The Daily Telegraph - Features
Why British children could soon be wearing dentures
‘Dental deserts’, exacerbated by the Covid pandemic, have left parents struggling to get NHS checkups, leading to a rising tide of tooth decay among the nation’s youngsters,
Like most parents, Katherine Gorman took her children to the dentist every six months. Until, that is, the north London practice that had seen her sons Jack, nine, and Max, four, since they were babies, suddenly told her they were no longer treating NHS patients.
If Katherine wanted the practice to carry on checking their teeth, they said last summer, she’d need to pay for each child privately, on a £7-per-month protection plan, just as she had always paid £11 a month for her adult equivalent. When she refused, she says, they cancelled her next appointment – supposedly on Covid grounds.
Katherine, 41, withdrew herself and her children – her resistance being part cost, part “principle” – but has since been unable to find another practice that will take her children on the NHS near her home. “I’ve called around 12 but they don’t have availability,” she says.
Almost a year after their last appointment, she is starting to worry. Jack already had one filling aged six and she has “no way of knowing” if he needs another. “He’s now got an almost full set of adult teeth, for him this is crucial.”
Last week it was revealed swathes of England have become “dental deserts” in which the NHS is taking on no new patients. Across England, 86.3 per cent of dentists are not taking on new adult patients. For children, the figure is nearly as high, at 78.8 per cent. According to Healthwatch, the entire county of Somerset is now unable to register with an NHS dentist – and children are among the worst hit. If there are spaces to register, patients may be none the wiser as practices fail to provide up-to-date website information. In a recent survey, 4,177 practices had not updated their profiles in the last 90 days.
NHS Digital data reveals only one in seven under-fives saw a dentist in 2020, compared with one in three in 2019, with the British Dental Association warning this “collapse” in access for children during the pandemic will lead to record tooth extractions. New figures show the number of operations on children to remove rotten teeth fell by 58 per cent in 2020-21 as hospitals concentrated on Covid pressures. It is time to “wake up” to the crisis facing NHS dentistry, says the BDA.
Tooth decay is already the most common reason for children aged five to nine to be admitted to hospital, and some are missing school due to being in pain. Last week it emerged that staff at Trinity Academy Grammar in West Yorkshire had called in volunteer dentists from Dentaid – a dental charity that usually helps those in developing countries – to treat pupils. “We’ve had to take students to hospital because their tooth decay has been that bad,” said head teacher Charlie Johnson.
Dr Mervyn Druian, a former NHS dentist who now practises privately, says the state of children’s NHS dentistry is “a scandal that has been ignored.
In 35 years, I’ve never known it so bad. Youngsters are going to grow up missing teeth and having to wear a denture to replace them.
It is a tragedy that a first world country is providing a dental service that would embarrass a third world one.”
So what’s causing the crisis? This month research by University College London revealed children are eating three times the amount of sugar they should by age seven, with fruit juices and smoothies – which parents often assume are healthy – making up the greatest share of sugar in their diets.
But arguably more critical is the underfunding of a convoluted NHS dental contract. Dentists are paid on a complex system of dental units and if a dentist has used up all their units, they are unable to perform paid treatment for the NHS. There’s also a chronic shortage – 2,000 dentists left the NHS last year, an increase of 951 from the previous year. Add to this the pandemic, which created both a backlog for existing patients and an obstacle to parents signing their children up at all.
This toxic combination has forced many to choose between paying for their offspring to go private or forfeiting visits altogether. Dr Shabnam Zai, who works for a private dentist practice, is seeing an increasing number whose decay is too advanced for fillings. “We’re doing more extractions,” she says. “The youngest child came to us when he was three. His mother had been unable to get an NHS appointment during the pandemic.”
According to Healthwatch, even though we all have a right to see an NHS dentist, the NHS only allocates enough money to treat 50 per cent of the population and NHS Digital figures show the dental contract had a 33 per cent pay cut in real terms between 2010 and 2020.
“The current contract is not fit for purpose,” says Chris Groombridge, managing director of 543 Dental Centre and chair of children’s charity Teeth Team.
He adds that up to 30 per cent of the UK’s dentists came from Europe but have left since Brexit, and those remaining have been put under ever-greater financial stress since the pandemic, due to the NHS slashing appointments to reduce the risk of Covid and forcing dentists to spend thousands on ventilation systems, further lowering morale.
Gorman believes dental practices are using unfair tactics to increase their number of private patients. One tactic parents have reported to Healthwatch is having their children turned away as NHS patients unless they’re willing to register with a practice privately themselves, which is against NHS guidelines. The organisation says it’s hard to prove how rife this is or if wires are simply being crossed in communication.
Healthwatch also found practices were removing NHS patients from their lists if they hadn’t made an appointment for a period of time. This happened to Rachel Gardener, who spotted a hole in her seven-year-old son’s tooth in January. “Our dentist said he and I had been taken off their books because we hadn’t been in during lockdown,” says Rachel, 38, from Bristol.
She has since called “well over 100” dentists to try to get her son a filling. Most said they could see him privately – which Rachel, who is unable to work because of a heart condition, can’t afford – but not on the NHS. “It made me angry. Every child should be seen for free,” she says.
A spokesperson for the NHS in the South West said: “More than 550 additional urgent care appointments are available every month across Somerset. We are in the process of securing extra high street dental services to further increase capacity.”
Three weeks ago, Rachel bought a temporary dental filler from a pharmacy that she fitted on him herself: “Luckily he’s not in pain now, but I don’t know how long it will last,” she says.
The NHS advises all children to have their first appointment by age one, as problems with milk teeth can reverberate throughout adulthood. “If children have teeth extracted aged four, five or six, the space those teeth save for their permanent teeth is lost, so these come out overcrowded and poorly positioned, which becomes an orthodontic issue,” says Dr Druian.
An NHS spokesperson said: “The NHS has been clear that dental practices must prioritise children, and we have taken unprecedented action throughout the pandemic to support dentists to continue to treat their patients. An additional £50 million was made available to support patients with urgent care needs in January – as well as income protection for practices unable to deliver their usual levels of activity – and anyone with concerns should contact their local dentist as they usually would or seek advice from NHS 111.”
Yet for children waiting in pain, this may be too little, too late.
‘I’ve never known it so bad. Young people are going to grow up missing teeth’