FGDP(UK) Dean, Ian Mills, reflects on oral health care amongst the most vulnerable groups in society.
The oral health of the general population has improved significantly over the last fifty years, and the dental profession can be congratulated on their role in helping to achieve this. Sadly, there is still an unacceptably high level of disease within specifics groups of the population which tends to be concentrated within the most vulnerable groups in our society. We may have been successful in delivering better oral health for many, but we have been largely ineffectual in addressing inequality and supporting those who are most in need our support.
The inverse care law was proposed almost fifty years ago by Julian Tudor Hart1 to describe the perverse relationship between the need for health care and its actual utilisation. "The availability of good medical care tends to vary inversely with the need for it in the population served."
Despite the progress in oral healthcare provision over that time, the inverse care law would seem to be working “effectively” within NHS Dentistry; where those in most need have the greatest difficulty in accessing services.
This has been highlighted most recently in a Care Quality Commission (CQC) Report on the state of oral health care in care homes across England. The level of care provided is clearly sub-optimal and this needs to be addressed with a degree of urgency to ensure that we provide access to high quality care for this vulnerable group.
Mouth Care Matters is a programme supported by Health Education England which aims to improve oral health in hospital and community care settings where patients may be unable to carry out their own personal care and rely on others for support. Recently expanded, the programme is personalised for patients and has been shown to deliver better clinical outcomes. Resources including personalised mouth care screening and assessments with daily recording sheets ensure regular care for the mouth including dry mouth care, ulcer care and denture care. Find out more about it at http://www.mouthcarematters.hee.nhs.uk/links-resources/mouth-care-matters-resources/.
In practice we may see patients who have carers, or indeed are carers themselves. We can all help to reinforce the message that even if someone is ill or bed bound in hospital, or unable to care for themselves, their oral care needs are a priority. The FGDP(UK) publication Dementia-Friendly Dentistry: Good Practice Guidelines is designed to help support you in adapting patient management and clinical decisions for the 5% of people with the condition in the UK.
Such initiatives should be welcomed as an attempt to address some of the inequalities within oral health care, but we desperately need a long-term oral health strategy which delivers high quality care for those who are most in need. We face similar challenges across the devolved nations, and central to any oral health strategy must be development of an effective NHS Dental Contract for primary care which is adequately funded and targets resources at those with the highest need. Failure to do so will simply exacerbate the growing level of inequality and provide further evidence to support the existence of Tudor Hart’s inverse care law.
1. Hart, Julian Tudor (27 April 1971). "The Inverse Care Law". Socialist Health Association. Retrieved 1 April 2015.