| Description | This document sets out the context within which prison dental services are delivered in Scotland, and provides a summary the findings of the recent dental health needs assessment. |
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| Website Publication Date | February 06, 2004 |
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Scottish Prisons' Dental Health Survey 2002: Summary
Colwyn M Jones BDS FDS DDPH MSc
Consultant in Dental Public Health
Highland NHS Board
Mary McCann BDS MPH
Deputy Chief Dental Officer
Scottish Executive Health Department
Zoann Nugent PHD
Chief Statistician
Dental Health Services Research Unit
University of Dundee
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EXECUTIVE SUMMARY, SCOTTISH PRISONS, DENTAL HEALTH SURVEY 2002
This survey of the dental health and attitudes of the Scottish prison population was commissioned by the Scottish Executive Health Department.
Aim
The aim of the survey was to provide accurate and up-to-date information on the dental health of the Scottish prison population. The findings will help to plan appropriate & effective oral health services in prisons across Scotland.
Method
The fieldwork for this cross sectional prevalence survey was co-ordinated by the Scottish Consultants in Dental Public Health. Three dentists with experience of epidemiological fieldwork in previous national Adult Dental Health Surveys carried out the dental examinations. The survey consisted of a structured interview followed by dental examinations of a random sample of the Scottish prison population. Three prisoner groups were identified: females, male young offenders and adult males. The objectives were to interview and carry out dental examinations of approximately 750 subjects. The survey protocol followed the 1998 UK Adult Dental Health Survey methodology thus allowing direct comparison to the Scottish population. Ethical approval for the survey was granted by the Scottish Prison Healthcare Policy Group and the Multi-centre Research Ethics Committee for Scotland (MREC).
Study Timetable
The fieldwork was carried out in April/May 2002. The Dental Health Services Research Unit, University of Dundee carried out data cleaning & statistical analysis.
Results
559 prisoners participated in the survey, a 75% response rate.
The results showed that on average the prison population had more decayed but fewer filled teeth than the Scottish population. The severity of tooth decay was also considerably worse in the prison population, especially for female prisoners. Reported length of stay data showed that it took two years to improve the dental health of prisoners. No other more serious pathology (e.g. suspected malignancy) was found in any subject.
CONCLUSIONS AND RECOMMENDATIONS;
1. Oral health/public health
1.1
Dental Health was significantly worse in prisoners than in the general population. A major determinant of poor oral health within the general population is the socio-economic circumstances in which individuals live (Daly et al 2002).
i) Prisoners had significantly more decayed teeth, fewer filled teeth and fewer natural teeth than the general population.
ii) The prevalence of severe decay, as defined by teeth with decay which extends into the dental pulp (usually requiring extraction of the tooth), was three times higher in the prison population than in the general population.
iii) In female prisons, severe decay was fourteen times more prevalent than in the general female Scottish population.
1.2 Poor oral health is also linked to the abuse of opiates, and other drugs. Prolonged drug abuse is often associated with self-neglect and the adoption of a diet which promotes tooth decay (Titsas & Ferguson 2002). The 1999/2000 Scottish Prisons Service annual report, recorded that 74.5% of the mandatory drug tests which were carried out were positive (SPS 2001).
Recommendations 1.3 The Scottish Executive should ensure that allappropriate public health measures are in place to reduce inequalities in the general health and dental health of the Scottish population. 1.4 All prescribers of methadone should take steps to limit the adverse dental health effects of methadone in the community. Harm minimisation by prescription of sugar free preparations to recovering drug addicts in the general Scottish population is recommended. This may be developed through Local Prescribing Protocols. 1.5 Pharmacists should promote the use of sugar-free methadone, and by linking with dental professionals and HEBS raise awareness of the detrimental impact of sugared methadone on dental health. 1.6 All staff including the Scottish Prison Medical Services involved in the care of recovering addicts should be aware of the adverse effects of sugared methadone on teeth. 1.7 The Scottish Prison Service should continue to ensure that sugar-free methadone is prescribed to recovering addicts in prisons. |
2. Prevention and registration
2.1 Almost all prisoners with natural teeth reported that they carried out toothbrushing at least once a day.
2.2 The reasons that prisoners reported for visiting a dentist were very different from those reported by the Scottish population. Fewer attended for a regular dental check-up and significantly more attended because of toothache or other trouble with their teeth. As the prison population is, in general, inclined to wait until they have pain from their teeth before treatment is sought, removal of diseased teeth is a far more likely treatment option than restorations.
2.3 Nearly 4 out of 5 prisoners seen in the survey required dental care or advice.
Recommendations 2.4 Suitable toothbrushes and fluoride toothpaste should continue to be made available free of charge to all prisoners 2.5 The Scottish Prison Service should consider redesigning prison dental services to make better use of the skills of dental hygienists and therapists in the delivery of preventive dental care. 2.6 Oral health promotion aimed at improving dental health (oral hygiene, self care & dietary advice) should be expanded as an integral part of general health promotion already present in the prison system. 2.7 The development of oral health promotion by peers within the long-term prison community may be a model of improving oral health suitable for the prison population. |
3. Service availability and access
3.1 Almost 70% of prisoners had visited a prison dentist and a similar proportion reported it was difficult to get an appointment and that the dentist was not present in the prison frequently enough.
3.2 The results of the survey show considerable unmet dental need in the prison population compared to the Scottish adult population. A considerable expansion (estimated at two to three times) of the prison dental service is required to meet the dental needs of the prison population.
3.3 It was shown to take up to 2 years for the dental health of prisoners to show sustained improvement. Changes to the prison induction system to include questions about dental attendance may help to get prisoners treated more quickly.
3.4 Attempts to improve the effectiveness and efficiency of the Prison Dental Service may render the prison population dentally fit more speedily.
Recommendations 3.5 Screening for dental disease should form part of the induction process for those entering Scottish prisons, perhaps by an appropriate algorithm being developed to support dental screening on induction to Scottish prisons. 3.6 A system of care which allows stabilisation of dental disease as soon as possible after admission to prison should be adopted by the Scottish Prison Service 3.7 The Scottish Prison Service should link to any future national guidelines for triaging dental patients into routine and emergency categories. 3.8 Local Protocols for the referral of prisoners to dental specialists (eg Oral & Maxillofacial surgery, general anaesthesia, sedation etc) should be formally developed. |
4. Quality and Standards
4.1 The Scottish Prison Service Health Care Standard 9;
"To provide dental treatment within prisons to a standard that would normally be available under NHS contract, to a civilian population. To provide either within prison, or without, access to a dental surgery, equipped and decorated to current proper standards."
4.2 A greater proportion of prisoners have full and partial dentures than does the general population and clinicians working in the prison service may require more expertise than general dental practitioners in this area of care.
4.3 As prisoners had significantly more decayed teeth, and as the prevalence of severe decay (as classified by teeth with decay which extends into the dental pulp) was three times higher in the prison population (14-fold in the female prisoners) dentists with significant oral surgery training may be required to meet the needs of the prison population.
Recommendations 4.4 The training needs of dentists and Professionals Complementary to Dentistry working in the Scottish Prison Service should be acknowledged. SPS should continue to encourage participation in regular postgraduate training by prison dental personnel 4.5 Prison dental surgeries should continue to be subject to local Primary Care Trust practice inspection programmes. 4.6 Prison dental services should develop an accreditation programme for prison dental practices in Scotland, modelled on future national quality standards |
5. Responsive services
5.1 Female prisoners had significantly higher levels of self-reported anxiety about visiting a dentist than male prisoners.
5.2 Up to 77% of prisoners report long waiting times for routine dental treatment whilst in prison.
Recommendations 5.3 The Scottish Prison Service should consider expansion of the current dental service to meet the high levels of need identified in this report 5.4 The Government requires NHS Boards to provide arrangements for providing access to Out-of-Hours dental emergency care. Advice should be available and urgent cases should be assessed within 24 hours. To match NHS standards, the Prison Service will need to provide an equivalent quality of out of hours or emergency care. 5.5 The Scottish Prison Service should consider more flexible use of clinical facilities in prisons to treat unmet dental needs. |
6. Human resources and teamworking
6.1 General Dental Practitioners are often reluctant to spend more than a few sessions away from their own practices as their overheads still accrue. Therefore, expansion of services may require employment of more than one GDP in any prison, with or without hygienists and therapists, or a move to a salaried service
Recommendations 6.2 Alternative methods of employing prison dentists should be explored. For instance, employing a full time dentist to serve prisons located within distinct geographical localities should be considered 6.3 Expanded dental teams, utilising the skills of dental hygienists and therapists should be considered |
7. Infrastructure and Resources
7.1 Dental clinics should meet the same quality standards as in general dental practice in Scotland. This is best achieved by inclusion of prison dental services in the dental practice inspection programmes organised in each health Board area.
Recommendations 7.2 The dental services in the Scottish Prison Service should be resourced at a level which reflects the very high levels of dental need which exist in Scottish prisons. The Scottish Prison Service must ensure that the quality of the supporting infrastructure is fit for purpose. Prison dentists must highlight relevant professional issues to the SPS. |
SCOTTISH PRISONS, DENTAL HEALTH SURVEY 2002
SCOTTISH HEALTH BOARDS' DENTAL EPIDEMIOLOGICAL PROGRAMME (SHBDEP*)
Prepared by
Colwyn M Jones BDS FDS DDPH MSc MFPH
Consultant in Dental Public Health
Highland NHS Board
Mary McCann BDS MPH
Deputy Chief Dental Officer
Scottish Executive Health Department
Zoann Nugent PHD
Chief Statistician
Dental Health Services Research Unit
University of Dundee
Address for correspondence;
Colwyn M Jones BDS FDS DDPH MSc MFPH
Consultant in Dental Public Health
Highland NHS Board
Beechwood Park
Inverness IV2 3HG
Tel: 01463 704817
Fax: 01463 717666
e-mail:colwyn.jones@hhb.scot.nhs.uk
*SHBDEP - The Scottish Health Boards' Dental Epidemiology Programme, is a joint venture between all fifteen Health Boards and the Dental Health Services Research Unit at the University of Dundee, carries out annual standardised dental surveys, with trained and calibrated dental examiners, based on core guidelines produced by the British Association for the Study of Community Dentistry.