contracts. Karen Faux reports
Earlier this summer, tabloid headlines proclaimed that NHS dentistry is in the grip of a crisis. The root of the problem is new contracts, introduced by the Government in April, which change the way in which dentists can charge their patients.
With many dental practices now saying these new contracts make it difficult for them to continue with NHS work, there is growing concern that children's teeth are particularly at risk.
Graham Wilding, dentist and founder of the Stop the Rot campaign along with the National Day Nurseries Association, believes there needs to be a climate in which surgeries can flourish rather than one in which they are contracting.
'Many people are experiencing difficulties in finding a dentist,' he says.
'My own practice is inundated with requests from new patients. Existing practices simply can't see everybody.'
Although children's dental health has steadily improved over the past 30 years, Mr Wilding is concerned at a combination of circumstances which are conspiring against young teeth.
'As well as the shortage of NHS dentists there is also the uncontrolled levels of sugar in foods children eat and the change in childcare patterns,' he says. 'The more time children spend in out-of-school clubs and other types of extended childcare, the less opportunity there is for parents to directly supervise their teeth brushing. They may also be exposed to unsuitable food and drinks.'
Gaps in care
The Government undertakes major dental health surveys every ten years and its last report, in 2003, found that 43 per cent of five-year-olds had obvious decay in their primary teeth. This is much the same finding as the 1993 survey, although there was a small drop in the average number of teeth being filled.
Over half of children were reported as having visited the dentist before the age of three in 2003, compared with a quarter in 1983. But despite this apparent rise in attendance, around 10 per cent of children in all age groups were reported as having experienced difficulty in accessing NHS dental care at some point.
Although some might accuse it of being complacent about levels of child dental health, the Department of Health says it is working hard to promote better diet, reduce sugar intake, improve oral hygiene and increase the use of fluoride.
A spokeswoman says, 'The improvement in dental health over the past 30 years has largely been due to the introduction of fluoridated toothpaste in the 1970s and a greater knowledge of the factors in diet that lead to poor oral health.'
While the UK average for tooth decay in five-year-olds may be around the 40 per cent mark, this varies between regions. In some areas in the north it is as high as 70 per cent.
According to the Department of Health, poor dental health is related primarily to diet, which in itself relates to the way people live and their social environment.
It says, 'Not surprisingly, poor oral health is prevalent in those areas of the country which have greater social stress and inequity. Broadly speaking, dental disease is more common the further north and west you go in the UK. The Welsh Valleys, urban areas in West Yorkshire, north-west England and Scotland have the highest level over the disease - and are over three times higher than compared with the south.'
Good habits
Family dentist Nick Patsias of Beckenham, Kent, believes that despite the recent publicity about the state of the nation's dental care, people are largely ignorant of the changes. Reality will only kick in when they have to go to a dentist and encounter problems finding one who will treat them.
'Under the new system, most dentists would be reluctant to take on a new child who needs a mouthful of fillings,' he says.
'My advice to families is to find a dentist who will take the children on and take them there early, before decay sets in. It is also important to go regularly. Patients are no longer automatically registered for 15 months as before and therefore there is no automatic right to continuous treatment.
Dentists will inevitably be much more accommodating with regular patients than with those who only turn up with a problem.'
Mr Patsias assserts that if families are really committed to getting proper advice, they should consider paying for it. 'Although in our own practice we give the option for children to be treated on the NHS, many parents opt for a Denplan type scheme which costs as little as 6.50 a month.
This includes preventative treatment and advice in our preventative dental unit by qualified hygienists, which will make it unlikely the children will ever discover what a filling is.'
Prevention is always better than cure and Graham Wilding believes that a campaign such as Stop the Rot is hugely worthwhile. He started the campaign in association with the NDNA after continually witnessing young children in pain visiting his surgery in Lancashire. He praises the support that nurseries have given it.
'It makes sense to get children into good habits while they are at nursery,' he says. 'Nursery teachers are looking for activities that support routine, and regular tooth brushing fits very nicely within that.
It gives children a sense of security and they enjoy the brushing. Children will copy others who are proficient at it.'
Mr Wilding also believes it is proving a very effective way to inform parents. 'Unfortunately there will always be parents who don't care or who are unaware. Through the nursery and their own children they can be educated about ensuring better dental health for their family.'
Given the importance of taking a child to the dentist early on, the current shortage of NHS provision could prove a stumbling block for many families.
But in the meantime, a campaign such as Stop the Rot is working well on the ground to ensure that a child's trip to the dentist need never be anything other than perfectly . painless.
Further information
* British Dental Association www.bda.org
* www.nhs.uk
* www.stop-the-rot.co.uk
Full to capacity
The Government's changes mean that patients will technically no longer be registered with their dentist. A dental practice will try to offer patients an appointment within the time it has set aside for NHS work. The NHS now asks dentists to provide a fixed, limited amount of NHS care each year and so they have to allocate their time and their NHS budget accordingly.
NHS dental treatment is free to:
* Children and young people under 18
* Those under 19 in full-time education
* Expectant mothers
* Mothers with a baby up to 12 months
* Anyone receiving Income Support or Family Credit
* Families with a certificate for full help with the cost of NHS services.
A dentist has a fixed capacity for NHS treatment and although there are no longer registration lists, a dentist may not have the capacity to see a particular patient. If this is the case, the patient will need to contact the local Primary Care Trust (PCT), which may be able to provide an alternative NHS dentist.
With as many as one in ten new dental contracts still unsigned, there can be no denying that - at least in the short term - there will be a scarcity of NHS capacity, which could cause problems for patients.
However, the Department of Health maintains that in the long term, the new arrangements will have benefits. A spokesperson says, 'Dentists will move from the old contract, which rewarded them for the amount of treatment they undertook rather than for preventing disease, to a contract that allows them to spend more time with their patients focusing on prevention.'
But Kent dentist Nick Patsias does not agree. 'The contractual changes will make it much more difficult for families to source free dental care for their children,' he says. 'The funding for children's dentistry has been kept to a bare minimum for years and has been effectively reduced again with this new contract.'
He adds, 'There is also a postcode lottery as to which PCT will award child-only contracts to dentists. In many areas the Trusts have refused to allow child contracts, which have forced dentists totally out of the NHS.'