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This paper will summarize some of the clinical and organizational challenges for dentists and dental care professionals who are interested in working in custodial environments. This briefly covers some of the difficulties and pressures that the dental team face in providing dental care within these very specific environments. There are some features unique to this population group that can negatively affect their dental health experiences, related to socio-economic, lifestyle and other factors. In general, prisoners enjoy poorer dental health and mental health than the general population and present a greater degree of learning difficulties than the population at large. This requires additional skills and training for the dental teams treating this group and presents a number of challenges not always found in the provision of routine primary care dentistry.
CPD/Clinical Relevance: Although the article describes the provision of care for the prison environment in England, this is mirrored in other parts of the United Kingdom and the same general considerations will apply and be recognized in prisons in other national systems of dental care. Many of the areas covered are relevant independent of the systems in which care is delivered.
Article
There are a number of different secure custodial environments in the UK, including prisons, young offender institutions, secure hospitals and immigration removal centres. Although primarily concentrated in prisons, this article will touch on dental care provision in all these environments. Currently, there are 150 prisons and Youth Offender Institutes (YOIs) in England and Wales managed by Her Majesty's Prison Service (HMPS), part of the National Offender Management Service of the United Kingdom Government, and private companies such as Serco and G4S. In Northern Ireland there are three active prisons that are operated by the Northern Ireland Prison Service as well as a Juvenile Justice Centre operated by the Youth Justice Agency. The Scottish Prison Service operates 12 prisons and a Youth Offender Institute and there are also two privately run Scottish prisons.1
From April 2013, the health services in these settings have all been commissioned in the same way through NHS England. Providers may be NHS Trusts, private healthcare providers with NHS Contracts or individual dental providers, providing primary dental care as Mandatory Services under the General Dental Services of the National Health Service (NHS). Local Authorities are responsible under The Care Act 2014 that came into force in April 2015 for assessing social care needs of all adults in custody in their area, except in Immigration Removal Centres (IRCs), and providing or commissioning care and support to meet these needs. It is usual for there to be multiple providers of health and social care in secure environments. Often, a main healthcare provider will be commissioned and dental services will be sub-commissioned by that provider.
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