Your NHS dentistry and oral health update

Special focus bulletin: mouth cancer prevention

 30th November 2021 (Issue 35)

An update from Sara Hurley and Anna Ireland

Dear colleague,

Following on from the May 2021 Dental Bulletin which focused on mouth cancer (particularly its early identification and referral pathways), this issue focuses on the dental team’s role in the prevention of mouth cancer.

This is particularly appropriate as we come to the end of Mouth Cancer Action Month (MCAM), the UK's biggest charity campaign for mouth cancer awareness. It takes place throughout November, to raise awareness of mouth cancer and share the important message of being mouth aware.

Oral cancer and its prevention are covered in the new edition of Delivering Better Oral Health (DBOH):

• Chapter 2 Summary guidance table 3; Prevention of Oral Cancer
• Chapter 6 Oral Cancer
• Chapter 11 Smoking and tobacco use
• Chapter 12 Alcohol

Chapter 2 provides the evidence-based advice and professional interventions that dental teams can deliver to prevent oral cancer. With chapter 6, 11 and 12 providing further information and resources to support this.

There are several identifiable risk factors for oral cancer, but most prominent are tobacco use and alcohol consumption, particularly in combination with one another. Infection with the human papilloma virus is an important risk for oropharyngeal cancer, possibly in combination with tobacco and alcohol. Excessive exposure to ultraviolet (UV) light is a risk factor for outer lip cancer.

Dentists, and other members of the clinical dental team, have key roles in the prevention and early identification of mouth cancers. As the only dedicated professionals regularly examining a patient’s mouth, dental professionals are well-placed placed to identify patients at particularly high risk. Along with early identification, diagnosis and management, engaging in prevention can achieve better outcomes for patients.

This bulletin focuses specifically on tobacco and alcohol use and contains information on what dental teams can do to address these risk factors.

Best wishes,

Sara and Anna

Addressing tobacco use as a risk factor

Tobacco is the major modifiable risk factor for mouth cancer and smokers who also drink alcohol are at much higher risk. These people are a priority for prevention of mouth cancer and any interventions by the dental team will also contribute to their patients’ general health improvement.

Very brief advice for those who smoke or use tobacco involves the 3 As: Ask, Advise, Act.

Ask

All patients (adolescents and adults) should have their smoking status (current smoker, ex-smoker, never smoked) established at the beginning of a course of dental care, recorded, and checked at every opportunity. This is part of a normal medical history in a dental setting and should be explored during the consultation:

‘Do you smoke?’

‘Do you use tobacco products? e.g. snuff, paan, chewing tobacco, shisha’

The member of the dental team who elicits this information should ensure this information is recorded in the patient's clinical notes.

Advise

Advice involves making a simple statement such as:

‘The best way to stop smoking is with a combination of behavioural support and stop smoking aids, which can significantly increase the chance of stopping’.

Evidence of what works best is shown in the infographic below produced by Public Health England. This health improvement work is now carried out by the new Office of Health Improvement and Disparities.

Act

For people who wish to stop, refer them to specialist support services where these are available. If these are not available, it is important to actively refer (not signpost) patients to their GP or pharmacist:

‘Would you like me to refer you for specialist stop-smoking advice and support?’

For those who are not ready to stop, affirm that this opportunity will remain open to them with:

‘That is fine, but help is available. Let me know if you change your mind’.

A summary of this smoking pathway may be a useful reminder of the 3 As for the dental team.

For further information including what works best to support a quit attempt, pharmacotherapy and vaping see DBOH chapter 11.

Training for the dental team

The National Centre for Smoking Cessation and Training (NCSCT) has online training to support delivery of very brief advice in the form of ASK, ADVISE, ACT designed to be used opportunistically in less than a minute in almost any consultation with a smoker. All dental team members can undertake the NCSCT training as part of regular continuing professional development. Use of the evidence-informed pathway will increase the chance of a successful quit attempt. It just takes 30 seconds and can give patients the motivation to gain professional help which will increase their chances of quitting.

It’s important that all members of a dental team are aware of the stop smoking support services offered locally and how these operate. Arranging a meeting with a representative of a local provider could provide a useful opportunity for dental teams to learn about the service offer and the best ways of referring dental patients. You can also locate your local stop smoking service here.

In addition, e-learning for healthcare has training resources for the delivery of brief advice in your everyday practice regarding both tobacco and alcohol use.

Identification and brief advice on alcohol

A significant proportion of the generally healthy population visit a dentist on a regular basis. There is evidence that identifying patients’ alcohol health risk and sharing this with them along with some advice on cutting down, is effective in reducing alcohol consumption.

Asking patients about their alcohol consumption

The AUDIT (Alcohol Use Disorders Identification Test for Consumption) screening tool was originally developed by the World Health Organization as a simple method of screening for excessive drinking and to assist in brief assessment. Its shortened form, AUDIT-C, includes three questions and is now widely used as a screening tool and is shown below. It is also available as a patient scratch card. There is evidence that this brief alcohol screening tool can be successfully used in general dental practice to identify patients at risk of harm from excessive alcohol consumption.

Advise and Act

Advise the patient of the level of alcohol health risk indicated by their score. Provide feedback and information relevant to their level of risk and give a patient information leaflet. Further information on how to do this is found in Chapter 12 DBOH.

Training and resources

Dental teams can access online training:

E-learning for healthcare: Alcohol Identification and Brief Advice programme. This includes useful videos which demonstrate practicing AUDIT-C specifically for dental teams.

E-learning for healthcare: Alcohol and Tobacco Brief Interventions programme.

​Wednesday's webinar with the Chief Dental Officer on the latest IPC guidance and SOP changes 

Sara Hurley, Chief Dental Officer England, is hosting a webinar for all dental care professionals and practice team members on what the changes mean for the delivery of primary care dentistry. 

Date: Wednesday 01 December 2021
Time: 19:00 - 20:00
Click here to register for the webinar 

Please take the time to read both the IPC guidance and the SOP. Although on the webinar we will take questions through the chat box, we would appreciate it if you send questions in advance so we can make sure as many as possible are answered as part of the presentation. 

Email the Chief Dental Officer at england.cdoexecutive@nhs.net 

Please note the webinar will not cover contractual issues.

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Previous NHS dentistry and oral health bulletins this year

Previous bulletins can be accessed by clicking on the links below:

NHS primary care bulletin

The NHS primary care bulletin provides resources on health policy and practice and we encourage you to sign up for this, too. It is aimed at teams across general practice, dentistry, community pharmacy and optometry. 

COVID-19 advice, guidance and resources

Communications resources for NHS dental practices

Click on the links below to view and download useful communication resources:

• Click here for social media image cards and patient leaflets
• Click here for social media assets and posters explaining IPC requirements
• Click here to download website/social media copy and scripts for answer machine message, text message and emails.

NHS updates to the profession 

Key letters from the Chief Dental Officer and the NHS dentistry and oral health team are online here. 

Transition to Recovery: Dentistry's standard operating procedure

The latest version was published on Thursday 25 November. Changes to the previous SOP are in yellow. You can read the SOP online here. 

COVID-19: infection prevention and control dental guidance

The guidance is an appendix to and should be read in conjunction with the national guidance on infection prevention and control for COVID-19 . You can read the general guidance and the specialist dental appendix online here.

Avoidance of doubt note: provision of phased treatments

This document is to support dental professionals, and to clarify where it might be appropriate to provide phased treatment spanning over several courses of treatment (CoT). You can read it online here.

Health and wellbeing support