The dental team & complete health

I recently came across a fascinating book (published in 1966) that was written to provide useful information about the dental profession, particularly for those considering applying for a career as a dentist. The author, Leslie J. Godden, was a former Editor of the British Dental Journal (1953-1968).¹ What caught my eye was the book's title, The dentist and his world,² clearly reflecting that time in which the great majority of dental students and dentists were male. That contrasts clearly with the modern-day gender split in many countries, where most dental students are female (for example, at the School of Dentistry in Dundee, the current first year BDS cohort comprises 49 female and 9 male students). The book was one of a series, the titles dominated by the male protagonist with The artist and his world, The teacher and his world, and The lawyer and his world, among others. Recognition of women in professional roles was indicated in only a minority, thus The nurse and her world, as well as (maybe) Dancers and their world. Clearly, these titles reflect the attitudes to work and gender at the time. As they say, the past is another country. On women in the dental profession, Dr Godden wrote ‘…the work is suitable for women and their proportion of the profession is increasing'. He goes on to mention the merits of part-time working and the importance of gentleness in the practice of dentistry (interpret as you will!). He also berates the NHS: ‘its value has been amply demonstrated, and the nation would not wish to be without it, but neither the medical, dental, nor pharmaceutical professions can be said to be content with the present conditions of service within it'. Maybe the past is not such a different country after all.

The changing demographics of the profession are clearly very relevant in workforce planning. In acknowledging the current workforce shortage, the NHS England Long Term Plan outlined a strategy to expand dentist training places by 40% by 2031-32, with the further aim that dental hygienists (DHs) and dental therapists (DTs) will deliver 15% of NHS dental activity - likely a tripling of the levels of activity provided by DHs and DTs currently.³ This is only to be welcomed, given that problems of access to dental services are barely out of the headlines.

These planned increases in workforce numbers, together with full utilisation of the wider dental team, are not only essential components of workforce planning to provide the best outcomes for patients, but will also provide greater opportunity for dental professionals to contribute to complete patient health. In other words, we as a profession can take a leading role in the earlier identification of a range of common chronic diseases, not just those of the oral cavity, but other conditions such as metabolic syndrome, obesity, diabetes, and cardiovascular diseases to name a few. Many of these diseases result from lifestyle choices and the obesogenic environment that much of the world's population now lives in, and the dental team has the privileged position of seeing (healthy) patients on a regular basis. Frequent and regular dental recalls are therefore essential not only for ensuring good oral health but for providing opportunities for beneficial general health interventions.

It is now time for action in redefining the role of dental healthcare professionals as part of overall healthcare...

Complete health can include elements such as checklists to assess overall health and wellbeing (with subsequent signposting of patients for appropriate investigations or care), assessments such as the Diabetes UK Type 2 Diabetes ‘Know your risk' calculator (https://riskscore.diabetes.org.uk/start), diet analysis, blood pressure measurement, finger-prick blood testing, as well as conversations about risk factors such as smoking. Of course, the challenge is the time required for additional procedures, but the opportunity is now ripe for significant changes to the nature of the care provision by the dental team to underpin a prevention-focused and wellbeing-driven (as opposed to disease-driven) model. Empowering patients to engage in effective self-care will yield enormous public health benefits, and the dental profession is uniquely placed to maximise patient empowerment by the regular and frequent contact we have. Improved patient self-care coupled with preventive recall strategies will also yield huge economic benefits through savings for healthcare systems.

It is now time for action in redefining the role of dental healthcare professionals as part of overall healthcare, to fully incorporate the wellness management approach. Going back to The dentist and his world, the author hinted at these concepts as long ago as 1966, reflecting on the importance of making the patients ‘whole again' through the range of medical and dental means. Now is the moment to make this happen.