Dental health for all

Alison Johnstone calls for more action to improve dental health in the most disadvantaged areas.

The National Dental Inspection Programme report published last week revealed that 69.5 per cent of children living in the most deprived areas showed no signs of tooth decay, compared to 88.1 per cent in the least deprived. The British Dental Association (BDA) Scotland has warned that attendance from patients in Scotland’s most deprived communities has plummeted to record lows, in contrast to figures from the least deprived areas. This disparity does not just exist for children, as there is an attendance gap of nine percentage points for children and ten for adults, both having increased from just three percentage points in 2008.

While registration levels at the dentist continue to be high, BDA Scotland has cautioned against ignoring the widening gap between rich and poor when it comes to attendance. A significant number of people register but never actually make an appointment and, as of September 2018, only seven out of ten registered patients had seen an NHS dentist within the last two years.

Children and adults from the most deprived communities were far less likely to have seen their dentist within those two years than those from the least deprived. There is an expanding gulf between registration and attendance that must be urgently addressed.

The Childsmile programme, which aims to improve the oral health of children in Scotland and reduce inequalities in dental health has had some success in this regard. Parents bring their children to the dentist and receive advice about teeth brushing, diet and dental care. Giving children the best start in life in terms of dental health will hopefully encourage continued attendance as they grow older. There is also anecdotal evidence that parents will often make appointments themselves after ¬having attended with their child, helping to tackle that disconnect between registration and attendance.

The importance of early intervention cannot be overstated, and dentists are well-placed to deliver preventative healthcare. They provide advice on nutrition, smoking cessation, alcohol intake, and play a key role in cancer diagnosis. Residents in Scotland’s most deprived communities are more than twice as likely to develop and die from oral cancer, and early detection is vital.

However, the Minister for Public Health has previously admitted that some patients are experiencing “unacceptable” waits for dental treatment. BDA Scotland has cautioned against the possible introduction of two-year waits between dental appointments for low-risk patients as part of the Scottish Government’s Oral Health Improvement Plan. If dentists are afforded the opportunity to detect oral cancers early, lives can be saved. With this in mind, reducing access to dental appointments is surely a step in the wrong direction.

An adequate workforce is crucial to success, however many dentists are leaving the profession or retiring, frequently citing the stressful working environment. Health Boards are struggling to recruit sufficient numbers while the Scottish general dentistry budget is falling in real terms and BDS Scotland has warned about the impact of the diminishing workforce on patient care. The Scottish Government must ensure the sustainability of dentistry or attendance levels in our most deprived communities will not ¬continue to decay. It is not acceptable that privileged children continue to have more healthy smiles.

This blog was first published in the Evening News on 29 October 2019.