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Implications for policy and practice

Implications for policy and practice. On behalf of the ADHS consortium. Professor Richard G Watt. Presentation. Recap on findings from user consultation Highlight selected key findings from survey Identify implications of survey findings for Policy Clinical practice Research

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Implications for policy and practice

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  1. Implications for policy and practice On behalf of the ADHS consortium Professor Richard G Watt

  2. Presentation • Recap on findings from user consultation • Highlight selected key findings from survey • Identify implications of survey findings for • Policy • Clinical practice • Research • Conclusions and thanks

  3. Consultation Recommendations • Appreciation of importance of mapping trends over time • Greater detail requested on service utilization and experience of NHS dental care • Major interest on access and barriers to care • Request for less detail on dentures, perio etc • Recognition for inclusion of new items eg anxiety, treatment needs • Links to broader agenda eg smoking, diet • Greater relevance and value for local level eg SHA • More concise and user friendly reporting

  4. Cautionary note • Cross sectional survey design • Measurement issues • Periodontal disease • Sampling • Scotland not included • Institutionalized and other groups excluded • Reporting concerns • Variable response rates across sites • Respondent reporting bias?

  5. Summary of good news

  6. Unique methodological opportunityReview national trends over 40 years

  7. 1968

  8. 1978

  9. 1988

  10. 1988

  11. 1998

  12. 1998

  13. 2009

  14. Clinical indicators • Dramatic improvement in proportion of population who are dentate (94%) • Proportion of adults in England who were edentate has fallen by 22% points from 28% in 1978 to 6% in 2009 • Overall mean number of teeth amongst dentate was 25.7 of which 17.9 were sound and untreated • Prevalence of caries in England fallen from 46% to 28% since 1998. • Overall 17% of dentate adults had very healthy periodontal condition • 10% of sample had excellent overall oral health

  15. Behaviours and service use • Majority (75%) population report toothbrushing at least twice a day • Most (76%) use high/med strength fluoride toothpaste • Almost two-thirds (61%) of dentate attend for regular check-up

  16. Majority (76%) had visited dentist within last 2 years • Vast majority (92%) were able to make NHS appointment • High level of satisfaction with NHS dentists

  17. Subjective measures • Overall 81% stated their general health was good or very good; 71% rated oral health as good or very good • Since 1998 proportion experiencing one or more problem on OHIP-14 fell from 51% to 39% in 2009

  18. Areas of concern

  19. Disease patterns • Just under a third (31%) of dentate adults had obvious decay, with average number of teeth affected 2.7. • Strong inequalities in caries experience by social class and health behaviours • Just over half (54%) of dentate had gingival bleeding • Overall 45% of adults had periodontal pocketing exceeding 4mm - majority moderate • 15% showed moderate tooth wear

  20. Urgent conditions • 9% reported current pain. • 8% reported experienced pain fairly or very often in previous 12 months. • 7% had one or more PUFA lesion • 8% had one or more untreated teeth with unrestorable decay • Adults had increased likelihood of both pain and serious caries/sepsis if they: • Irregular attenders; • Less frequent brushers & • Current smokers

  21. Complexity and maintenance • 97% of dentate aged 45-54 had a filled tooth with 9.1 teeth affected • Over third (37%) had a crown – average 3 per person • Nearly a fifth (19%) had three or more indicators of complexity – particularly for over 45 year olds • Analysis showed strong association with various behaviours

  22. Health behaviour and service use • Just over fifth smokers (22%) – only 9% reported being given advice on cessation • Almost two thirds (64%) no recollection of being asked about diet • Cost concerns remain a barrier to access – 19% delayed attendance • 12% scored 19 or more on MDAS indicating extreme dental anxiety • 20% not satisfied with last dental visit

  23. Impacts of dental diseases • 39% experienced one or more problems from OHIP-14 • Physical pain (30%) • Psychological discomfort (19%) • A third had difficulty performing at least one element of OIDP • Difficulty eating (21%) • Smiling (15%) • Inequalities by social class

  24. Speculation on explanations for overall improvements

  25. Definitely not caused by …. • National preventive or oral health promotion programme – none exists • Clinical preventive measures – only recently being more widely undertaken

  26. Possible factors include: • Broader changes in society • Use of fluoride toothpaste • Reduction in smoking • Improvements in hygiene • Changes in diet patterns? • Changes in clinical treatments & diagnosis • Less interventionist approach • Greater public interest and motivation for health/oral health • Other factors??

  27. Implications

  28. Implications - policy • Future nature of NHS Dental Services • Support preventive & non interventionist care for younger healthy cohorts • Meet increasingly complex needs of 45 year olds plus • Crown and bridge • Endodontic treatment • Advanced perio treatment • Address oral health inequalities

  29. Personnel planning • Develop future workforce responsive to oral health needs of population • Appropriate skill mix • Oral health promotion policy • Need for evidence based national OHP policy that includes adults and older people • Encourages maintenance of good oral health • Development of oral health literacy including appropriate use of dental services

  30. Implications - practice • Use of dental teams with range of skills • Need for specialist clinical skills • Key role for DCPs in prevention and maintenance • Appropriate recall intervals for different patient groups • Interface between primary and secondary care • Improve referral systems • Community based consultant services • Dentists with special interests etc

  31. Implications - research • Explore in greater depth trends over time and possible explanatory factors • Monitoring and evaluation of new systems of care and prevention – baseline measures • Link to local/’regional’ booster surveys – national comparisons • Linkage of ADHS 2009 with other health and social surveys

  32. Conclusions • Overall very positive findings for 2009 ADHS • Range of significant improvements since 1998 • Still areas of concern especially for 45 year olds plus • Need for survey findings to inform future development of dental services and personnel planning • ADHS 2009 highlights value of national surveys

  33. Adult Dental Health Survey 2009 The NHS Information Centre commissioned the survey, with funding provided by the Department of Health in England, the Welsh Assembly Government and the Department for Social Services and Public Safety in Northern Ireland. The Office for National Statistics (ONS) was the lead contractor working in partnership with the National Centre for Social Research, the Northern Ireland Statistic & Research Agency, and a team of academics from the Universities of Birmingham, Cardiff, Dundee, Newcastle and University College London

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