Oral Health JSNA

Nationally

Delivering Better Oral Health Toolkit (OHID)11

Evidence-based guidance for dental teams on prevention, including fluoride use, diet, smoking cessation and oral hygiene.

National Dental Epidemiology Programme (NDEP)12

Natural Water Fluoridation and Supervised Toothbrushing Schemes (Oral Health Promotion Team)

Healthy Start Scheme13

This scheme supports low-income families with access to healthy food and vitamins, indirectly supporting oral health. Government funding of oral health resources (Toothbrushes and toothpaste) to support oral health promotion and help with some of the inequalities of access to oral health resources.

Oral Health Strategy 202514

We have four priorities to improve our population's oral health:

• Improve access to routine dental care, like check-ups
• Increase the number of urgent care appointments
• Tackle dental workforce recruitment and retention issues
• Focus on preventing poor oral health

We will work closely with partners in the public and voluntary sectors to deliver services that work for patients and dental professionals. This includes:

• Offering more than 1,000 extra out-of-hours dental appointments per year
• Supporting community dental services to give vulnerable people care closer to home
• Providing an additional 109,000 urgent care appointments every year
• Launching a network of Urgent Dental Access Centres
• Working with partners to support people to look after their gums and teeth
• Supporting NHS 111 to deal with dental calls by expanding the Dental Clinical Assessment Services (DCAS) workforce
• Reducing waiting times for specialist minor oral surgery and orthodontic services
• Working with partners on education and training schemes that keep our dental workforce engaged and skilled
• Investing in local NHS dental services by targeting funds and support to the most deprived communities

Supporting the national agenda

In the NHS 10-Year Health Plan and our strategy is well-placed to support the Government's three shifts – particularly by delivering more dental services in our communities and focusing on preventing dental disease.

Regionally

The Northeast Oral Health Needs Assessment 2023 identified targeted interventions to reduce dental decay:

• Toothbrush and toothpaste distribution to vulnerable families
• Oral health training for non-dental professionals (e.g. health visitors and social workers)
• Integration with Family Hubs and early years services
• Community outreach to improve access and health literacy.

Locally

Local authorities are statutorily required to provide or commission oral health promotion programmes to improve the local population, to the extent that they consider appropriate based on levels of need in their areas15. NICE Guidelines include recommendations for local authorities to improve oral health through developing and implementing a strategy that meets the needs of the local community and promote and protect the oral health of the population.

Tees Oral Health Promotion Service

Hartlepool Borough Council contributes to funding the Tees Oral Health Promotion Service alongside three other local authorities (Stockton, Middlesbrough, and Redcar and Cleveland). The Tees Oral Health Promotion Service delivers a toothbrushing programme to Early Years settings and primary schools; provides workforce training for health visitors, school nurses, family support workers, and in residential and care settings.

In general, Hartlepool benefits from the effects of natural water fluoridation on oral health: data indicates that children living in the most deprived wards had similar levels of dental decay as children living in the least deprived wards in Stockton-on-Tees (non-fluoridated). In Hartlepool, there is also a lower proportion of missing and filled teeth compared to local areas in the region. The prevalence of experience of dental decay of 5-year-olds is also similar to the average for England. However, observing this trend over time, the prevalence may not indicate an improving picture, unlike the regional and national figures. Tooth decay is driven by many factors, including poor diet and toothbrushing habits, and there is strong association with deprivation. A targeted fluoride varnish programme may further help to mitigate against these drivers of poor oral health in children in Hartlepool.

There is a strong public health evidence-base for this intervention. The national Guideline Development Group (GDG) is confident that the benefits outweigh the harms of this intervention, typically based on high or moderate certainty evidence. The professional intervention of applying fluoride varnish (2.26% sodium fluoride) to teeth 2 times a year has strong evidence for preventing dental caries in all children aged 3-6 years.16 Public Health will be looking at implementing a fluoride varnish programme to complement the oral health promotion due to Hartlepool’s water supply naturally containing fluoride, a targeted local fluoride varnishing programme has not been commissioned before. This would potentially provide an opportunity for the intervention to be piloted and evaluated, in line with NICE’s recommendation.

Commissioned services:

• Targeted supervised toothbrushing in nurseries and schools in areas of high need
• Oral health promotion through Family Hubs and early years settings
• Dental packs (toothbrushes, toothpaste) distributed to families in deprived areas
• Looked After Children dental check monitoring and support
• Partnerships with schools to promote health eating and reduce sugar intake.