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Why is the UK a Third World when it comes to Dentistry?

If people see a dentist once a year, visit a hygienist three or four times a year, have a healthy diet without too much sugar, and take responsibility for their own oral health, they should keep their teeth for life. 80 per cent of the patients that come to my practice only need an annual check up; that is because they are meticulous about cleaning their teeth and gums, and realise the benefits of such an investment.  But they are not the norm.  Many people in the UK have appalling oral health.  I see people, even on television, with obvious gaps where they have lost teeth.

The common view on this is the lack of NHS dentists, but that is not the case – there are NHS dentists in most areas, although they may often be a junior partner in a practice. However many people just do not make a regular appointment to have their teeth checked – the latest adult dental health survey showed that only 58 per cent of patients tried to see an NHS dentist in the past three years.[1]  Yet this is one area of health where prevention is much easier than cure.  As in all branches of medicine, technology has advanced dramatically in dentistry, and it is possible to ensure most people have a good set of healthy teeth and gums – which makes it easier to eat, and of course looks more attractive.

Yes funding is an issue; currently the National Health Service currently spends 2.8 per cent of its health budget on dental services, which is enough to treat 56 per cent of the population in England.[2]  This means that dentists can actually run out of NHS funded treatment time: Each NHS dentist is given an annual financial limit of work they can carry out on the NHS, and once this limit has been reached, the dentist can no longer recoup the costs, so has to either work for free or refuse to carry out any more NHS treatment until the next financial year. Which doesn’t help a patient with screaming tooth ache.

Underfunded NHS dentistry also leads to tooth extraction and a plastic denture rather than root canal and a crown, or an implant.  The former is a relatively simple procedure and takes little time. Root canal treatment is complicated, time consuming and needs delicate and expensive instruments. An implant, which can cost between two and five thousand pounds if done privately, involves specific training for the dentist, and several lengthy visits to the surgery by the patient.

This means that many NHS dentists no longer offer such sophisticated procedures, and the advanced dental technology which may have less invasive and more permanent techniques, are only available in the private sector.

So for the British public there are two extremes – a limited and underfunded NHS dental service, and a sophisticated, but therefore expensive private sector.  If people can neither afford, nor wish to invest in the latter, they will have poor teeth.  If there’s to be no more NHS funding then there needs to be more insurance services such as the one introduced by BUPA. Countries which have routine dental insurance have a public with better teeth.

But there is one cheaper option which could help UK residents and that is to train more dental hygienists, and to educate the public to visit the hygienist three or four times a year.  As I have already stated, preventing dental decay is an easy option, especially if you have your teeth and gums properly cleaned and checked regularly.  It is the highly trained hygienists who do this – they remove calcified deposits of plaque from under the surface of the gums and it is this bacteria-filled plaque which causes gums to bleed and teeth to decay. Therefore regular visits prevent decay and ensure patients keep their teeth. It makes sense therefore to not only train more hygienists, but to persuade the public to see them regularly. Hopefully then the healthy teeth I see in patients in my practice would be seen nationwide.


[1] Adult Dental Health Survey 2009 (published in March 2011)

[2] British Dental Association

Dr Mervyn Druian
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