The Big Social Impact

It all starts with the mouth

It’s unique to UK schools of dentistry. In Dundee, researchers investigating oral health problems in the community don’t talk about transforming teeth, they talk about transforming lives! Researchers in the Oral Health and Health Research Programme in the Dental Health Services Research Unit (DHSRU) find out about who people are and encourage them to speak about themselves.  Working collaboratively with people within their communities finds oral health solutions to transform lives.

Professor Ruth Freeman, co-Director of DHSRU, says the approach is to help those experiencing social exclusion to explore their main concerns and to enable them to know themselves.  Working collaboratively with socially excluded clients, allows tailoring of an oral health regime to their needs which increases empowerment for self-care.  “It’s about taking an holistic approach,” says Professor Freeman. “Only by appreciating problems from the perspective of the individual can we start to transform lives.  What we’re doing is to use oral health as a vehicle to understand how people manage their lives and what we can do to assist them.  This is the approach that Tahira Akbar adopts in our work with Derek Richards, Consultant in Dental Public Health from NHS Forth Valley and Tayside, and the Scottish Prison Service with regard to health improvement interventions for prisoners across Scotland.”

Emma Coles, a Research Fellow with DHSRU drives another programme - the Smile4life project - which focuses on those experiencing homelessness.  Homeless people are one of the priority groups identified in the Scottish Government’s Dental Action Plan and National Oral Health Improvement Strategy for Priority Groups.  Following a survey of 853 homeless people which examined oral health, general health and psycho-social wellbeing, initial work showed that for homeless people, the number of decayed and extracted teeth explained nearly a quarter of the depression experienced.  Emma conducted one-to-one interviews with a number of homeless people about their oral health. One of the common threads that arose in the Smile4life survey and the interviews was a lack of self confidence caused by poor oral health – many people felt embarrassed about how their mouths and teeth looked. 

“Many homeless people have poor oral health due to difficulties in their lives as reflected in being unable to access dental care, lack of preventive care or the consequences of substance misuse” says Emma Coles. “They may not have been to the dentist for a long time; taking the first step to go back can be difficult and they may require support to do this – so we need to understand the barriers homeless people experience and the difficulties they have in their lives.”

From the survey and in-depth work, a training guide and intervention has been developed, which will be used by health and social care staff in the homelessness sector– with the goal of improving the oral health of homeless people and increasing their access to dental care using the main concerns of the homeless person as a driver.

Understanding the homeless person’s difficulties and felt needs provides a platform for engagement with health services.  Staff and practitioners working in the homelessness sector are able to use the Smile4life intervention to engage their clients with the subject of oral health, encourage them to make changes, and support them to access the dental treatment they need.

“To go back to the dentist after a long gap in attendance, people have to be at the point where they are able to make changes in their lives.” explains Emma Coles.  “For many homeless people, having a nice smile instead of trying to hide their mouth transforms their lives. It may seem very minor - just your teeth – but it is much so bigger than that. Once people look better, they start to feel better, take better care of themselves and have the confidence to make other positive changes in their lives.”

DHSRU also engages with parents who have problems with taking their children to dentists.  This is particular relevant for families residing in socially deprived areas. Many parents and children experience anxieties which results in them being unable to make or failing to keep appointments.  Dr. Sucharita Nanjappa is working on the DAPER study – which stands for Developing an inventory to Assess Parental concerns and Enable child dental Registration. This is commissioned and funded by the Scotland Government’s oral health Childsmile Programme. DAPER aims to understand the problems that families face in attending for dental care with their young children.

 “As part of the study Dr Stephanie Chambers interviewed parents from across Scotland to find out more about their everyday lives and the daily challenges they experienced,” explains Dr. Nanjappa.  “This has led to the development of the Parental Dental Concerns Scale, a checklist of parental main concerns.  This is is being used by Childsmile Dental Health Support Workers (DHSWs) in NHS Tayside and NHS Highland, to identify families who require additional support to access dental care for their children.”

To engage with these families the DAPER team, in collaboration with DJCAD at the University of Dundee, developed the Chatterbox toolkit.  Chatterbox consists of a set of activity cards, appointment postcards and a timeline – so users can construct a visual picture of their day, with problems encountered and tasks they wish to achieve. DHSWs use the Chatterbox to let the parents discuss any daily challenges and together they identify solutions to enable the family access dental care. The goal is for parents to identify times when they can access dental services and get support to enable their children to visit dental clinics.  Chatterbox is a University of Dundee initiative and is being piloted with families from areas of high social deprivation in NHS Tayside and NHS Highland.  It is envisaged that this approach will not only transform teeth but also the lives of children and their families who experience social and health inequality.

Dr Stephanie Chambers heads up the EATPro at DHSRU.  EATPro is a teacher-led programme which promotes healthier eating behaviour in school children, by working with primary schools to investigate effective ways of integrating food and health into teaching as part of the national Curriculum for Excellence.  This follows on from Dr Chambers’ important work on food policy and the systematic review on childhood obesity and dental health.

At Dundee, you’ll find that dentistry and oral health improvement comes in many guises – and with regard to those experiencing health inequalities and social exclusion- interventions tailored to an individual’s need, using proportional universalism, has the potential to ensure health equity for all.