Utilising the dental workforce in England, United Kingdom, to optimise the response to COVID-19.

COVID-19 presents a unique and significant challenge to healthcare systems across the globe. Dental workforce redeployment, in England, during the response to Coronavirus (COVID-19), is the first reported national effort to redeploy a professional body into new clinical environments. The policy decision to facilitate redeployment of the dental workforce, in March 2020, by the Office of the Chief Dental Officer (OCDO), increased flexibility within workforce systems and allowed increasing demand on healthcare services to be managed safely and effectively. This paper outlines how this policy change was achieved via a multi-professional approach, mapping competencies of the dental workforce to high-priority areas of healthcare need. The dental workforce has a varied and often specialised skill set, offering expertise in infection prevention and control, airway management and often, behaviour management. These skills can be an important contribution to tackling a pandemic where expertise in these areas is vital. This increase in workforce supply allows healthcare systems to improve their surge response capabilities. Additionally, redeployment presents an opportunity to create greater and sustained collaboration between the medical and dental professions, leading to greater understanding of the contribution of oral health to wider medical wellbeing.

Understanding the impact of COVID-19 on dental antibiotic prescribing across England: 'it was a minefield'.

Introduction The COVID-19 pandemic impacted significantly on dental service delivery across England.Objective To explore how and why the pandemic affected antibiotic prescribing by primary care dentists.Methods Mixed-methods study: secondary analysis of routinely collected NHS dental antibiotic prescribing data from before and during the pandemic; and an online survey of dentists (NHS and private) across England's regions.Results Dental antibiotic prescribing increased 22% in the pandemic's first year, with regional variation from a 12.1% increase in London to 29.1% in East of England. Of 159 dentists surveyed, 60% had prescribed 'many more' antibiotics. Some urgent dental centres required antibiotics before accepting referrals, irrespective of clinical appropriateness. Diagnosing remotely was hard. Antibiotics were used to delay aerosol generating procedures and fill gaps in services. Widespread frustration existed.Discussion Maintaining access to urgent dental care during a future pandemic would include availability of high-grade personal protective equipment for dental teams. Everyone must understand the impact of restricted dental access on antibiotic overprescribing and hence antibiotic resistance.Conclusion Reduced dental access and changes in dental service delivery because of the pandemic increased antibiotic prescribing. Ensuring uninterrupted access for all to effective urgent dental care is an important element of global efforts to tackle antibiotic resistance.

An overview of adult dental fee exemptions in NHS primary dental care in England.

Aims To explore the current landscape of NHS primary dental care services for fee-exempt adult patients and observe attendance, band claiming and geographical patterns.Materials and methods Data were analysed from FP17 claims submitted to NHS Business Services Authority from 2006-2019.Results Fee-exempt adult patients in 2018-2019 account for 23.7% of all adult claims in NHS primary dental care. This percentage has decreased year-on-year since 2011-2012 from 31.5%. In 2018-2019, there were significantly fewer band 1 claims for fee-exempt adult patients (36.0%) compared to their fee-paying counterparts (58.3%). Treatment needs appear to be higher for fee-exempt adult patients since more band 2 and 3 treatment claims were completed (49.0%) compared to fee-payers (30.8%). Band 3 claims were three times higher for fee-exempt adult patients.Discussion Adults with fee exemptions must be able to access timely oral health services since they appear to have higher treatment needs than fee-payers. The areas with the highest proportion of fee-exempt adult patients reflect relative levels of deprivation across regions in England. Barriers to access must be reduced to fully engage all groups of patients and improve oral health.Conclusion Oral health inequalities appear to exist between fee-paying and fee-exempt adult patients. The post-pandemic world will offer a unique opportunity to reassess NHS dental services.

How did COVID-19 impact on dental antibiotic prescribing across England?

Introduction Antibiotic resistance is a global problem driven by unnecessary antibiotic use. Between 25 March-8 June 2020, COVID-19 restrictions severely reduced access to dentistry in England. Dental practices were instructed to manage patients remotely with advice, analgesics and antibiotics, where appropriate.Aim To describe the impact of the policy to restrict dental access on antibiotic prescribing.Methods NHS Business Services Authority 2018-2020 data for England were analysed to describe national and regional trends in dental antibiotic use.Results Antibiotic prescribing in April to July 2020 was 25% higher than April to July 2019, with a peak in June 2020. Some regions experienced greater increases and for longer periods than others. The increase was highest in London (60%) and lowest in the South West (10%). East of England had the highest rate of dental antibiotic prescriptions per 1,000 of the population every month over the study period (April to July 2020).Conclusion Restricted access to dental care due to COVID-19 resulted in greatly increased dental antibiotic prescribing, against an otherwise downward trend. As dental care adapts to the COVID-19 era, it is important to ensure access for all to high-quality urgent dental care. Understanding the reasons for variation will help to optimise the use of antibiotics in the future.

Developing leadership in dentists and schoolteachers to improve oral health inequalities.

With oral diseases affecting people of all ages in every country of the world, new approaches are necessary to remove inequalities in oral health and increase access to oral health education. With over 1 billion children attending school, developing dental leadership skills not only in dental professionals but also in schoolteachers will help to spread oral health prevention messages effectively, implement healthy habits at a young age and impact a greater proportion of the global population to improve their oral health.

The Addis Ababa Declaration to end infant oral mutilation.

In 2019, chief dental officers from Ethiopia, Somalia, Kenya, Tanzania, Rwanda, Democratic Republic of Congo and Sudan attended the inaugural End Infant Oral Mutilation Conference in Addis Ababa, Ethiopia. The subsequent Addis Ababa Declaration has launched a public health action programme across the continent, aiming to impact over 100 million people in 5 years.

Education and training for dental leadership - A case study of the Senior Dental Leadership programme.

Leadership training in dentistry is equally as important as gaining clinical skills. The dental profession must urgently develop young dental leaders, so the profession is able to transform poor oral health. The Senior Dental Leadership programme demonstrates how leadership, mentorship and networking can produce strong dental leaders who have significantly improved oral health in low-income countries.

Dental public health capacity worldwide: Results of a global survey.

The World Federation of Public Health Associations' Oral Health Working Group (WFPHA OHWG) carried out a survey to establish the extent of global dental public health (DPH) capacity. Senior stakeholders in DPH completed 124 surveys, covering 73 countries and all WHO regions. The survey evaluated DPH workforce within the country, funding, education, current services, and integration between public health and DPH in countries across the world. In 62 per cent of countries, DPH is only partially integrated in the public health system, while in 25 per cent of countries it has not yet been formally integrated. DPH programs at Masters level are available in 44 per cent of countries. Over half of countries have 0 to 10 trained DPH professionals. Because both poor oral and general health share several common risk factors, DPH must be integrated into national health systems and budgets, with an emphasis on having trained DPH specialists available in every country to collaborate in healthcare policy and provision.