Abstract

Oral health conditions affect a significant proportion of the population, with many patients not engaging with dental services or prioritising oral healthcare. There is increasing evidence of associations between oral and general health, including a bidirectional link between type 2 diabetes and periodontal disease, and a number of prescribed medications also have oral health-related adverse effects. Medication-related osteonecrosis of the jaw (MRONJ) is an adverse effect of a range of medications used to treat osteoporosis and cancer. It has significant implications for patients and is challenging to treat, therefore the prioritisation of preventive measures through effective interprofessional collaboration is recommended for this patient group. This thesis represents the cumulation of 5 individual peer reviewed publications that explore the role of the pharmacist in the promotion of oral health and in the prevention of MRONJ. A grounded theory approach was adopted in this work, with a range of semi-structured interviews and focus groups undertaken with a total of 82 healthcare professionals and patients. Constant comparative analysis enabled the enrichment of data through an iterative process of data collection and analysis, with Ritchie and Spencer’s framework analysis facilitating the identification and prioritisation of salient themes. In the final paper forming this thesis, a community pharmacy-based oral health intervention was developed and piloted on over 1,000 patients in County Durham. Each of the studies has produced independent results and they are presented individually in this thesis. This is followed by the exploration of the work as a whole through the Rainbow Model of Integrated Care. iii This work has highlighted that MRONJ has significant detrimental implications for quality of life, causing a range of significant physical, psychological and social complications. However, it has also shown that there is limited knowledge of the condition amongst healthcare professionals and patients, and that the recommended preventive care is not prioritised in practice. Dental professionals are isolated from other professional groups, with my research demonstrating that a lack of integration and collaboration between dental and general healthcare services limits the quality of patient care. An increased focus on preventive dental care and interprofessional education on oral health could help to reduce the risk of MRONJ and to improve both the oral and general health of the population. This work has identified that pharmacists are able to play a greater role in the provision of oral healthcare and in preventing MRONJ. This research has identified that pharmacists are able to provide oral health interventions which are acceptable to patients and can result in positive intentions to change oral health behaviours. This includes engaging with patients who have a poor history of accessing dental services. I have added to the existing literature and provided evidence for commissioners and policy makers, demonstrating a key role for pharmacists in oral healthcare.