National Association of Prison Dentistry UK Conference – Birmingham 3 rd February 2012 Setting up a Dental Health Education Programme in HMP Prisons Alison Willis Dental Health Co-ordinator Worcestershire Health and Care NHS Trust

Worcestershire has two prison establishments:  HMP Hewell – is a male prison and holds category B, C, D & remand – operational capacity 1431  HMP Long Lartin -is a male adult prison in the high secure estate and holds both category A and B prisoners serving between 4 years and life. The prison operational capacity is 622 prisoners.

Prisoner Profile In HMP Hewell the prisoner profile is a familiar one across the UK;  Mainly young men from deprived backgrounds  With low literacy and educational attainment  History of drug-taking and alcohol abuse  Underlying poor nutrition and heavy smoking Overall maintaining good oral health is a challenge! - ‘Managing the impossible’………?

The Challenges in Providing Dental Health Programmes in Prisons Fieldwork Practicalities: Security clearance – for high security prisons it can take months Mandatory training/induction Risk assessments Efficient use of dental clinic time and skills, lack of space Giving free samples of toothpaste and toothbrushes – security  General prison security issues, sessions shortened by security procedures  Oral health promotion should a integral part of general health promotion, staff cutbacks and lack of funds in Healthcare – Health Promotion not seen as a priority  Availability of dental care materials, even where these are available they may be prohibitively expensive to prisoners whose average wage may just be a few pounds a week  Prisoners lifestyle factors

Improving Oral Health Key Areas for Action  Increasing the use of fluoride to prevent tooth decay  Improving diet and reducing sugar intake  Encouraging preventive dental care  Reduce smoking  Increasing early detection of mouth cancer  Reducing dental injuries

Prison Toothbrush and Toothpaste

Dental Health Education Session: A discussion on a healthy and a unhealthy mouth Plaque – gum disease, tooth decay Diet advice Smoking, drugs and methadone Disclosing and effective toothbrushing technique.

What happens if we don’t remove the plaque? Plaque Gum Disease Calculus Mobile Teeth

Evaluation What would you change in your oral health routine after today’s session? Brush more effectively Brushing systematically Not rinsing after brushing Reducing the frequency and amount of sugary drinks and foods. Eat more fruit and vegetables Stop smoking or sign to smoking cessation programme

The Way Forward  Improving the quality of free toothbrushes provided to prisoners  Availability of affordable dental care products on the canteen  Ensure avoidable artificial sweeteners are available in the canteen  Linking oral health promotion to general health e.g. smoking cessation – joint clinics  Reduce waiting lists for smoking cessation  Clarify the roles and skills of the dental team – extend the roles of nurses & therapists  Ensure that your future plans for the service include improved oral health and hygiene. Particular attention should be paid to interventions where there is evidence of proven effectiveness.

Thank you for listening