When I look at the humanitarian crisis unfolding in Ukraine, like everyone I feel deep sadness for the millions of lives shattered by the conflict. From the safety of the UK, we can only imagine the suffering people are experiencing.
As a medical clinician my thoughts also turn to practical matters. Once they have safeguarded the lives of the millions of refugees flocking into their countries (and God bless them for doing so), how do host countries go about providing basic health care services to people in dire need of them?
It is not an enviable task. If the situation in Poland, Hungary and Ukraine’s other western neighbours mirrors that in the UK, their national health services would already have been struggling to recover from the biggest global pandemic in a century.
In my professional field, dentistry, the impacts of Covid-19 remain particularly acute. The latest NHS statistics for England reveal that only 15.8 million adults (effectively a third of the population) were seen by an NHS dentist in the 24 months up to December 2021 — a fall of nearly 4 million adults from the previous year, and 6 million adults from the year before that.
The statistics for children are equally grim. 5.1 million (42%) were seen in the past 12 months, and only 3.6 million (29%) in the preceding year.
It is fair to assume that the same backlogs (and hence future problems) are stacking up in Central and Eastern Europe. Oral health will not be the most pressing priority there, I appreciate. But, nevertheless, people will be rightly concerned about personal health and hygiene regimes for both themselves and their children.
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So what should the advice be? What can people do to help themselves? In the absence of any available in-person dental care (subject to acute shortage), the focus should be on preventative measures.
As a practicing dental clinician, I have taken a close interest in preventative approaches to oral health, and particularly children’s oral health, for over 30 years. The lesson is clear: measures that can prevent future problems need to be appropriately prioritised. They will not only significantly alleviate patient suffering, but also reduce the financial burden on stretched health services.
The numbers involved are far from trifling. In England, tooth decay is still the most common reason for hospital admissions in 6-10 year olds. In 2015-16 the cost of tooth extractions alone in 0-19 years olds was over £50 million. These are shocking statistics.
Short of seeing a dentist, the main preventative measures are well known to anyone who has been paying attention to public health messages over the past decades: brush twice a day, floss, avoid sugary food and drink, don’t smoke. To the list can be added another easily-accessible fix that stimulates saliva and helps keep the mouth clean: chewing sugar-free gum.
The scientific case for the benefits of chewing gum is slowly being established. As an academic consultant working in public health, I have been privy to it. Hence, I take a close interest in a systematic literature review being undertaken by the Faculty of Dentistry at King’s College London.
King’s is conducting a systematic review and meta-analysis of the role of sugar-free chewing gum on plaque quantity in the oral cavity. In other words, they are quantifying the benefits to oral health from the simple act of chewing sugar-free gum.
More research is needed, a fact acknowledged in Public Health England’s ‘Better Oral Health’ guidance. But the results are promising.
An earlier 2019 study by King’s found that people who chew regularly develop 28% fewer cavities than those who do not. The equivalent percentage for using fluoride toothpastes and supplements was 24%.
Similarly, King’s current review has found that chewing sugar-free gum, in particular xylitol SFG, reduces the quantity of plaque in the oral cavity in comparison to non SFG chewing or no chewing.
Given the population benefits of effective prevention, the use of sugar-free gum promises to become an important public health intervention. And for practitioners like me who are particularly concerned about oral care in vulnerable families, it is doubly important.
Sadly, bad oral health doesn’t affect everyone equally. Public Health England statistics show that inequalities in tooth decay between the most and least deprived 5 year-olds have increased between 2008 and 2019.
In the same way, the disruption to basic dental services in Ukraine and neighbouring countries will have harsh and lasting effects on the people living there. Chewing sugar-free gum may be a drop in the ocean compared to the far graver problems they currently face, but it is a simple preventative measure in reach of everyone.
Professor Liz Kay is President of the British Dental Association.