Written evidence submitted by Richard Bannister (DTY0020)
I am a practicing dentist, in private practice but have previously worked for the NHS.
I believe the problems with NHS dentistry are down to a number of factors but here are four main ones.
1) Increasing patient / social expectations, whilst investment is not keeping pace. In the 1970s patients were content with simple fillings, extractions and dentures. Nowadays dentistry is much more complicated, we are better able to save teeth, and social expectation is therefore to keep more teeth for longer.
This comes at a price in time and manpower. For instance, a root canal on a molar tooth is a highly complex procedure involving tiny instruments less than 1/10 millimetre in diameter; even a highly skilled dentist should be taking around two hours or more. Many cases are too complex and need ideally should be referred to a specialist or DWSI (dentist with special interest), though there is little or no provision for this. Furthermore, these teeth need further protection with a crown (another hour and a half). 3 1/2 hours work, versus half an hour for an extraction.
The current contract is severely under-funded for such advanced treatments, and any NHS dentist performing these treatments is operating at a heavy loss.
2) Insufficient dentists (especially since Brexit) / insufficient dentists in poorer areas of the UK. Many graduates unfortunately do not want to work in remote, rural or economically-disadvantaged areas, yet these are the areas that need NHS dentistry the most.
3) Prevention: Personal oral hygiene, diet, and fluoride to prevent cavities
4) Trainee dental nurses being required to register with the GDC almost immediately. There are many hoops to jump through, when often a young trainee just wants to see whether the job is right for them. This is off-putting for many and it is becoming increasingly hard to recruit nurses.
1) NHS dentistry can either be a comprehensive service for some (eg those on benefits, children, pensioners), or a limited service for all. It is abundantly clear that it CANNOT be a comprehensive service to all, which it still purports to be. I believe no molar root canal treatment should be available on the NHS. If the tooth needs extracting, so be it, or the patient can pay to go private. I believe no white fillings on molars should be available, as these take significantly longer to do than amalgam at higher cost, yet there is no evidence of them lasting any longer than amalgam. It should be allowed for dentists to mix NHS and private care, as long as the patient is fully-informed and consented.
2) Positive incentives for dentists, particularly young and overseas-qualified, to work in more remote areas. Streamlining of examining processes for overseas graduates looking to work in the UK.
3) Tooth decay and gum disease are largely preventable conditions. Better in-school education, and advice to parents in maternity departments and early years institutions is needed. Water fluoridation is the most cost-effective way of reducing overall tooth decay levels, particularly in the more socially and economically deprived areas.
4) Trainee nurses should have a 6 month grace period where they work as an apprentice dental nurse, before having to start the registration process.