CDS in Wales.1
This role includes the provision of dental care for vulnerable children who are unable to receive dental care via the General Dental Services (GDS).
Much of this care is provided in deprived areas in the Swansea, Neath and Port Talbot areas.
Many of the children seen by the CDS suffer from very poor oral health often due to poor oral hygiene, unsuitable diets and lack of parental support due to an ignorance of the importance of good oral health.
Whilst the CDS actively seeks to provide care for all the vulnerable people including children who seek its services, it has not always been easy to provide care for children in more deprived areas. Very often these children are not brought to CDS clinics by their parents until they are experiencing acute dental pain or oral infection and by this time treatment involving dental extraction is usually necessary.
The ABMUHB CDS now has an active and efficient Designed to Smile (D2S) team that is currently based in Cwmbwrla Health Centre, Swansea and Cwmavon Health Centre, Port Talbot.
Responses to the Committee’s Questions
The take-up of the supervised tooth brushing scheme for 3-5 year olds
The ABMUHB D2S team has been actively pursuing the Welsh Assembly Government’s aim of reducing oral health inequalities in Wales by developing an effective supervised tooth brushing programme in the Swansea, Neath and Port Talbot areas.
The D2S team has exceeded its initial target of tooth brushing programmes for 3-5 year old children in 66 schools by 2011.
This has resulted in approximately 12,000 children in the Swansea, Neath/Port Talbot area participating in tooth brushing programmes.
For many children, particularly those in deprived areas, this supervised brushing programme may have been the only form of oral hygiene they have had regular access to.
The D2S team has worked tirelessly to establish excellent links with the school staffs participating in this programme enabling a team approach to improving the oral health of children to be developed.
This can only bode well for the future and reduce the levels of caries in children.
The promotional programme for 6-11 year olds
The D2S team has provided age specific oral health education teaching sessions to all age groups since the beginning of its inclusion into the programme.
Teaching sessions have been provided not only to those schools and nurseries taking part in the tooth brushing part of the scheme but also for many others who are not involved, making a total of 140 settings participating in this programme.
The content of the lessons provided to schools is in accordance with the National Curriculum and The Scientific Basis of Oral Health Education.
The D2S team leader regularly reports to the CDS CSM/SDO on all aspects of D2S activities including this promotional programme and D2S team members are regularly assessed and promotional methods monitored to ensure consistency and effectiveness.
I feel strongly that this programme offers considerable potential for raising awareness of the importance of good oral health and for reducing oral health inequalities in the long term.2
Whether the investment has delivered improved health outcomes for the most disadvantaged children and young people
Apart from supervised tooth brushing and oral health promotional activities, the D2S team has also developed other health improvement initiatives particularly with regard to diet and obesity.
A large section of teaching sessions focus on healthy eating and drinking. Children are encouraged to begin to make small, short term realistic changes in their diet which will hopefully lead to more sustainable long-term normal ‘healthy eating’ habits.
D2S team members have undertaken the Open College Network (OCN) level two training in ‘Community Food and Nutrition Skills for the Early Years’ and also ‘Brief Intervention in Smoking Cessation’.
These courses have proved the D2S team with the knowledge and confidence to incorporate this information and expand on the oral health education provided.
This has been particularly beneficial as the team are having requests to attend senior citizen groups as many grandparents are joint carers if not primary carers for their grandchildren.
Whether the programme is operating consistently across Wales in all areas of need
The CDS has been involved in providing care for vulnerable people in the Swansea, Neath and Port Talbot areas for many years. As a result, the areas of high need and high risk for poor oral health are relatively well known to the CDS.
From reports given to me by the D2S team leader, I am sure that the D2S team has worked in the Swansea, Neath and Port Talbot areas to make certain that all areas of need are receiving the highest quality of care and involvement from D2S. This will continue to develop as September sees the expansion of the Fissure Sealant programme which will involve joint working between the D2S and the CDS.
Fluoride varnish application will also be introduced in the New Year.
How effective the expansion of the programme has been, particularly in relation to 0-3 year olds
To ensure this part of the programme has been effective, the D2S team has developed good links and working relationships with care groups including schools, Flying Start and independent nurseries.
There are now 29 settings of this age group tooth brushing within the D2S programme.
The D2S team works closely with health visitors and provides them with packs to distribute at children’s 7-month of age assessments.
The D2S team also provides health visitors with oral health education which they are able to pass on to the children’s parents.
This service is distributed by the health visitors in addition to the already established referral pathway into CDS dental services for those children who have not yet accessed them.
Links have also been made with childcare providers who use their own homes as business premises. This group has also received oral health education.
The D2S team also deliver oral health promotion advice to parents and carers through organised sessions in schools, mother and toddler groups, breastfeeding groups, fetes, coffee mornings and health awareness events.
Whether the programme addresses the needs of all groups of children and young people
I am aware that the D2S team has established contacts and links with many groups and organisations including not only children’s groups but also:
- Drug and Alcohol User Groups
- Ethnic Minority Groups
- Special Needs Activity Centres
- Family support groups
- Speech and language teams
- Swansea Young Single Homeless Project
- The Travelling Community.
The contacts established with these various groups and the links between D2S and the wider CDS has also resulted in an enhanced awareness of the role of the CDS in the provision of dental care for vulnerable people and of the appropriate referral pathways for care within the CDS.
The extent to which the D2S programme has been integrated into wider local and national initiatives such as the Welsh Network of Healthy School Schemes and Flying Start
The D2Smile team has integrated successfully with the local healthy school schemes and provided evidence based oral health messages in training days for the Open College Network on food and fitness.
The team is also involved in the implementation of the Swansea Gold Standard Healthy snack Award for Pre-school Settings.
Other partners in this group are the Dietetics Department ABMUHB, City and County of Swansea Environment Department and Flying Start.
The D2S Co-ordinator has developed an excellent local D2S team that is clearly capable of networking and developing an oral health promotional initiative.
This could have considerable potential benefits for not only the CDS but for other groups of vulnerable people in the future if the decision is made to develop other health promotion initiatives.3
Building such a team takes time and this success deserves recognition.
The current and potential implications for paediatric dentistry, including reviewing the strengthened role of the CDS in children’s public health
The CDS CSM/SDO is also a member of the ABMUHB D2S Steering Group and works closely with the D2S team manager to ensure that both services operate in a complimentary, effective and efficient manner.
The CDS D2S team consistently promotes the services provided by the wider CDS, and provides information not only to schools but also to all the other groups it encounters of the best way CDS services can be accessed.
This has resulted in the development of a wider range of contact groups referring patients to the CDS. Early evidence suggests that the numbers of children referred to the CDS has increased as a result.
This joint working between the D2S and wider CDS will facilitate the development of paediatric dental care within the CDS.
This development is already underway with the introduction of a team within the CDS that is specifically responsible for the dental care of children.
As many of the children seen by the CDS require some form of special care dentistry, the development of links with children’s carers and support groups by the D2S team is invaluable to the CDS.
Many of the children seen by the CDS are highly dependent upon their carers and without good links and working relationships with these carers the CDS role becomes very difficult.
The anticipated reduction in dental decay that the D2S programme will produce will result in children retaining more of their teeth. This will result in other challenges to the dental profession and the CDS that may include increased orthodontic, restorative and possibly conscious sedation service demands as fewer children will require multiple extractions and treatment under general anaesthesia.
The ABMUHB CDS has introduced a conscious sedation service which includes service provision for children. Sedation can often provide an alternative to general anaesthesia in the dental management of certain vulnerable children.
The children’s team within ABM CDS is working to meet further demand on these services as part of an improved recruitment and retention staffing policy. Further development will include the recruitment of a specialist in paediatric dentistry within the CDS.
Into next year it is planned that the coordination of D2S input and other CDS provision e.g. school screening and mobile treatment services will be further developed. More children would come into the programme and many of these children will almost certainly require additional care via the CDS.
The expansion of D2S activities in the coming year will greatly facilitate the school screening carried out by the CDS and the coordination of CDS mobile dental unit activity for children’s dentistry.
The CDS also has a commitment to provide training for groups including Dental Foundation Trainees and other dental care professionals. The D2S team has kindly allowed CDS staff to attend and observe their activities and have provided these groups with an important instructional overview of an oral health promotional programme for children in action.
The work of the D2S team has helped to enhance the understanding of the local dental community of the importance of oral health promotion amongst children and of working with the CDS. The CSM/SDO has also already had meetings with representatives of the Welsh Government`s local GDS Child Pilot initiative.
This is in line with the D2S/CDS role of developing joint working and liaison with other groups. If this pilot initiative develops further, this will facilitate further joint working between the CDS and GDS. This will enable the CDS and GDS to work together as a team to provide better dental care for children.
Conclusion
I have worked with the D2S manager for several years and find that she has established an efficient, motivated team within the CDS that is working hard to improve the oral health of children.
This team could also be aligned in the future to develop oral health promotional initiatives for other vulnerable groups.
These groups could include dependent elderly people, the homeless and people with mental health problems. Very often, the oral health of these people is very poor and effective oral health promotion could possibly help to improve this in the longer term.4
This activity could further complement and enhance the role of the CDS in the dental care of vulnerable people.
I would also like to thank Mandy Silva, the D2S team leader in ABMUHB CDS, together with the members of the ABMUHB D2S Steering Group, for supplying some of the facts included in this document, for their hard work on the D2S initiative and for the help and support they have given to the CDS.
D.H.J. Davies
BDS, LDSRCS, DPDS, MFGDP, MClinDent, DSCDRCS
Clinical Service Manager/Senior Dental Officer
Specialist in Special Care Dentistry
References
1. Ministerial Letter EH/ML/014/08. Dental Services for Vulnerable People and the Role of the Community Dental Service. (31.10.08). Available at: http://wales.gov.uk/topics/health/publications/health/ministerial/letter014
2. Watt R and Sheiham A. Inequalities in oral health: a review of the evidence and recommendations for action. British Dental Journal 1999; 187(1): 6-12.
3. King P. Community Dental Programmes. In: Nunn J (editor) Disability and Oral care. London: IADH, 2000. pp. 115-122.
4. Kleinman ER et al. Trends for NHS primary dental care for older people in England: implications for the future. Gerodontology 2009; 26: 193-201.