With health and dental systems set to be put under immense pressure from refugees arriving from Ukraine, Professor Liz Kay outlines how families can maintain good oral health in anticipation of being unable to see their dentists for some time. 

When I look at the humanitarian crisis unfolding in Ukraine, like everyone I feel deep sadness for the millions of lives torn apart by conflict. From the safety of the UK, we can only imagine the suffering.

As a medical clinician my thoughts also turn to practical matters. Once they have safeguarded the lives of the millions of refugees flocking into their countries (and God bless them for doing so), how do host countries go about providing basic health care services to people in dire need?

It is not an enviable task. If the situation in Poland, Hungary and Ukraine's other western neighbours mirrors that in the UK, their national health services will already be struggling to recover from the biggest global pandemic in a century.

In my professional field, dentistry, the impacts of COVID-19 remain particularly acute. The latest NHS statistics for England reveal that only 15.8 million adults (effectively a third of the population) were seen by an NHS dentist in the 24 months up to December 2021 – a fall of nearly 4 million adults from the previous year, and 6 million adults from the year before that. The statistics for children are equally grim. 5.1 million (42 per cent) were seen in the past 12 months, and only 3.6 million (29 per cent) in the preceding year.

It is fair to assume that the same backlogs (and hence future problems) are stacking up in Central and Eastern Europe. Oral health will not be the most pressing priority, I appreciate. But, nevertheless, people will rightly be concerned about personal health and hygiene regimes for both themselves and their children.

So what should the advice be? What can people do to help themselves? In the absence of any available in-person dental care (subject to acute shortage), the focus should be on preventative measures.

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I have taken a close interest in preventative approaches to oral health, and particularly children's oral health, for over 30 years. The lesson is clear: measures that can prevent future problems need to be prioritised. They will not only significantly alleviate patient suffering, but also reduce the financial burden on stretched health services.

The numbers involved are far from trifling. In England, tooth decay is still the most common reason for hospital admissions in 6-10 year olds. In 2015-16 the cost of tooth extractions alone in 0-19 years olds was over £50 million.

Short of seeing a dentist, the main preventative measures are well known to anyone who has been paying attention to public health messages: brush twice a day, floss, avoid sugary food and drink, don't smoke. To the list can be added another easily-accessible fix that stimulates saliva and helps keep the mouth clean: chewing sugar-free gum.

The scientific case for the benefits of chewing gum is compelling.

As an academic consultant working in public health, I am taking a particular interest in work being done by the Faculty of Dentistry at King's, London. King's is conducting a meta-analysis of the role of sugar-free chewing gum on plaque quantity in the oral cavity. The results show clear benefits. An earlier 2019 study by King's found that people who chew develop 28 per cent fewer cavities than those who do not. The equivalent percentage for using fluoride toothpastes and supplements was 24 per cent.

Public Health England is slowly catching up, and sugar-free gum is likely to feature more prominently as an important public health intervention in the future. For practitioners like me who are particularly concerned about oral care in vulnerable families, this is very welcome.

Sadly, bad oral health is not an equal opportunities affliction. Public Health England statistics show that inequalities in tooth decay between the most and least deprived 5 year-olds have increased between 2008 and 2019. This is shocking.

In exactly the same way, the disruption to basic dental services in Ukraine and neighbouring countries will have harsh and lasting effects on the people living there. Chewing sugar-free gum may be a drop in the ocean compared to the problems they currently face, but it is a simple preventative measure in reach of everyone.

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