Issues and Challenges Identified with Prison Dentistry - Essay Example

WHETHER THE DENTAL HEALTH OF PATIENTS ATTENDING A LOCAL GENERAL DENTAL PRACTICE SIGNIFICANTLY DIFFERS FROM THAT OF PATIENTS ATTENDING THE LOCAL PRISON DENTAL PRACTICE INTRODUCTION The most important aspects of dental practise in prisons include the quality and prevention of further problems in future for a person. There should be provisions for urgent dental care for those who need it. All prisoners must have the access to dental care according to their needs. The most important aim of dental practise in prisons is to reduce the future occurrence of dental problems. This is achieved only by modification of the life style. The important things include using fluoride toothpaste, stopping tobacco chewing and modification of diet for proper dental health. In a prison there is lot of limitations for such things. "In the past, the provision of dental services in prisons has been of variable quality. For this reason, the Strategy for Modernising Dental Services for Prisoners in England was published in 2003. Every Prison was required, in consultation with the local primary care trust, to develop a Dental Action Plan for improving their dental service. 4.75 million over three years was allocated towards the implementation of these plans." (Harvey, S. et al. 2005). The authorities must provide dental check up for at least 200 to 250 prisoners per week. The dental service needs to be universal based on clinical needs and must provide all sorts of services to the patients, but inside the prisons it has certain limitations for providing all sorts of dental services. ISSUES IDENTIFIED WITH PRISON DENTISTRY Long waiting times for treatment Care pathway not linked to length of stay Isolation Quality variable Lack of management audit Limited prevention Efficiency of prison system (Jenner, T. n.d.) In case of trauma to the face or cheeks the person may present with severe bleeding and the prisoner should be taken to the emergency department, but this must be in line with the local health care provisions and according to the security policies in the prison. In acute dental pain is advisable to take the person to a dentist within 24 hours or at least to an appropriate practitioner within 24 hours. The prisoner needs routine follow up with in six weeks in all most every case and this is also restricted by certain prison policies. THE CHALLENGES The incidence of untreated dental disease in prisoners is much high when compared with that of the general population, so the dental health needs of prisoners is much high. Since the prisoners neglect their oral health for such a very long time the problem may in the most aggravated form. "While dental care is a critical component of overall quality health care, many prisoners enter correctional facilities in the United States with little history of good dental hygiene and even less history of access to dentists for routine dental examinations. As a result, the incarceration experience presents opportunities for inmates to receive quality dental care, often for the first time in their lives. Dental care delivered by correctional dentists is complicated, however, by the array of serious dental conditions and difficult to treat dental problems in clinical settings". (Vaughan, M.S. et al. 2006) The poor nutritional status may also aggravate the problem. Smoking must be prevented in high risk cases. "The higher proportion of drug users in prison compared to general population can also explain the greater need for dental treatment. Methadone users in particular have a high level of oral disease". (Rotary. et al. 2007)Another important problem is that the dental care sessions may be shorted by security problems. Other important issues in dental health care include the lack of space in prisons, insufficient staff for treatment, lack of funding for health promotion and outdated facilities for health care in prisons. A report published in Sage Journal describes that there is variation in dental care provided to the prisoners. "Forty-five states and the District of Columbia returned surveys, 88%. Seventy-three percent of respondents had dental directors that coordinated dental care. Seventy-two percent described their District of Columbia as providing emergency care and some routine care. Fifty-two percent required inmates to make a co-payment for dental services. Twenty-six percent indicated that their states were providing dental care through managed care. There were no correlations between the level of care that inmates received and hypothesized indicators. There was substantial variation in the way dental care was provided to inmate populations by the states". (Makrides, N.S. & Shulman, J. D. 2002) Usually emergency cases are given priority in dental health care in prisons and routine follow up is neglected and this in turn created increased incidence of dental health problems. "Prison dentistry completely differs from that of private practice operations. Due to years of oral health neglect, the need of inmates far exceeds that of the general population. Prison Dentistry is hard core, no cosmetic dentistry, no crowns, no whiting, no implants, etcThe primary focus is on treating dental emergencies/infections, extracting thousands of non-salvageable teeth, restorative treatment - fillings, fabrication of partial and complete dentures and periodontal treatment - cleanings". (Smallwood Prison Dental services, Inc. n.d.) Most of the prisoners enter the prison without proper knowledge about the dental care and its importance, and they may tend to neglect their dental hygiene for a very long time. The chronic smokers in the prison have a high risk of developing mouth cancer. Many prisons do not include fruits and vegetables in the diet which is very important for general as well as dental health. Another important in dental health care problem when compared with the local dental practise is that the number of prison population is increasing. There is shortage of health care professionals and infrastructure in prisons due to this. Many prisoners will exaggerate their symptom due to various reasons and many urgent cases need not be truly urgent. Most of the prisoners have a chaotic life style and they really do not care much about the dental hygiene. "The dental health needs of prisoners differ from those of the general population. Prisoners generally have a poorer standard of oral health, with increased levels of emergency cases, higher rates of substance misuse and smoking, and underlying poor nutrition. The demand for dental care in prisons is also increasing as the prison population continues to grow. Prison dentists, along with other healthcare workers in the prison setting, are in a unique position in that they are required to balance the need to provide the best possible care to their patients with the priorities and restrictions imposed by the prison environment. These include the inability to provide sedation and general anaesthesia within the prison setting, different protocols for pre and post-operative pain relief, the need to minimise referrals outside of the prison and security issues". (Dentistry. co.uk. 2007) Some prisoners demand cosmetic surgery which is inappropriate and create lot of issues regarding preference of treatment for other people also. "Prison dentists do a limited scope of services because they are state-funded. They do not do cosmetic dentistry of any kind". (Kinton, J. 2009.) "As the prison population is, in general, inclined to wait until they have pain from their teeth before treatment is sought, removal of diseased teeth is a far more likely treatment option than restorations". (Jones, C.M. et al. 2004) The shortage of security staff to supervise the clinic is another important issue. This in turn fails to attract dentist and other allied healthcare professional to work in the prison. Many dentists are not willing to work within the service specification in the jail and this in turn has created shortage in the staff for dental care. . "Guidelines for the Appointment of Dentists with Special Interests in Prison Dentistry are produced by the Faculty of General Dental Practice UK in conjunction with the Department of Health, the Oxford Deanery, and the British Association for the Study of Community Dentistry and NHS Primary Care Contracting. It is intended to help prison managers and healthcare commissioners define more closely the role and working arrangements for prison dentists. The competency frameworks set out in the document will also help prison dentists to identify their learning needs, and undertake further training so that they can improve standards of care. According to the organisation, prisoners generally have a poorer standard of oral health, with increased levels of emergency cases, higher rates of substance misuse and smoking, and underlying poor nutrition. The demand for dental care in prisons is also increasing as the prison population continues to grow". (Bajaj, A. ed. 2008.) Since the difficulty in getting dentist to work in prisons the health care managers are reluctant to arrange dental check up. CONCLUSION So there quiet a lot of difference exists between the dental health of patients attending a local general dental practice and that of patients attending the local prison dental practice. "The governor, prison officers, health care staff and prison dental team should work together to provide dental care to suitable to the needs of the prisoners. The prisoner's length of stay should be considered when assessing the dental requirements as this will assist in setting priority among the dental needs of the prisoners. Oral health is inextricably linked to overall health as well as to self esteem, and the prison service and dental team are responsible for ensuring that oral health needs are available and accessible as part of the health care delivery systems. If prisoners receive good oral health care, prisoner's satisfaction and security will benefit. Dental service should be recognised as an integral part of a comprehensive health service for prisoners and administrative support and specific training programmes should be available for dental service as required". (Moller, L. et al 2007) "If good oral health care is provided to prisoners, the benefit will extend to their families, their communities and the nation as a whole". (Greifinger, R B. et al. 2007.) REFERENCES Bajaj, A. ed. 2008. Launch of national standards fro prison dentists. British Dental Journal. 204 (10) Nature Publishing group. [Online] Available at: http://www.nature.com/bdj/journal/v204/n1/full/bdj.2007.1229.html [accessed 17 Apr 2009] Dentistry. co.uk. 2007. Launch of national standards fro prison dentists. [Online] Available at: http://www.dentistry.co.uk/news/news_detail.phpid=897 [accessed 18 Apr 2009] Greifinger, R B . et al . 2007. Public Health Behind Bars. From Prisons to Communities. New York : Springer. Harvey, S. et al. 2005. Reforming prison dental services in England - a guide to good practice. [Accessed 17 Apr 2009] Available at: http://www.opm.co.uk/resources/papers/health/prison_dental_reportWEB.pdf. Jenner, T. n.d. Modernising prison dental services - the policy [Online] Available at: http://www.ohrn.nhs.uk/conferences/past/PHRN160905TJ.pdf. [accessed 16 Apr 2009] Jones, C.M. et al. 2004. Scottish Prisons' Dental Health survey 2002: Summary. [Online] [Updated 21 June 2005] Available at: http://www.scotland.gov.uk/Publications/2004/02/18869/32882 [accessed 19 Apr 2009] Kinton, J. 2009. Area's most wanted: Prison dentists. Mansfield News Journal. [Online] [Updated Mar 2009] Available at:http://www.mansfieldnewsjournal.com/article/20090408/NEWS01/304080003 [accessed 18 Apr 2009] Makrides, N.S. & Shulman, J. D. 2002. Dental health care of Prison populations. Journal of Correctional Health Care. Sage journals Online. 9(3). P. 291-306 [Accessed 17 Apr 2009] Available at: http://jcx.sagepub.com/cgi/content/abstract/9/3/291 Moller, L . et al 2007. Health in prisons: a WHO guide to the essentials in prison health. Denmark: WHO Rotary. et al. 2007. An insight into prison dentistry. BDS elective report. [Online] Available at: https://dspace.gla.ac.uk/bitstream/1905/727/3/Roarty_Walker.pdf. [accessed 19 Apr 2009] Smallwood Prison Dental services, Inc. n.d. Making a Difference. [Online] Available at: http://www.smallwoodpds.com/company.html [accessed 16 Apr 2009] Vaughan, M.S. et al. 2006. Section 1983 Liability against prison officials and dentists for delaying dental care in correctional institutions. Paper presented at the annual meeting of the American Society of Criminology, Los Angeles Convention Center, Los Angeles. Oct 31, 2006. [Accessed 16 Apr 2009] Available at: http://www.allacademic.com/meta/p160574_index.html Read More