The British Dental Association has warned the oral health gap in Wales is set to widen in light of official data that nearly 2 million treatments were lost in Wales during 2020-21, with practices facing an enormous backlog of urgent treatment that has built up during lockdown. New estimates place the volume of NHS dentistry delivered at a little over a fifth of usual of usual levels.
Dentists have stressed patients across Wales will now inevitably face worse outcomes, with opportunities lost to act on the early signs of tooth decay, gum disease and even oral cancer. While practices in Wales did not suspend all face-to-face care like colleagues in other UK nations, access was and remains limited, with services operating at a fraction of former capacity.
Dentist leaders are now deeply concerned that the national effort Wales has made addressing oral health inequality in recent years risks being undermined by the COVID pandemic, with access to services currently so limited and major public health programmes suspended. The pioneering Designed to Smile programme, much of which is delivered via schools and nurseries, has yet to fully resume owing to lockdown and ongoing restrictions on activities such as supervised brushing.
The BDA is now actively encouraging all candidates seeking election to the Senedd to commit to bridging these divides. It has set out an action plan including expansion of Designed to Smile to cover 6 to 10-year-olds, tackling workforce issues in impoverished rural communities, and investment of sugar levy proceeds in public health programmes.
More than a third of children in Wales have dental decay by the time they arrive at primary school, with those in more deprived communities suffering a higher burden of disease. Official surveys have indicated children in Hywel Dda are nearly 3 times as likely to undergo extraction of teeth under general anaesthetic as their counterparts in more affluent Powys.
Poor outcomes and difficulties securing timely access to services among young adults also mirrors socio-economic background. Many older people are now retaining natural teeth, but often with complex needs and co-morbidities that can make even basic care – such as brushing teeth – a challenge.
Access to NHS dental services faced crisis prior to the pandemic. Back in 2012, 37% of practices were accepting new NHS patients, but by 2019 fewer than 16% were able to take on new adults. The BDA has urged aspiring Senedd members to make a definitive break from the past, and drop the widely discredited NHS contract system that has been suspended during COVID. The target-based system had effectively capped patient numbers, and not rewarded preventive work.
Dentists have also implored the next Welsh Government to expand the existing £450,000 fund for ventilation equipment to radically expand access to dentistry. Patient volumes have been significantly reduced by COVID restrictions that require surgeries to sit fallow between most standard treatment procedures. With COVID-19 anticipated to remain at an endemic level for the foreseeable future, the BDA has stressed further action here is now a necessity to adequately ‘future proof’ the service. In February the Northern Irish government pledged £1.5 million to support investment in this area.
Wales has suffered from historic underfunding relative to other UK devolved nations. Government spend on NHS dentistry in Wales was £47 per head prior to the pandemic. The BDA say it now time at the very least to bring investment in line with Scotland (£55 per head) and Northern Ireland (£56 per head.).
Russell Gidney, Chair of the British Dental Association’s Welsh General Dental Practice Committee, said:
“Families across Wales have seen what life is like without dentistry, and the impact could be felt for years to come. The sad fact is that the real progress we’ve made on tackling unacceptable health inequalities now risks going into reverse.
“NHS Dentistry was in crisis long before COVID. We have started down the right path, but the next Senedd must go further.
“Oral health is not a nice to have or an optional extra. Wales now has the chance to break with the past, and rebuild a service millions depend on with prevention at its heart.”
The BDA Wales manifesto: Bridging the Gap: Tackling Oral Health Inequalities (PDF)
Policy priorities include:
- Future-proof dental services, by building on existing commitments to support ventilation costs and radically boost patient numbers
- Restart Designed to Smile as soon as possible and invest £2 million to expand the scheme to cover older children.
- Reverse underfunding of dental domiciliary services for older people in care.
- Ring-fence income from the sugar levy to support public health programmes.
- Make it easier to recruit dentists across Wales by offering incentives for practising in rural areas and reintroducing payment models that recognise and reward commitment to NHS services.
- Level the remuneration playing field for dental core trainees and remove the lottery of foundation training placements - so that those who want to train in Wales can stay in Wales.
- Reform the General Dental Contract. There can be no return to the discredited target-based contract that underpinned NHS dentistry in Wales since 2006, and dentists must be allowed to continue to prioritise patients based on their clinical judgement.
- End chronic underfunding. Bring investment in oral health at least in line with other UK devolved nations.