Delivery as the key to better outcomes


  Posted by: Dental Design      15th May 2020

Is oral health around the UK in a good, bad or improving state? One set of data can lead to multiple articles that are wildly different in tone, depending on which news outlet has published it, the editorial stance it has taken and which statistics it has chosen to focus on. 

Of course, how we interpret any article we read, or see on the news, will depend on our personal perspective, experience and if we are a ‘glass half-full or half-empty’ person. Also, working on the front line, many of us would agree that the problem of access is the number-one barrier to improving the statistics. Wherever we work, there will be large sections of our local community who either cannot get an appointment with an NHS dentist and/or can’t afford treatment.[i] So, until the problem of access is solved, ‘improvements’ will relate to the portion of patients currently using services.   

We must ensure that, for the patients we do see, they become loyal, regular attendees and that the prevention message is delivered so effectively, that they need to come less often for maintenance appointments. Prevention is central – if we can prevent oral disease and keep more people orally healthy for longer, we can turn our attentions to those who need extra support.

Loyal patients expect more than a silent check-up. Interestingly, a historical study into patient loyalty found that the most important factors for returning to a practice included, “care and attention”, “the dentist puts you at ease” and that treatment is explained properly.[ii] This survey may be 20 years old, but surely this is what people want today, too? With all the talk of digital technology and the amazing advances in treatment, it’s easy to push bread-and-butter care to one side. But there is a strong argument that it’s the basics – such as talking to our patients, listening to their concerns and helping them with things like correct brushing technique – that really make a difference.

Enabling people to feel at ease, so that they trust our advice, isn’t something that everyone finds easy. This is where training and up-skilling can come in. More dental practitioners are upskilling in order to offer more and help more patients. Improved oral health starts with thinking about how care is delivered and ensuring that delivery changes when needs change.

The issue of skill-mix is also a theoretical focus for how to improve modern dental service delivery. An article from 2015 into skill-mix in the dental practice found that this could be the key to better outcomes for everyone, within the preventive model.
It said: “Ensuring ‘the right number of people with the right skills are in the right place at the right time to provide the right services to the right people’ is critical… to ensure future services are cost-effective, efficient and reduce health inequalities.”[iii] The study concludes: “Within an integrated team, the dentist and their hygienist-therapists all have the chance of ‘up-skilling’ to better meet the needs of the population in the future.” 

Because we have an ageing population, dentists, dental hygienists and dental therapists will be seeing more older patients with complex health needs. But we will also see families who need to know the right way to care for their teeth and mouth in order to keep future appointments to a minimum. With better use of skill-mix, dental hygienists and dental therapists will be able to help ‘healthy’ patients with brushing technique, if they don’t need further treatment from the dentist. Preventive care is built upon technique and good tools – cleaning correctly and effectively, learning how to clean interdental spaces and using any adjunctive products the practitioner recommends. The tools used to brush with should be high-quality, easy and enjoyable to use and functional. Many recommend the TANDEX range, which includes something for all ages and dental situations. Everyone loves a prop – and showing patients how to use a premium brush to get into all the nooks and crannies of the mouth equates to a preventive-maintenance appointment with real added value. It’s the added value – including dietary advice and answering questions on all sorts of related topics – that keep people receptive and loyal. The net effect hopefully is better oral health, because they take good care of their teeth between appointments.

What do we make of the often-contradictory headlines around the state of oral health in the UK? Well, perspective is key and we must also recognise that we will help more people by allowing them to access dental services, if we can support our orally healthy patients to stay that way for longer. Skill-mix is a relevant and hot topic in modern service delivery and a strong preventive approach is the key to statistics that won’t give mixed messages.


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Author: Kimberley Lloyd- Rees graduated from the University of Sheffield in 2010, where she now works as a clinical tutor in Dental Hygiene and Therapy as well as working in practice. She has spent her career working across a variety of specialist private and mixed dental practices, for the MOD and volunteering her time to a dental charity in Nepal.


[i] Million missing out on NHS dentistry. BBC, 20 November 2019. Link: (accessed December 2019)

[ii] Holt VP, McHugh K. Factors influencing patient loyalty to dentist and dental practice. British Dental Journal. 1997 Nov; 183 (10): 365.

[iii] Brocklehurst P, Macey R. Skill-mix in preventive dental practice – will it help address need in the future? BMC Oral Health 2015 Dec (Vol. 15, No. 1, p. S10). BioMed Central.

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