Transforming lives through improved oral health

Academic spotlight: Robert Witton, Professor of Community Dentistry

Take care of someone’s teeth and you can transform their life.

It’s the kind of statement you might expect from any dental professional. But Professor Robert Witton has a unique level of evidence to support the claim. Seeing tens of thousands of patients through his ten years as a general dental practitioner, in addition to helping 6,000 every year through the University’s dental clinics, he knows the positive benefits of improving a person’s oral health. A person attends a job interview where they would previously have felt unable. Someone enters a relationship they would otherwise have shied away from. An individual reconnects with a family member they haven’t seen for years.

“Improving a person’s oral health gives them greater confidence and pride. From there, they feel empowered, enough to make transformational life choices. It is an incredibly important aspect of personal health. And seeing the impact can be hugely rewarding.”

Joining the army

Rob is now one of the most influential figures in the UK dental public health sector. But his first forays into the field came during an eight-year stint in the Army. Having completed his dentistry degree, he always knew he wanted to travel and develop his own leadership skills. This resulted in military training at the Royal Military Academy Sandhurst, after which he was stationed in Northern Ireland, Cyprus, Germany and the Balkans.

Dentists have played a key role in the military for centuries. It stems from a time when good teeth were necessary to bite open the gunpowder cartridges used to spark life into rifles. While that may no longer be part of a soldier’s armoury of skills, good oral health is still essential and that was the primary focus of Rob’s work. However, he was also involved in a number of key operations where he came into contact with members of the public. But perhaps most influential for Rob was a period in Kosovo, where he worked in a dental centre through which he and colleagues provided support to local communities who were cut off by the conflict.

“On a daily basis, I was treating soldiers’ dental issues so they could function. But some of the local people hadn’t seen a dentist for years, if ever, and their teeth were in a terrible state. It was a powerful experience, and got me thinking quite differently as a clinician.”

On the path to the community dentistry

Leaving the Army, Rob was clear that dental public health was where his future lay. After an 18-month spell in Portsmouth, he arrived at the University of Plymouth in 2008. Working in, and with, the community had always been a key aspiration within the Peninsula Dental School. But with the school having only been in operation, at that point, for two years the full plan for how its vision would be put into practice hadn’t yet been realised.

Rob initially joined the School as its first dental speciality trainee, but – in 2012 – after completing his specialist training he was formally tasked with making that vision a reality. That coincided with the publication of the Government’s Health and Social Care Act, which provided organisations with the opportunity of taking over facilities previously run by the NHS. A year later, the Peninsula Dental Social Enterprise CIC (PDSE) was launched with Rob as its Chief Executive, a role he continues in today.

In the decade since, PDSE has become one of the University’s most prominent and impactful success stories. Since its launch, it has operated four clinics across Devon and Cornwall – two in Plymouth, one in Exeter and one in Truro – with a fifth, also in Plymouth, hoped to become a reality in late 2024. The numbers of people benefitting from its services are a testament to the level of demand, but also its ever-growing reputation for excellence.

Where some dental schools might struggle to get patients, that isn’t an issue in the South West. In the past year alone, PDSE has treated over 6,000 patients across the South West, offering over 33,000 appointments. This is a significant increase from the previous year, clearly reflecting many of the current challenges facing the dental profession. These patients include many of the most vulnerable in our society – people experiencing homelessness, people with dementia, young children, refugees, military veterans and children who have been in care.

These are groups that fall between the cracks. People feel embarrassment and shame when going into healthcare settings, and there has always been a myth that you can’t provide dental care to these groups, or that it’s not cost effective. We’ve demonstrated that neither is true.

Rob Witton, Luke Pollard and Laira Green pupils

Nicola Brown from the Community Engagement Team at PDSE with pupils at Prince Rock Primary School

The successes have certainly not gone unnoticed. Since 2013, PDSE has earned more than 20 regional and national awards, including wins at the Guardian University Awards, the Oral Health Awards, the Business Leader Awards and more. PDSE was also an integral part of the University’s success in the 2023 Times Higher Education Awards, where it won the Outstanding Contribution to the Local Community category, and it is consistently acknowledged among the most impactful social enterprises in the UK.

Since it was first launched, the local community has not been the only beneficiary of PDSE’s work. The idea of sending students out into the community has always been a novel one. But, alongside lectures and learning in the Simulated Dental Learning Environment, students now experience differing levels of community engagement and care across the four existing facilities.

“Many of our students do come from quite privileged backgrounds. They have never had direct experience of homelessness, or perhaps of forces veterans. We take our students down to the Salvation Army in Devonport to speak to its clients, and students are always really interested to hear their stories. These conversations result in benefits for the people we are treating but also the students and their future careers.”

With the demand for the service is clearly there, the will to expand the numbers of people being treated – and the number of students being trained – is also present. But to deliver that requires significant additional funding. To that end, Rob and colleagues throughout the School are involved in ongoing discussions with MPs and policy makers. It has resulted in regular visits by politicians from across the political spectrum, both to the Dental School and the facilities run by PDSE.

Through his role on the Plymouth Dental Task Force, Rob is also driving the development of the city’s dental strategy. A key element of this is improving young people’s dental health, and PDSE has delivered a supervised tooth brushing scheme in Devon for the past four years that has helped over 25,000 children. In late 2023, partnerships were launched with five primary schools in Plymouth to enable children to have dental appointments from their foundation year until they are 16.

That link between practice and policy is also something Rob is pushing outside of his roles at the University. Adding a third string to his bow, he works for the NHS to provide public health advice and develop future strategies. This, he says, lets him see what is happening across the region and gives him an understanding of the particular issues being faced in different communities. The result is that far from splitting himself three ways, the three roles directly complement each other.

Supporting global initiatives

The impact of Rob’s work is not solely confined to the South West. Being selected to take part in a programme at Harvard University in 2019 gave him the chance to engage with senior figures from the world of dentistry globally. This has since resulted in projects in the Philippines and Ethiopia, and an ongoing initiative in Liberia.

If the UK’s dental sector has its challenges, Liberia barely has a dental sector at all. At the time of our conversation, the nation of around 5million people has just seven registered dentists.

To try and change that, Rob has worked with colleagues in the country to establish its first dental training school, including writing its curriculum. As a result, its first cohort of dental therapy students are now in their second year with plans to grow its offering in the future.

“Liberia is one of the poorest countries in the world. And until recently, the Liberian government had no reference to dentistry in any of their policies. We have managed to change that, and to get government funding for the training school, but there is still a long way to go.”

Looking forward

His Inaugural Professorial Lecture comes as Rob prepared to mark the 25^th anniversary of his own graduation. His passion for the subject is still evident, but he is also clear that the profession needs to change. The dental contract, he says, doesn’t serve the needs of professionals or patients. There is also a need to change the models of care and the way dentists are trained, with Rob’s preferred approach being to roll out the methods developed in Plymouth nationally. There is also a need to change how dentists perceive themselves, and to help them feel part of the NHS’ primary care model.

Through his work in Liberia, Rob has witnessed people dying as a result of dental infections. And while the UK isn’t facing anything like that, he has also seen increases in the number of people going into A&E for dental treatment. Admissions for the extraction of teeth is also the primary cause of hospital admissions among young children, further emphasising the importance of the University’s own work with local schools.

The current national mood around dentistry is of a profession in crisis, and in some senses we cannot avoid that. But Plymouth is a shining example of a method that works and what can be achieved. We can’t solve the problem alone, but we can certainly play a part. And if we can roll out our approach more widely, there is no reason why dentistry cannot make a huge contribution to the overall health of the nation.

Join Professor Robert Witton's Inaugural Professorial Lecture, where he speaks about his journey into the specialty of dental public health, and his broad academic interests spanning his roles in dental education, public health, and community dentistry.

Oral diseases, despite being preventable, continue to be a major public health problem in England, placing a significant cost on society and the NHS. Moreover, poor oral health disproportionately affects the most vulnerable and disadvantaged in society, and there are stark examples of these oral health inequalities in our local communities

Wednesday 28 February | 18:00 | Free to attend in person or online

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Peninsula Dental Social Enterprise (PDSE)

PDSE is a Community Interest Company (CIC) committed to improving oral health across the South West. They run dental education facilities in Plymouth, Truro and Exeter, where students from the University treat NHS patients; improve awareness of oral health in the wider community, focusing on groups such as schoolchildren, the elderly, parents, those with specific conditions, people with special needs, substance abusers, the homeless and prisoners; and ensure access to dental care for all, but especially for those groups who may feel excluded from mainstream dentistry.