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Get ready to impact oral health

Gail Vernon looks at the progress of a preventive initiative.

Delivering better oral health: An evidence-based toolkit for prevention (DBOH) was published by the British Association for the Study of Community Dentistry in 2007 at the request of the Department of Health. It supports dental teams in a more preventive approach to dental care based on evidence as there was an acknowledgment that dental practices and their teams had access to a vast amount of information and research. The publication was intended to provide a simple guide to the evidence explaining what research meant in practical terms for the preventive advice and treatment of their patients. The intention was that DBOH would be regularly updated and indeed it has been revised twice since its launch in 2007 – once in 2009 and then again in 2014, when after the introduction of the Health and Social Care Act, Public Health England took on the leadership of its development. In 2017 the current edition was updated in response to policy changes in the healthy eating and alcohol sections. Additionally, and in response to requests from dental professionals, two patient facing quick guides for improving oral health were added for adults and children. As a living document, DBOH is now being updated once again to produce version four following an engagement process with a wide range of stakeholders including industry colleagues accessed through the BDIA.

Impact of DBOH

Delivering better oral health has had a significant impact since its launch in 2007 on dental teams, their patients, the wider service and our industry. In particular, toothpaste manufacturers have responded to the statement that children’s toothpaste needs to have at least 1,000 parts per million fluoride to be effective in preventing tooth decay. Manufacturers have reformulated their products to adhere to this standard.

The piloted dental reform activities of 2009 and beyond are based on guidance and practices from DBOH offering an opportunity to industrialise and systemise preventive dental care. An example of this would be the NHS Starting Well Programme launched in England which focuses on areas with the poorest oral health in five-year-old children. This programme promoted dental attendance of young children and the delivery of preventive care and advice based on guidance found in DBOH.

Delivering better oral health is also incorporated in the undergraduate training of dentists and dental care professionals, and has been cited by the Platform for Better Oral Health in Europe as an example of good practice which should be replicated across Europe to improve oral health. The document has proved effective within dental teams, as dental practices have been incorporating this guidance within their everyday practice. Every dental practice with an NHS provision is asked to declare that the course of treatment they have provided complies with DBOH guidance. This has also led to a shift in emphasis towards more skill mix and the employment of dental care professionals.

Developing version four

The current work being undertaken to develop version four began with Public Health England engaging with stakeholders in 2017/2018 to find out what they think about DBOH, including what was missing or needed revisiting due to emergence of new evidence, guidelines or changes in policy. This engagement extended to industry partners including the membership of the BDIA via an engagement event delivered as a slide show/webinar outlining the guidance development process. This was followed by a survey for feedback. This initial engagement took place in September 2018, allowing BDIA members to comment on proposals and share feedback.

An oversight group reviewed feedback from all stakeholder groups. They supported the guidance working and guideline development groups using ‘AGREE II’ principles (Appraisal of Guidelines of Research and Evaluation). This approach ensures the quality and transparency of the guidance development process. AGREE II principles are based on six domains; scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability and editorial independence.

All stakeholders have had the opportunity to share feedback twice, once following the initial engagement and again through the final draught document shared in April 2021. It is worth noting this process was anticipated to be completed much earlier, however covid has caused a delay. Public Health England has also been looking at the implementation of DBOH as many stakeholders commented that whilst some practices are engaged, others are not. There will be a particular focus on implementation to promote maximum impact in use. This implementation will use evidence from implementation science and translational research to develop an action plan for the optimal engagement of DBOH.

Version four is due for publication this autumn. Unlike previous editions, version four will be applicable across the United Kingdom.

Article written by

Gail Vernon

Director, VSM Marketing

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