Choosing Wisely in Dentistry: Sustainable Oral Health

In recent years there has been increased interest in sustainability in healthcare, and specifically in dentistry. Sustainability is described as encompassing three pillars: economic, social, and environmental. For clinicians and patients, the three pillars mean having to consider the clinical and cost-effectiveness of those decisions, as well as the environmental impact. The United Nation’s COP26, highlighted the need for dentistry to engage in common efforts to promote and coordinate sustainability across policy, service delivery, provision of care, research, and education.

The Covid-19 pandemic brought into sharp focus the sustainability of NHS dental services, both from a financial and an environmental perspective. The NHS has limited resources, with fixed budgets, and must prioritise the treatments delivered. The largest contributors to the carbon footprint of NHS dental services are travel (patients and staff) and procurement. A recent study exploring the of 17 different dental procedures, identified that routine examinations contribute the highest proportion at 27.1%, followed by scale and polish at 13.4%. The single most important factor in improving sustainability in dentistry is prevention. Encouraging a low sugar diet and efficient oral hygiene will reduce the clinical burden currently placed on the dental provision.

The Scottish Dental Clinical Effectiveness Programme (SDCEP), a well-respected provider of dental guidance, offers a potentially valuable mechanism for communicating sustainability messages. On behalf of NHS Education for Scotland (NES), in November 2022 SDCEP, convened a workshop of international stakeholders, to discuss current activity and future strategies related to sustainable oral healthcare. Findings identified that sustainability is still an emerging field with significant uncertainty about what it means for patients and the profession. Building on these findings, the aim of this PhD is to further explore sustainability in oral health and prioritise research in this area.

Objectives:

1. To review the literature on sustainability in oral health, using the three pillars of sustainability (Social, Economic and Environmental) as a framework to appraise the current evidence base, and identify how sustainable oral health is defined.
2. Conduct theoretically informed interviews with primary care dental team members, patients, and other key stakeholders to explore views and beliefs around sustainability within NHS dentistry.
3. Informed by the literature review and interview findings, conduct a prioritisation exercise, following James Lind Alliance (JLA) methodology, to identify and prioritise unanswered questions or evidence uncertainties related to sustainable oral health.
4. Rank evidence uncertainties and agree the top ten priorities in sustainable oral health research, in order to make recommendations for research priorities and funding in UK primary care dentistry.

The study can be tailored to the student’s specific skills and interests; however, an interest in dental public health, behaviour change and/or environmental sustainability would be beneficial.

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Our research community thrives on the diversity of students and staff which helps to make the University of Dundee a UK university of choice for postgraduate research. We welcome applications from all talented individuals and are committed to widening access to those who have the ability and potential to benefit from higher education.