Oral health (health and wellbeing needs in South Tyneside)

• NICE public health guidance (PH55) is aimed at public health and wider social and educational bodies as well as personnel within them and makes recommendations on how to assess oral health needs, develop local strategies and deliver community-based interventions in England.

Fluoride use

• Fluoride acts in several ways to slow and prevent the decay process and also to reverse decay in its early stages. The most important modes of action are to reduce demineralisation and promote re-mineralisation so that minerals are deposited back into the tooth surface. The effectiveness of fluoride reducing levels of tooth decay at an individual level and at a community level is well documented.

Key interventions to consider are:

• Targeted delivery of toothbrushes and toothpaste by health visitors
  • This has a high return on investment. The evidence for this is from studies which followed this approach with postal delivery of toothbrushes and toothpaste but this is likely to require additional staff and resources.
• Introduce supervised brushing in targeted areas
  • In the North East a small number of nurseries have developed schemes which they now sustain without extra funding. Supervised brushing schemes would likely require resource from the oral health promotion workforce in addition to start-up and continuing costs materials.  This could give an estimated £3.06 returned per £1 spent after 5 years (£3.66 after 10 years).
• Water fluoridation
  • Water fluoridation is one of a range of interventions available to improve oral health, and the only one that does not require behaviour change by individuals.
  • All water contains small amounts of naturally occurring fluoride. Fluoride in water at the optimal concentration (one part per million or 1mg fluoride per litre of water [1mg/l]) can reduce the likelihood of tooth decay and minimise its severity. Where the naturally occurring fluoride level is too low to provide these benefits, a water fluoridation scheme raises it to one part per million.
  • Reviews of studies conducted around the world confirm that water fluoridation is an effective, safe public health measure suitable for consideration in localities where tooth decay levels are of concern.
  • Local authorities also have the power to make proposals regarding water fluoridation schemes, a duty to conduct public consultations in relation to such proposals and powers to make decisions about such proposals.
• Adopt a common risk factor approach
  • Continue current evidence based interventions in smoking cessation and alcohol control services. Adopt best practice guidelines around tackling obesity and ensure that the activity from the childhood healthy weight group, the tobacco alliance and the alcohol harm reduction group reflect current oral health needs
  • Seek to ensure oral health promotion is included in training and education of health and social care staff so 'high risk' individuals are encouraged to see a dentist regularly for early detection of oral cancer.
• Sugar reduction
  • Tooth decay is linked with sugar consumption. Reducing sugar consumption should be part of the wider nutrition / food plan and PHE's sugar reduction work highlights a number of approaches to consider.
• Return on investment for oral health improvement
  • PHE's ROI highlights the difference in return over 5 and 10 years for health improvement programmes. Further information the potential return on investment on oral health interventions can be found on Figure 5 of the Appendices.