Log in
The UCL Dental Public Health Group have made a significant contribution to oral health policy in the UK and internationally through their research on oral health inequalities and the need for a reorientation of dental services towards a more evidence based, integrated preventive approach addressing common risks for oral diseases and other chronic conditions. Our work has influenced local national oral health policies and the development of clinical practice guidelines to reduce oral health inequalities and provide the opportunity for dental professionals to prevent both oral and systemic disease.
"One in 10 adults in Wales has no natural teeth" (BBC News), "Cost puts off some going to the dentist" (BBC News) and "Overall improvement masks dental health concerns", (British Dental Association, Press Release). These are examples of the sensational headlines which accompanied the publication of the findings of the 2009 Adult Dental Health Survey (ADHS). Researchers at Birmingham's Dental School were key members of the research consortium that carried out both the ADHS as well as the 2003 Child Dental Health Survey (CDHS). The findings from these surveys demonstrated an overall improvement in the nation's oral health but also highlighted areas of inequality. The Government regards these surveys as being of vital importance in providing gold-standard information about the nation's oral health and uses the findings to inform oral health policy in the areas of workforce planning, the provision of, and access to, dental services. The impact of these internationally-leading studies is reflected in Government policy documents and in public debates about the future provision of dentistry.
Research carried out at Newcastle University in the mid-1990s showed that the dental health profile of older people was changing rapidly: the number of people with no natural teeth was falling and a cohort of people with complex restoration needs had emerged as an important patient group. Those trends were confirmed by analysis of the 1998 Adult Dental Health Survey data, with further changes shown in children in 2003. It became clear to policymakers that substantial reform of NHS dental services in England would be required if the projected future needs of the population were to be met. The 2009 Steele review of NHS dentistry analysed the problems with the existing dental contract, from which a set of recommendations for public policy reform were put forward, which have now been adopted into a prototype NHS dental contract which is currently being piloted.
This case study highlights a body of research around health Research Priority Setting (RPS) that assists policy makers in effectively targeting research that has the greatest potential health benefit. Empirical research on RPS led to organizational changes, and new policies within the Cochrane Collaboration along with new training resources and new RPS exercises. A research gap on inequalities in the risk of oral cancer in the English South Asian population led to an evidence synthesis exercise being carried out by the National Institute for Health and Care Excellence (NICE) and the formulation of a new public health guideline.
The `People in Public Health' (PIPH) study and related research on health trainers, health champions and volunteers has brought together evidence on rationales for lay engagement, effectiveness and models of support. Dissemination activities, supported by a Department of Health grant, have achieved reach into various policy arenas and national networks. At the same time there is evidence of research utilisation in public health practice. One of the impacts has been the establishment of `Active Citizens for Health', a national network of partner organisations to bring together evidence and learning that has been hosted by Leeds Metropolitan University.
Research by the UCL Dental Public Health Group has led the international field in the development and validation of quality of life (QoL) measures associated with oral health. Tsakos and Sheiham instigated the development of the Oral Impacts on Daily Performances (OIDP) measure in 1996 followed by the Child Oral Impacts on Daily Life (Child-OIDP) in 2004. Both of these outcome measures have been employed in epidemiological surveys of needs assessment by local health providers in London resulting in enhanced use of resources, better staff training, and improved patient care and health care access. These measures have been employed in the most significant NHS surveys of oral health of adults and children in the UK as well as used by health organisations across the globe. The outcomes of Tsakos' research on oral epidemiology and QoL, together with engagement with policy makers in the UK and Europe, have raised the profile of oral health and is influencing health care policies nationally and internationally.
This programme of research has, through producing national guidance and improving understanding of professional behaviour, enabled delivery of evidence based practice by dental practitioners in primary care. Its impacts include:
Health inequalities are recognised as a critical UK policy issue with life expectancy gaps of up to 28 years between the least and most deprived areas. This case-study demonstrates how Durham University research has led to: (a) changing health service commissioning (with County Durham and Darlington Primary Care Trust [PCT]): (b) influencing NHS funding policy (by generating Parliamentary debate); as well as (c) contributing to the development of the new public health system in England and Wales (as part of the Strategic Review of Health Inequalities in England post-2010 [Marmot Review]).
School dental screening was a statutory function of the NHS. University of Manchester (UoM) research demonstrated that the national screening programme was ineffective and likely to increase inequalities in health and service utilisation. As a direct result of UoM research, the National Screening Committee recommended that the national programme should stop. This changed Departments of Health policy resulting in new guidance to the NHS, which stopped the screening programme and redirected resources to treatment services for vulnerable groups and prevention programmes. In 2010 in England the costs of a national screening programme were estimated to be £17m per year; money released for reallocation to other dental services.
Evidence about the need for and provision of health visiting services generated through research undertaken at King's College London (KCL) has underpinned major changes in national policies for health visiting. Our findings about health visitors' practice, availability and distribution of services and effectiveness in terms of parenting/child outcomes, revealed both shortfalls in provision and opportunities for improvement and led to the development of a new caseload weighting tool and funding model for service planning. The accumulated evidence from this research helped convince the UK Government in 2010 to commit to 4,200 more health visitors by 2015 — a workforce expansion of nearly 50% — in a time of austerity and restraint elsewhere in the public sector.