Introduction This paper is the second of four reviews exploring the relationships between oral health and general medical conditions, in order to support teams within Public Health England, health practitioners and policymakers.Aim This review aimed to explore the most contemporary evidence on whether poor oral health and pulmonary disease occurs in the same individuals or populations, to outline the nature of the relationship between these two health outcomes, and discuss the implication of any findings for health services and future research.Methods The work was undertaken by a group comprising consultant clinicians from medicine and dentistry, trainees, public health, and academics. The methodology involved a streamlined rapid review process and synthesis of the data.Results The results identified a number of systematic reviews of medium to high quality which provide evidence that oral health and oral hygiene habits have an impact on incidence and outcomes of lung diseases, such as pneumonia and chronic obstructive pulmonary disease in people living in the community and in long-term care facilities. The findings are discussed in relation to the implications for service and future research.Conclusion The cumulative evidence of this review suggests an association between oral and pulmonary disease, specifically COPD and pneumonia, and incidence of the latter can be reduced by oral hygiene measures such as chlorhexidine and povidone iodine in all patients, while toothbrushing reduces the incidence, duration, and mortality from pneumonia in community and hospital patients.

People in residential or continuing care have an equal right to good oral health as people residing in the community. Entry to residential or continuing care provides an opportunity to assess need, identify problems, improve oral and dental health thereby contributing to improved general health and quality of life. This document provides guidance to establish standards for oral health care which are appropriate to the needs, demands and choices of individuals whether they live in continuing or residential care (Appendix 5).

The formation of a local joint professional network (LJPN) in Northamptonshire has led to a joint Continuing professional development initiative and an audit project to determine the take up of annual health checks by patients with diabetes mellitus with dentists, optometrists, pharmacists as well as the usual check with the General Medical Practice team. The findings showed that a significant number of patients (29-50%) do not access available dental, optometry and pharmacy advice. Better collaboration between the professions has the potential to improve health outcomes in diabetes mellitus and other areas where lifestyle modification reduces adverse health risks. A patient advice card (SWEETWISE) was developed by the group and could be used to help educate patients and health professionals.

desire to leave practice. A lack of leadership opportunities for GPs was found to negatively affect job satisfaction due to reduced autonomy and opportunities to impact upon decision making. Formal leadership training could be developed, which has been shown to increase engagement with leadership in clinical commissioning groups and reduce the conflict of values that a hybrid clinical-leadership role brings. Other ways towards increasing leadership without detracting from clinical work would be to create leadership fellow positions and advisory posts, to ease GPs into these roles.

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