Over 35% of five year old children in areas of England with high levels of deprivation have had tooth decay, compared to only 13.5% in more affluent areas, according to the government’s own National Dental Epidemiology Programme survey carried out in 2022 and released at the end of March. 

The survey is the latest in a long-line of reports and articles that show the crisis in dentistry in England. 

The British Dental Association (BDA) has called on the government to “act urgently” to reverse the growing inequality in child oral health in England: 

“With tooth decay the leading cause of hospital admissions for five-to-nine-year-olds, there is a significant, and preventable, knock-on cost to the NHS”.

The survey’s findings, note the BDA, are not a result of behaviour, poor choices or a lack of education, rather: 

“They are a result of a wider system failure to take forward proven, cost-effective public health measures that prevent tooth decay and improve everyone’s health and wellbeing.”

There are several steps that the BDA is urging the government to make, in order to reduce this inequality. Including, imposing further restrictions on the marketing and sale of sugary food and drinks, policies to improve access to affordable, healthy food, and increasing water fluoridation schemes.

The BDA notes that government cuts to the Public Health Grant (down 26% overall since 2015) have reduced campaigns promoting good oral health to children.

Of major importance, however, in reducing inequality is being able to access free child dental services for preventative advice and early diagnosis. 

But a survey by the BDA published at the start of March found that over half of dentists in England (50.3%) report having reduced NHS commitments since the start of the pandemic.

The BDA’s analysis of government data shows an unmet need for dentistry in 2022 of over 11 million people, or almost one in four of England’s adult population. 

And the survey shows that things will get worse, with 74% of those who responded to the survey stating their intention to reduce – or further reduce – NHS work. 43% indicate an intention to go fully private, with 42% likely to change career or seek early retirement. Over 1 in 10 are stating an intention to move to practice abroad. 

Since the survey, BUPA has announced that 85 of its dental practices will close this year, unable to carry on due to the problem of staff recruitment. The company, which provides both private and NHS dental services, says it has not been able to recruit enough dentists to provide NHS care for many months. So many more patients will now be left trying to find another dentist.

On 20 March, the CQC produced a report on dentistry in care homes – Smiling matters: Oral health in care homes – which reveals a collapse in access to dentistry in care homes.

Feedback from care providers shows that since 2019, and the onset of lockdown, the proportion of residents never accessing NHS dental care routinely has grown from 6% to 25%. Those providers who said residents were always or mostly always able to access care fell from 67% to 35%.

Even if you are one of the lucky ones who finds a dentist willing to treat you on the NHS, from the 24th April you will have to pay 8.5% more for treatments. The Government has hiked the prices of NHS dental services. 

However, if you thought this meant your dentist would get more money – think again as the BDA notes:

“If you treat NHS patients, we want to help you set the record straight on who benefits from this increase. The revenue raised by this rise doesn’t go to dentists. It will do nothing to help struggling practices or the millions of patients unable to secure an appointment.”

“Ministers are simply making our patients pay more so they can pay less.”

The crisis hasn’t appeared overnight, but has been brewing for many years since a new dental contract was introduced in 2006. The pandemic exacerbated the issues as practices had to stop seeing non-emergency patients, but the rot had set in long before March 2020.

The 2006 dental contract pays dentist’s by units of dental activity (UDA), but the payment dentists’ receive do not cover the cost of the work. Less complex treatments that take little time are paid the same as more complex treatments that take hours. To cover costs, dentists take private work, this leaves less time to see and treat NHS patients. 

As people go longer and longer between seeing a dentist, when they do eventually see one, they often need much more extensive work done – not just a single filling, but many fillings or root canal work and extractions. The more complicated the work, the longer it takes, the more cost for the dentist, yet the UDA contract made no allowances for this.

Complaints about the 2006 contract began almost as soon as it was put in place. Finally in July 2022, sixteen years and a lot of lobbying by the BDA later, NHS England announced changes to the contract, but as Shawn Charlwood, chair of the British Dental Association’s general dental practice committee, said:

 “These are modest, marginal changes that will not fix the rotten foundations this service is built on. Our patients need Ministers to do more than paper over the cracks. These tweaks will do precious little to keep dentists in the NHS or ensure millions get the care they urgently need…Today is little more than a small step on the road to real reform. If government considers this a final destination then it will mean the death of NHS dentistry in England.”

Even with the changes, less complex work continues to be rewarded at the same rate as treatments that take hours.

To make matters worse, the BDA has highlighted that over 10% of the service’s £3 billion NHS budget (about £400 million) has not been spent and will be ‘clawed back’ by NHS England. The underspend is due to dentists not being able to meet the contract for NHS work, not through lack of demand, but because of the crisis in recruitment of dentists.

Practices who do not hit their targets in the contract face financial sanctions. BDA chair Eddie Crouch said: 

“Patients will struggle to comprehend why this government is about to take hundreds of millions from the frontline during an access crisis….. It’s not because there’s any lack of demand for dentistry, it’s simply that practices are working to a failed contract and can’t fill vacancies.”

He added:

‘This will push dedicated NHS practices to the wall or to the private sector and leave whole communities with no options.’

A small light in the darkness, however, was the beginning of an inquiry by the Health and Social Care Committee in the Commons into NHS dental contract reform, recruitment and retention of dentistry professionals, and access to dental services.

The inquiry was prompted by a 2022 investigation, by the BBC, supported by the BDA, which found that nine out of 10 NHS dental practices were unable to accept new adult patients and eight in 10 NHS practices were not taking on new children for treatment.

The inquiry held its first public session on 21st March, with oral evidence from dental leaders on the NHS dentistry crisis.

Chair of the British Dental Association (BDA) General Practice Committee, Shawn Charlwood, told the inquiry:

“The fundamental barrier has been funding. There is only enough NHS dentistry commissioned in this country for 50% of the population. Now can you imagine if this was general medical practice? There would be rioting.”


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