Southwest Inclusion Oral Health Research Group

Theme leads – Dr Jo Erwin and Dr Martha Paisi

This research aims to provide insights into, and evidence of, the oral health behaviours, dental experience and access to dental services of care experienced children and young people (including care leavers).

Working with children and young people in care and care leavers and other stakeholders in a co-design approach, the research team have conducted/are conducting:

Following analysis of findings, a workshop with stakeholders and external experts will be held to reach consensus on recommendations for improving dental care and experiences of children and adolescents in care.

The findings of this research will be used to improve the oral health care for care experienced children and add to national and international knowledge about improving oral health behaviours and dental care access for this group.

Project link: The Plymouth Sunny Smiles Project

Co-production of health and social science research with vulnerable children and young people: A rapid review – https://onlinelibrary.wiley.com/doi/10.1111/hex.13991

A Scoping Review of the Oral Health Status, Oral Health Behaviours and Interventions to Improve the Oral Health of Children and Young People in Care and Care Leavers – https://www.mdpi.com/2304-6767/12/2/38

Access to Dental Care for Children and Young People in Care and Care Leavers: A Global Scoping Review – https://www.mdpi.com/2304-6767/12/2/37

What dental needs do care experienced children have and how do they access dental care?

Theme leads – Dr Jo Erwin and Dr Martha Paisi

A study about oral health care for autistic children and young people

Poor dental health in childhood can cause pain, affect quality of life and significantly affect adult dental health. Autistic children and young people (CYP) are at higher risk of cavities and gum disease than neurotypical CYP and are more likely to have teeth removed under general anaesthetic. It is important to understand why autistic CYP experience these differences so that actions can be taken to reduce them.

This research project aims to find evidence to answer the following three questions:

The research team firstly examined existing evidence on these topics by carrying out a systematic review of the academic papers and information available through policy documents, charities and websites. The review was restricted to CYP aged 0–19 years old and to studies carried out in countries with similar levels of healthcare to the UK (using the Human Development Index as an indicator).

The team went on to interview autistic CYP, parents/carers and dental health professionals. They explored participants’ experiences of caring for oral health and accessing and providing dental care and discussed how autistic CYP could be better supported to care for their oral health and to access dental care.

The findings from this qualitative research are being used to design a national survey of autistic CYP, parents and dental health professionals to further explore these issues.

After analysis of the survey findings this data, together with that from the qualitative research, will be considered at a workshop to be attended by stakeholders (including autistic young people) and external experts. This will aim to develop a series of recommendations for improving support for good oral health and access to dental care for autistic CYP. These will be shared nationally and internationally with a view to reducing the current oral health inequalities experienced by autistic CYP.

Project link: Plymouth youth autism dental project

Factors influencing oral health behaviours, access and delivery of dental care for autistic children and adolescents: A mixed-methods systematic review – https://onlinelibrary.wiley.com/doi/10.1111/hex.13544.

Factors Influencing the Oral Health Behaviours of Autistic Children and Young People: A Qualitative Study – https://onlinelibrary.wiley.com/doi/10.1111/hex.70130

Theme leads – Dr Martha Paisi , Miss Afsha Musa

This portfolio of research aims to explore the factors affecting the way that dental services might be integrated into wider healthcare provision for populations experiencing complex needs.

The research builds on previous work undertaken to identify barriers and facilitators to providing dental care and oral health promotion to populations with experience of homelessness, addiction, and other types of severe and multiple disadvantage.

The research team have involved multiple stakeholders including populations with lived experience of complex needs, general medical teams, general dental teams, dental outreach practitioners, individuals involved with third sector organisations, support workers and link practitioners, and senior management teams involved in planning and designing services.

This portfolio includes:

These projects aim to explore the barriers and opportunities to inter agency working and contribute to national and international knowledge about integrating dentistry and oral health promotion into the wider provision of care for populations experiencing complex needs.

The findings are also used in discussions with funders and commissioners to inform future recommendations for service design and provision.

Developing oral health services for people experiencing severe and multiple disadvantage: a case study from Southwest England – https://www.frontiersin.org/articles/10.3389/froh.2024.1283861/full

Is social enterprise good for dentistry? – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161704/

Dental care for homeless persons: Time for National Health Service reform – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483995/

Evaluation of a community dental clinic providing care to people experiencing homelessness: A mixed methods approach – https://pubmed.ncbi.nlm.nih.gov/32761764/

Strategies to improve oral health behaviours and dental access for people experiencing homelessness: a qualitative study – https://pubmed.ncbi.nlm.nih.gov/32801324/

‘Teeth Matter’: engaging people experiencing homelessness with oral health promotion efforts – https://www.nature.com/articles/s41415-019-0572-4

Management of plaque in people experiencing homelessness using ‘peer education’: a pilot study – https://pubmed.ncbi.nlm.nih.gov/31203339/

Dental Public Health in Action: Understanding oral health care needs and oral health-related quality of life in vulnerable adults in Plymouth – https://pubmed.ncbi.nlm.nih.gov/30234927/

Theme leads – Dr Martha Paisi and Dr Hannah Wheat

Oral diseases are highly prevalent among asylum seekers and refugees. This portfolio of work seeks to provide evidence on the factors influencing access of asylum seekers and refugees to oral health promotion and care.

Considering the acknowledged burden of oral diseases among this group and the reported disparity between service need and use, we conducted a systematic review to identify the barriers and facilitators to dental care access among ASRs in highly developed countries. Building upon the findings of this review, we also conducted a qualitative study of key stakeholders' perspectives and experiences on the factors affecting oral health care for asylum seekers and refugees in Plymouth.

The findings from both strands of work have been used to develop the ‘Welcome clinic’ which provides much needed care to this population group in Plymouth.

Future work will focus on evaluating the impact and acceptability of the service to improve service delivery and disseminate examples of good practice.

In addition, during initial observational work by our team at the PSDE Welcome Clinic a clear need for research into triadic communication between dental professionals, patients who do not speak little or no English and interpreters was identified. We are currently exploring opportunities to conduct a study that would collect and analyse (in micro-detail) video recordings of these types of triadic interactions. These data will be supplemented by interviews with all stakeholders involved. Study findings would make an important contribution to policy, research and practice and would be used to develop guidance on how specific communication practices can improve dental care experiences and perceptions by asylum seekers and refugees.

Barriers and facilitators to dental care access among asylum seekers and refugees in highly developed countries: a systematic review – https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-020-01321-1

Factors affecting oral health care for asylum seekers and refugees in England: a qualitative study of key stakeholders' perspectives and experiences – https://www.nature.com/articles/s41415-022-4340-5

Co-designing a film showcasing the dental experiences of community returners (ex-offenders) – https://www.frontiersin.org/journals/oral-health/articles/10.3389/froh.2024.1391438/full

Theme leads – Dr John Tredinnick-Rowe

The project aims to review and explore the gaps in knowledge about oral health promotion and dental care access among Gypsy, Roma, and Traveller (GRT) communities. This will direct future attempts to improve oral healthcare outcomes for these groups.

Working with staff from the NIHR Applied Research Collaboration South West (PenARC), we are conducting a scoping review of the literature on this topic. This involves bringing together all of the different sources of information and distilling down their lessons into workable approaches that can improve access to dental services or successfully promote them.

The findings will inform PDSE's approach to dental health promotion and access for the Gypsy, Romani, and Traveller populations. The results will be disseminated at a national conference.

Theme leads – Mr Anastasios Plessas

In recent years the importance of social accountability in healthcare education has been highlighted. Social accountability appears in regulatory standards and institution strategies around the world. Community engaged education is a pedagogy that has the potential to cultivate a sense of social accountability and empathy to healthcare students and help healthcare institutions to fulfil their social contract by producing graduates who will be better equipped to meet the needs of the communities they serve.

As part of its spiral curriculum, Peninsula Dental School has developed an innovative community engagement module; ‘‘Inter-Professional Engagement (IPE)’’, which runs during the first two years of the undergraduate dental (BDS) and dental hygiene and therapy (DTH) programmes, and it is centred on social accountability. The IPE module introduces students to the concepts of community engagement and social accountability, through experiential learning, in an attempt to develop students’ societal and community awareness so they recognise their future role in the healthcare system and wider society. The module seeks to improve students understanding of public health issues, oral health inequity, and the social determinants of health and how they affect particular population groups.

This research aims to explore the impact of community engaged dental education on undergraduate student’s views towards social accountability, empathy and attitudes towards interprofessional learning. This study is being conducted towards Anastasios’s doctoral research degree (PhD).

It consists of the following studies:

The findings of this research will be used to inform educational practice and to help us identify elements of IPE with the most influence on student’s views and attitudes towards social accountability. By producing a socially accountable workforce, it is anticipated that the needs of the most vulnerable populations in the society can be appropriately met and that way narrow oral health inequity.

The impact of community engaged healthcare education on undergraduate students' empathy and their views towards social accountability; a mixed methods systematic review – https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-024-06367-1

Theme leads – Mr Anastasios Plessas

Anastasios and our team have also investigated the impact of the COVID-19 pandemic on the front-line staff experiences in the delivery of urgent dental care in England. This was a qualitative study employing interviews with frontline staff such as dentists and nurses working in Urgent Dental Care hubs in England during the initial period of the pandemic when routine dental care was ceased. Our participants reported that contributing meaningfully during COVID-19, by applying their dentistry skills to help those at need, was a valued and beneficial experience. However, staff reported multifactorial stress and anxiety caused predominantly by concerns over safety and operational UDC challenges, which included fragmented communication and guidance, poor PPE availability and overwhelmingly high workload.

Anastasios also led a rapid evidence assessment on ‘mental health and wellbeing in dentistry’ commissioned by the General Dental Council. The review found evidence that dentists face mental health problems, such as anxiety, stress and burnout, during their training and professional lives. The review identified secondary and tertiary prevention-level interventions employed in the dental practice and education (such as psychoeducational interventions and counselling), which exhibited a positive impact to the mental health and wellbeing of dental professionals. We, however, highlighted the lack of primary prevention level interventions at system level.

Plessas A, Paisi M, Baines R, Wheat H, Delgado MB, Mills I, Witton R. (2021) Frontline experiences and perceptions of Urgent Dental Care centre staff in England during the COVID-19 pandemic: a qualitative study. British Dental Journal 6 : 1–10. DOI: 10.1038/s41415-021-3375-3.

Plessas A, Paisi M, Baines R, Wheat H, Delgado MB, Mills I & Witton R (2022) 'Working in an urgent dental care hub during the Covid-19 pandemic from a dental nurses' perspective' Dental Nursing 18, (2) 68-70

Plessas A, Paisi M, Bryce M, Burns L, O'Brien T, Hanoch Y, Witton R. (2022) Mental health and wellbeing interventions in the dental sector: a systematic review. Evid Based Dent. 7 : 1–8. DOI: 10.1038/s41432-022-0831-0.

Theme leads – Dr Joelle Booth

This portfolio of research aims to explore the multiple factors that contribute to the oral health inequalities experienced by those impacted by the criminal justice system.

Emerging research has indicated that those in secure settings have oral health four times poorer than the general population. Despite this, there is a paucity of research surrounding which factors contribute to these inequalities and what can be done to address them. A previously conducted global scoping review highlighted a lack of oral health improvement initiatives taking place within prison settings.

Furthermore, whilst there is evidence surrounding the oral health needs of those in prison, little is known about the oral health of those with a lived experience of the criminal justice system who now live within the community, community returners. Community returners juggle competing needs, face social exclusion, and experience a clustering of risk factors including substance abuse and mental illness. There is also a lack of evidence surrounding the oral health needs of children and young people in secure settings and those who have been impacted by a family member being incarcerated.

The research team have involved multiple community partners throughout this portfolio of work, including those who have a lived experience of the criminal justice system.

This portfolio includes:

This collection of research aims to explore the determinants that contribute to oral health inequalities experienced by all individuals who are impacted by the criminal justice system both directly and indirectly. It aims to better define their oral health needs, barriers to good oral health and highlight opportunities for oral health improvement through oral health promotion, education and access pathways.

Booth J, O'Malley L, Meek R, Goldrick NM, Maycock M, Clarkson J, Wanyonyi-Kay K. A scoping review of interventions to improve oral health in prison settings. Community Dent Oral Epidemiol. 2023 Jun;51(3):373-379. doi: 10.1111/cdoe.12811. Epub 2022 Nov 21. PMID: 36411370.

Watch the film on YouTube – My Story, My Words, My Mouth