Alice Bowe caught up with Margie Taylor, Chief Dental Officer for Scotland, to talk all things CBE, oral health and dental regulation...
Margie Taylor received a rather unexpected gift on her recent birthday, a letter saying that the Queen would be awarding her with a CBE for her services to dentistry in Scotland.
Margie has served in her role as Chief Dental Officer since May 2007. She has played a pivotal role in delivering the Childsmile campaign in Scotland, a national programme that aims to improve the oral health of children and reduce inequalities in access to dental services.
So, what is the secret behind her success in dentistry? Having teams of “good quality people,” according to Margie. She says that she is “enormously privileged to receive the CBE but recognises that many others have contributed to the improvement of oral health over the years and that’s helped me gain recognition”. Whether in her time at NHS Lanarkshire and NHS Fife, her work in clinical dentistry in Lothian, or advising the Scottish Government, Margie feels extremely fortunate to have always had talented people to work with and it is this, she says, that has motivated others to collaborate on the schemes she has worked on.
Team members have included the nursery nurses and school staff who Margie describes as the “heroines” behind the Childsmile scheme. “Not only are they getting toothpaste onto teeth,” said Margie, “they are establishing a habit from an early age that will stand the children in good stead throughout their life.” As well as supervised tooth brushing, nursery nurses provide children with healthy snacks and drinks to limit their sugar intake.
Margie believes this scheme is just the beginning, and that staff are playing a key role in laying the foundations for lifelong oral health: “If these children can grow up to have good teeth then their own children will have the expectation of having good teeth as well, and that goes on.”
The single most common reason for admitting a child to hospital for a general anaesthetic in Scotland is for tooth extraction, and it is a problem that hits the poorer people in society the hardest. It is these groups that Margie has targeted her efforts towards. “Good dental health is free,” she says, “there’s no reason why people who are in the poor end of society can’t have just as good teeth as those better off. What we have to do is make sure people know how to achieve that.”
On-going evaluations of the scheme have revealed a marked improvement in dental health; notably, fewer caries, fillings and dental extractions. The scheme was also found to be cost-efficient; the preventative approach means money is saved in avoidable treatments.
“There must be a better way of doing this.”
It is this improvement in children’s oral health that Margie has found to be the most rewarding part of her work. “When I was a young dentist, I spent a lot of time taking deciduous teeth out of four year olds, and I just thought, there must be a better way of doing this,” she told us.
“Dental decay is almost totally preventable, and not only are you doing something to the child that they might not like very much, but they’re missing time off school and a lot of them have been in discomfort before they’ve even seen you.” It was this that motivated Margie’s future work, “It just seemed to be a no-brainer to try and prevent the decay in the first place, particularly among children who are living in deprived areas.”
A further group in society that Margie has placed her attention on is the elderly. Better medical and dental care means that we have an increasing number of elderly people in society who still have their own teeth. This, combined with an increased incidence of dementia is providing a particular challenge to oral health. A combination of frailty, forgetfulness, and a possible a loss in manual dexterity can lead to a sudden deterioration in oral health and can affect a person’s quality of life.
The key to this, as with the younger age groups, is prevention, explained Margie. “We notice that registration among older people starts to go down as they get older, so one of the things we can encourage is that elderly patients maintain regular visits to the dentist.”
Margie also raised the issue of oral cancer, the risk of which increases with age. “If you’re an older, smoking, drinking male for instance, you’re more likely to get oral cancer. But if you get that oral cancer picked up at an early stage then clearly there’s more chance of it being treated effectively.”
Disciplinary action: “Just like disease, you’re better to prevent it.”
Margie’s mantra of ‘prevention is better than cure’ goes beyond treatment. She believes that a lot can be taken from this way of thinking in dental regulation too. It has long been said in the press that dentists feel overregulated and are being set unrealistic standards by the regulatory bodies, particularly the General Dental Council. NHS Scotland is currently piloting a way of using performance indicators to pick up any patterns of behaviour that might suggest a practitioner is in difficulty, with the intention of “helping them at the early stage so that they don’t get into trouble in the first place.”
A look to the future.
Margie sees any future dental system in Scotland being a prevention focussed, more modern, less complex and ‘paper-lite’ one. This is what has been identified in the government programme: A Stronger Scotland, published in September 2015. “The current system was developed when children and adults needed lots of fillings and extractions,” she said, “As dental health has improved we have to recognise that a system that was designed for people with bad teeth may not be best suited for dealing with people with good teeth in the future.”
Margie highlights the importance of advances in electronic systems in 2016; with plans for patient e-signatures and an electronic prior-approval process already underway.