Oral health (health and wellbeing needs in South Tyneside)

1. Reduce the population prevalence of dental disease - and especially levels of dental decay in young children and vulnerable groups
2. Reduce the inequalities in dental disease
3. Ensure oral health promotion programmes are evidence informed and delivered according to identified need.
4. Adopt a common risk factor approach to improving oral health and embed in local services.

• Public Health England recommends commissioning a range of upstream, midstream and downstream interventions based on the local oral health needs of the population. Some of these programmes may involve a universal approach whilst others may be targeted to areas of identified oral health inequalities following the Marmot principles of "proportionate universalism"
• For further information on levels of intervention see Figure 1 of the Appendices

1. Reduce prevalence of dental disease

• The effectiveness of fluoride in reducing levels of tooth decay at an individual level and at a community level is well documented. As advocated by PHE, local authorities should consider the case for water fluoridation in the context of local needs.

2. Reduce inequalities in dental disease

• Consideration should also be given to more targeted approaches in deprived communities such as tooth brushing programmes. The local oral health promotion team may be able to develop such an initiative with support from the children's integrated teams.
• Whilst the majority of oral health improvement programmes are directed towards children, service specification for care homes should include a responsibility for oral health that incorporates an oral health assessment on entry, daily mouth care in care plans for residents and regular access to an NHS dentist.
• Dental services for older people must be more integrated within the wider health and social care landscape. Developments in training, information sharing and referral pathways are necessary to achieve this. Formal and informal carers across all settings require appropriate training and support in ensuring adequate oral hygiene, recognising urgent dental conditions, and when and where to seek both routine and emergency dental treatment.

3. Ensure evidence informed oral health promotion

• Locally a review of oral health improvement programmes in line with national guidance, and the consideration integrating oral health improvement into existing commissioned programmes, would be beneficial.
• Nationally oral health policies, oral health needs assessments, staff training on oral health care and a system to ensure oral hygiene support is received are all more common in residential and nursing care homes than in 'care in your home' services and hospitals with inpatient facilities. Local efforts are needed to address this.

4. The common risk factor approach

• The common risk factor approach, integrates general health promotion by focusing on a small number of shared risk factors that can potentially impact a large number of chronic diseases. Reducing the sugar content of local food choices will have an impact obesity levels, especially childhood obesity, as well as reducing the impact upon oral health.
• Actions that could improve oral health through the environment include developing healthier children's centres and preschool settings, safe recreational areas (preventing dental trauma), removing high sugar food and drinks from public settings and introducing planning policies that promote healthier food outlets near schools.
• Efforts should be made to ensure that strategic approaches to tobacco, alcohol and obesity reflect the need to protect and promote oral health especially within deprived communities.