We would like to draw BDJ readers' attention to the formation of the South West Oncology Restorative dentistry Network (SWORN). As readers will be aware following the excellent BDJ collection on this theme (https://www.nature.com/collections/headandneckcancer), over 10,000 individuals in the UK are diagnosed with head and neck cancer (HNC) each year.* Patients are often treated with surgery, (chemo)radiotherapy, or a combination and can have life changing consequences which affect oral and dental health. HNC patients therefore have a heightened risk of primary dental disease on top of a background risk of cancer recurrence and osteoradionecrosis. These patients are therefore rightly of high priority within NHS dental services.

In the South West, in order to support these priority patients, we have set up SWORN which is a branch of the Restorative Managed Clinical Network (MCN). SWORN has several aims including to:

  • Improve links between GDC registrants involved in the management of HNC patients across the South West

  • Identify through audit and research the challenges facing HNC patients requiring dental care

  • Improve patient pathways and quality of care through a process of quality improvement and shared learning.

The inaugural meeting of SWORN was held in January 2024 with the key focus being identifying the areas of priority for the group. There was Consultant representation from seven NHS Foundation Trusts across the South West alongside attendance from dentists of other grades and dental hygienists.

The key challenge identified during the meeting was access to primary care dental services for HNC patients. In data presented at the meeting from University Hospitals Plymouth and Somerset Foundation Trusts, at least 40% of those undergoing a dental prehabilitation appointment did not have access to primary care dentistry. The South West has particular vulnerabilities in this regard, with a combination of a rural geography, low density of dentists and a rapidly ageing population.1 Over-65s are due to increase by 20% in the next 20 years and with HNC most common in over 60s, this will continue to add pressure to an already struggling system.

In a group ideas session to address this challenge, potential solutions were voiced including new commissioning initiatives. One such idea is being explored by members of the MCN through work with regional commissioners: Cancer Action Support Practices (CASP) to provide HNC patients with a temporary dental home for routine dentistry, preventative care and ongoing cancer surveillance. These would allow patients without a dental home to register with a practice and receive routine dentistry in a primary care setting, as well as facilitating discharge from secondary care restorative units once oral rehabilitation is completed. There has been significant interest in this model from Integrated Care Boards and it is hoped that this scheme could address several of the dental issues faced by the region.

Despite the dental challenges in the South West, we feel the formation and work of SWORN, alongside recent restorative dentistry consultant appointments (with a HNC focus) in Truro, Torbay and Somerset give reason for optimism. SWORN will work closely with NHS England, the South West Restorative MCN and the Restorative Dentistry Clinical Excellence Network to improve the care for HNC patients in the South West.

We encourage any dental professionals in the South West who are involved with the care of HNC patients to reach out to the SWORN group if they would like further information: this can be done via Email to england.swregionaldentaloffice@nhs.net.

*This work uses data that have been provided by patients and collected by the NHS as part of their care and support. The data are collated, maintained and quality assured by the National Cancer Registration and Analysis Service, which is part of NHS England (NHSE). The data are taken from the Get Data Out tables.