07 Aug 20

Dental public health in the light of COVID-19 - Emma Pacey

Inequality is the highest risk factor both for infectious diseases such as COVID-19 and for non-communicable diseases such as dental decay – and that has to be the focus of dental public health initiatives. This was the webinar take-home message from Miss Emma Pacey, a dental therapist and educationalist with a special interest in dental public health, who works both for Health Education England and King’s College Hospital.

Agreeing with the first speaker Sir Paul Beresford that the amount of dental decay in young children was unacceptably high, Miss Pacey drew the parallel between poor oral health and overweight/obesity, often another aspect of deprivation and lack of education. She asked: ‘Do we value the oral health of the children in our society, and if so, what are we going to do to tackle it?’

COVID-19 has brought both massive challenges and some opportunities, however, she commented. It has had an impact on incomes, priorities and shifting of routines, as well as the withdrawal of primary care, and has presented many organisations, especially the NHS, with a steep learning curve. In her job at Health Education England, she and colleagues have been working to ensure that the workforce is flexible, agile and able to respond to the demands of the pandemic. The workforce has undergone mass remobilisation to staff Nightingale Hospitals, the 111 phone service and the Track and Trace System, and find ways to interact with the public virtually. ‘The pandemic has provided us with the opportunity to monopolise on that response and ensure the health workforce is reflective of the needs of the population,’ she said.

At King’s, which is commissioned to promote oral health across nine local authorities in the South East, COVID-19 has meant that many programmes such as supervised toothbrushing have had to be temporarily suspended; instead she and her colleagues have been looking to reorientate their offer and find imaginative ways to engage with the public in lower risk situations, for example by distributing oral health packs or working in coordination with foodbanks, voucher schemes, or piggybacking on the free school meals service during the school holidays. ‘A large part of our current focus is on how to deliver health promotion virtually, in an impactful way, which does present an opportunity,’ she said.

A major concern following the lockdown has been the reduced access to care, she said, again disproportionally affecting deprived communities, and reducing safeguarding opportunities. Now that dental practices are opening up, waiting lists are being tackled and cases prioritised, involving another new decision making process. ‘COVID-19 has pushed us to our limits but has also shown the value of transferability of skills,’ she insisted. The pandemic has taught us about skill mix, and using the whole team to widen access to dental care. ‘We can engage our patients in behaviour change, and consider how we can deliver oral health education virtually.’

Remote video URL


Answering a question from a listener, Miss Pacey insisted that motivation of children and engaging mothers, must be positively framed – ‘no scare tactics’. Returning to her point about the link between poor oral health and overweight/obesity, she said that a message about ‘what’s good for teeth is also good for tummies’ allows dental health education to piggyback on broader health messages, which might provide a stronger reason for some members of the public to change their behaviour. She recommended dental teams work with other health professionals locally, such as pharmacists and education providers ‘to make every contact count’.

She ended on a positive note. ‘The good news is that we can provide the majority of evidence based care in a no-AGP (aerosol generating procedures) environment.’

Next time: Dr Nigel Carter – the view from the Oral Health Foundation


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