Dentists urge action on inequality in Holyrood race
7 April 2021
The British Dental Association has
urged all candidates contesting the Scottish election to pledge to commit to tackling the shameful inequalities in oral health set to go into overdrive as a result of the pandemic.
Unpublished data from Public Health Scotland has shown a dramatic reduction in NHS dentistry due to COVID, which is hitting those in most deprived communities the hardest. Between April and November 2020, the number of courses of treatment delivered was 83% lower than during the same period in 2019.
Official figures show that primary school children from the most deprived communities experience more than four times the level of tooth decay compared to children in the least deprived areas. Latest data also shows that in 2020 children and adults from the most deprived areas were less likely to have seen their dentist within the last two years than those from the least deprived areas (73.5% compared to 85.7% of children and 55.9% compared to 67.1% of adults) and this gap has widened compared to the year before.
The impact is now being felt in all corners of the service. The Public Dental Service– which treats specific patient groups including care home residents, children with additional needs and adults with disability – also faces a huge backlog, with many of its staff redeployed to urgent dental care centres. 2,500 children are now estimated by the BDA to be on waiting lists for dental extractions under general anaesthetic, which may take years to clear.
High street practices continue to face wide-ranging restrictions, which have radically reduced patient numbers, including the need to maintain gaps between most routine procedures where surgeries are left ‘fallow’ to reduce risk of viral transmission. Governments in Northern Ireland and Wales have already offered millions to help practices invest in new ventilation systems to cut down this time, and hence significantly expand patient volumes. The BDA is seeking commitments from Scotland’s parties to follow the same path.
The BDA says prevention is now more essential than ever. The pioneering Childsmile programme, delivered via primary schools and nurseries, has secured record-breaking reductions in decay but has been suspended for much of the last year, with many core elements like supervised brushing yet to resume. Restarting that programme and providing additional support in high needs areas is at the centre of the BDA’s plan, alongside calls for Health Boards to be supported to conduct feasibility studies on water fluoridation.
Dentistry challenges are now likely to be exacerbated by workforce problems. None of Scotland’s dental schools is on track to graduate classes at the usual time this year, which will have a domino effect on workforce planning for years to come. The BDA has called for a long-term strategy to ensure Scotland has the dentists it needs to meet this threat, and parallel challenges - including Brexit.
Oral cancers kill three times more Scots than car accidents – and the country has one of the highest rates for the condition in Europe. Residents in Scotland’s most deprived communities are more than twice as likely to develop and die from oral cancer as those in more affluent areas. The BDA is therefore seeking action on smoking cessation, and assurances that a rapid catch up programme will be in place to ensure school children are protected from the Human Papillomavirus via vaccination. HPV is an important risk factor for oral cancer, and while steps were in place to extend the programme to boys in the last academic year, the programme continues to face massive disruption as a result of school closures.
The Association is making direct contact with every candidate seeking election to Holyrood to ask them to commit to addressing oral health inequality.
Robert Donald, Chair of the British Dental Association’s Scottish Council said:
“A wealthy 21st century nation shouldn't accept that a wholly preventable disease remains the number one reason its children are admitted to hospital. Sadly, COVID risks undermining hard-won progress, while leaving our dental service a shadow of its former self.
“The result is that from decay to oral cancers, Scotland’s oral health gap is set to widen, and we need all parties to offer a plan.
“In this campaign we need candidates to do more than talk about ‘prevention’. From helping practices boost capacity, through to expansion of the sugar levy, we have set out simple steps that can put that principle into action, addressing inequality, and restoring services to millions.”
The BDA Scotland manifesto. Bridging the Gap: Tackling Oral Health Inequalities (PDF)
Policy priorities for the next Scottish Government include:
Address the backlog of unmet dental care need. Follow the lead of Welsh and Northern Irish governments by providing capital funding for ventilation to reduce “fallow time” and radically expand patient numbers. Work with NHS Boards to ensure sufficient resources are available at a local level to reduce waiting times for paediatric extractions under general anaesthetic.
Promote prevention to help tackle oral health inequalities. Reintroduce the Childsmile programme as soon as possible with additional support in areas with worst outcomes. Support NHS Boards to carry out fluoridation feasibility studies, along with investment to help facilitate its introduction where applicable.
Ensure NHS dentistry remains sustainable. Keep services sufficiently funded to remain sustainable and accessible to all those who need them, regardless of income. Move on from stop gap COVID arrangements to provide a long-term funding model that reflects how dentistry is delivered. Develop a strategic approach to dental workforce planning that recognises the impact of Brexit and COVID disruption on dental schools.
Improve access for vulnerable groups. Make a concerted effort to get low-income patients attending high street services, with proper resourcing for the Public Dental Service who care for Scotland’s most vulnerable patients.
Integrate oral health with wider public health priorities. Integrate initiatives to improve public health and tackle health inequalities, such as extending the sugar tax to a wider range of products. Provide sufficient resources for effective smoking cessation and alcohol treatment services, and work with NHS Boards to establish effective oral cancer referral pathways. Deliver a fast and effective catch-up programme for any children who have missed out on their HPV vaccination as a result of the pandemic.