Delivering Better Oral Health - Evidence into Practice

1. �Delivering Better Oral Health�- Evidence into Practice Sue Gregory Consultant in Dental Public Health NHS Bedfordshire, Luton PCT and Hertfordshire PCTs

2. Choosing Better Oral Health:An Oral Health Plan for England

3. Common Risk Factor Approach and Oral Health Fits well with �Choosing Health� Poor quality diet Inappropriate infant feeding practices Poor oral hygiene Smoking Excessive alcohol consumption And common risks factors for oral diseases include:And common risks factors for oral diseases include:

4. 7 Main Target Areas for Oral Health Improving diet and sugars intake Improving oral hygiene Optimising exposure to fluorides Tobacco control and promoting sensible alcohol use Reducing dento-facial injuries Professional training and support Research and development

5. Prevention in practice Simple messages Concise advice Evidence based with strength of evidence Practical and easy to use Good reference for sugar free medicines and fluoride concentration in toothpaste Links with healthy eating

6. The principles Statements supported by evidence � the stronger the better Update regularly to include new evidence Maximise the potential benefits of prevention Challenge the risk level approach in favour of a practice �population� approach Messages in line with wider health messages Provide information for The whole dental team Dental care at primary, secondary and tertiary level Primary Care Organisations to assist with commissioning

10. Prevention of caries in children aged 7 years and above

11. Prevention of caries in adults

12. Prevention of periodontal disease � to be used in addition to caries prevention

13. Prevention of oral cancer

17. Fluoride varnish Fluoride varnish costs 30 pence per application Skill mix - hygienists & therapists and even nurses (Scotland and North West) Effective Prevention better than Cure

22. A role for dentists Establish smoking status of all patients Advice should be clear firm and personalised Referral to Stop Smoking Services Help from the dental team Training for dental team Work with PCTs

23. Implementation actions Facilitate the use within dental practice Disseminate to the wider workforce who can influence health Consider fluoride strategies and workforce implications Plagarise!

27. Caries experience(dmft+DMFT) and reported brushing frequency

31. Summary of clinical trials Some of the studies that demonstrated the relationship between concentration and effectiveness are shown here. Taking the study second down from the top this compared 1000, 1500 and 2500. As the fluoride concentration increases ( to the right) so the amount of new caries gets less. This general trend is illustrated by the thick red arrow. Some of the studies that demonstrated the relationship between concentration and effectiveness are shown here. Taking the study second down from the top this compared 1000, 1500 and 2500. As the fluoride concentration increases ( to the right) so the amount of new caries gets less. This general trend is illustrated by the thick red arrow.

32. The benefits of fluoride toothpaste are concentration dependent For every increase in concentration of 1000 ppm F there is a further 8% reduction in caries and vice versa

35. Percentages of subjects with fluorosis for quintiles of the Townsend Ward Score

36. Conclusions

38. This slide shows the number of new caries lesions developing during a 3 year clinical trial. Those who rinse with a beaker of water have more tooth decay than those using their hand. This slide shows the number of new caries lesions developing during a 3 year clinical trial. Those who rinse with a beaker of water have more tooth decay than those using their hand.

41. Does the amount of toothpaste make a difference? When you compare the amount of caries that developed during this 3 year clinical trial with the amount of toothpaste reportedly placed on the brush there is no difference.Does the amount of toothpaste make a difference? When you compare the amount of caries that developed during this 3 year clinical trial with the amount of toothpaste reportedly placed on the brush there is no difference.

42. The amount of toothpaste applied is not associated with the benefits of fluoride toothpaste

43. The impact of variables on the effectiveness of fluoride toothpaste

44. The action of fluoride delivered to the tooth surface is two fold. Firstly it reduces the loss of mineral from the tooth when acid is present. The action of fluoride delivered to the tooth surface is two fold. Firstly it reduces the loss of mineral from the tooth when acid is present.

46. The risk of fluorosis from toothpaste is dose dependent The dose of fluoride is related to both the concentration of fluoride in the toothpaste and the amount swallowed

47. The impact of concentration and amount of toothpaste used on fluorosis risk

48. Brushing more than once a day with no more than a pea sized amount not associated with an increased risk of fluorosis

49. Simplified recommendation for all children For children aged 0-6 years the suggestion of what level of fluoride toothpaste to advise is shown above. The advice to all parents of such young children should be: Brush twice a day last thing at night and on one other occasion. Supervise toothbrushing; apply a smear or a pea-sized amount of toothpaste - stop toothpaste abuse. 1000 ppm F and 11350 ppm F paste Encourage the child to spit out excess toothpaste. Do not rinse with a large volume of water. For children aged 0-6 years the suggestion of what level of fluoride toothpaste to advise is shown above. The advice to all parents of such young children should be: Brush twice a day last thing at night and on one other occasion. Supervise toothbrushing; apply a smear or a pea-sized amount of toothpaste - stop toothpaste abuse. 1000 ppm F and 11350 ppm F paste Encourage the child to spit out excess toothpaste. Do not rinse with a large volume of water.

52. A Cochrane Review concluded that they reduced caries by 20%. Fluoride rinses should not be used by children <6 years because of the risk of swallowing.A Cochrane Review concluded that they reduced caries by 20%. Fluoride rinses should not be used by children <6 years because of the risk of swallowing.

55. What should PCTs be Doing to Commission for Oral Health? Collect appropriate information on oral health as required by regulations Consider having a local Oral Health Strategy as part of their LDP Consider using the key elements of Choosing Better Oral Health suite of documents as a basis for this Undertake Oral Health Needs Assessment Ensure that they receive appropriate advice in meeting Dental Public Health requirements