ADG Chair Neil Carmichael – The looming problem for forgotten dentistry

ADG Chair Neil Carmichael discusses the looming problem for forgotten dentistry in the Primary Care Journal.

One-third of adults in deprived areas of England have tooth decay. That was the key finding of the Public Health England oral health survey of those attending dental practices published this June. Was this one of the aftershocks of the recent lockdown in dentistry? No. This survey took place in 2018 which means only one thing for policymakers – now the figure is more than one third – and rising.

Should this be a surprise? Over the last 10 years, government net spend on NHS dentistry has been stagnant with no increase in line with inflation, which in real terms represents a cut. There have been significant challenges recruiting dental professionals to deliver NHS treatment in many regions and we are now seeing the outcomes of this for the “left behind” parts of the country confirmed in this report by Public Health England.

Providers of NHS dentistry faced significant recruitment challenges before the Covid-19 pandemic which have resulted in closures along the Yorkshire coast, Lincolnshire coast, South coast, around Portsmouth and in Cornwall, amongst other coastal and rural communities.

There are inequalities in access for certain groups, including homeless people and care home residents. The Smiling Matters Care Quality Commission (CQC) report last year confirmed it was difficult for residents to access dental care and 73 per cent of care plan reviews only partly covered or did not cover oral health at all.

Tooth decay is a leading cause of hospital admission in children. Almost 9 out of 10 hospital tooth extractions among children aged 0 to 5 years are due to preventable tooth decay. Furthermore, tooth extraction has been the most common hospital procedure in 6 to 10-year olds. None of this is new. It has all been articulated at great length by the profession in the call for evidence last year by the Health and Social Care Committee.

As dentistry reopens, the profession will be engaged in a desperate bid to catch up on urgent treatment. Hospitals are reported to have year-long waiting lists for dental treatment with three months of cancellations. Access to schools and care homes to undertake oral health programmes will remain restricted for months to come. The damage to some people’s oral health will be permanent.

Support to level-up 

We know that people from many walks of life have suffered hardship during the government lockdown and dentists are among those who have fallen through the cracks of government support.

There are around 3,000 purely private practices and many others with an NHS contract which also rely on private work for much of their income. Many have still to reopen and face unprecedented costs in additional personal protective equipment (PPE) requirements. The current guidelines for “fallow time” in surgeries between treatments means clinicians are only able to see about approximately six patients per day. The new complaint in MPs postbags is set to be the growing waiting lists for dental treatment.

It should be a major concern for the Government, given the volume of dental care provided by private practitioners, that if this part of the profession does not receive some state support many could go out of business. Once the outbreak is contained, this could leave those still standing unable to cope with the demand for treatment and exacerbate the already parlous state of access to dental care in the country.

Many policymakers have a view that oral health is only critical when it is an emergency, partly compounded by the “cosmetic” world we now live in. This greatly undervalues the importance of dentistry in general health (preventing cardiovascular disease and diagnosing oral cancer) and wellbeing.

Preventative measures are often half-hearted. It is welcome news that oral health will now be in the Early Years Foundation Stage reforms for schools – but uncertainties remain around assessing this and supervised toothbrushing, which has been successfully implemented in Scotland.

As we emerge from the pandemic, oral health inequalities will have deepened in many parts of England, which this Government claims it wishes to “level up”.

There are many proposals to address the perverse outcomes of NHS dental provision as it currently stands; flexible commissioning to expand preventative programmes being just one.

Jeremy Hunt recently agreed that now is the time for the Health and Social Care Committee to hold an inquiry into dentistry. Such an inquiry this Autumn could finally lead to a call for action for the Government to deliver and ‘level-up’ access to NHS dental care in England.