Oral health promotion: general dental practice

Context

This guideline complements NICE's guideline on dental checks: intervals between oral health reviews, the recommendations for dentists in section 1.8 of NICE's guideline on suspected cancer: recognition and referral and NICE's guideline on oral health for adults in care homes.

It does not cover the following (although the recommendations may be of interest):

Oral health is important to general health and wellbeing. It can also affect people's ability to eat, speak and socialise normally (Dental quality and outcomes framework Department of Health).

Poor oral health can lead to absences from school and workplaces. It can also affect the ability of children to learn, thrive and develop (Local authorities improving oral health: commissioning better oral health for children and young people – an evidence informed toolkit for local authorities Public Health England).

Oral health in England has improved significantly over recent decades. The Adult dental health survey 2009 (Health and Social Care Information Centre) reports that the proportion of adults in England without natural teeth has dropped from 28% to 6% in the past 30 years.

In addition, the number of children with signs of previous decay in permanent teeth has dropped. In 2013, for example, 46% of young people aged 15 – and 34% of those aged 12 – had 'obvious decay experience' in permanent teeth. This compares with 56% and 43% respectively in 2003.

However, oral health varies widely across England. For example, the prevalence of tooth decay among children aged 5 ranges from 12.5% in Brighton and Hove to 53.2% in Leicester (National Dental Epidemiology Programme for England, oral health survey of 5 year old children 2012 Public Health England). Poor oral health tends to be more prevalent among people who are socially or economically disadvantaged.

NHS dental services have more than a million contacts with patients each week (Improving dental care and oral health – call to action NHS England). In 2014, 56% of adults and 69% of children in England had seen an NHS dentist in the past 2 years. (NHS dental statistics for England 2013–14 Health and Social Care Information Centre.) Dental practice teams are well placed to deliver health improvement advice and to help people look after their oral health.

Each year the NHS in England spends around £3.4 billion on primary and secondary dental services (Improving dental care and oral health – call to action NHS England).

The NHS remuneration system for general dental practitioners is based on bands of dental activity. It focuses on the treatment and repair of teeth, rather than preventing future disease (NHS dental services in England Steele J; Dental contract reform – prototypes Department of Health). A new NHS contract for general dental practice is expected by 2018 and improving oral health and preventing disease will probably be key.