Crisis in child oral health

childrenMichael Watson discusses what needs to be done to improve the oral health of the nation’s children.

Last week I attended a meeting of the Commons Health Committee, which was discussing the crisis in child oral health.

One third of children in England suffer from tooth decay, which is the most common reason why five-nine-year-olds are admitted to hospital.

At the hearing, Professor Nigel Hunt, dean of the dental faculty at the RCS, and Stephen Fayle, a paediatric dental consultant from Leeds, said that the problem was caused both by a shortage in specialists and insufficient preventive care.

The message that came out at the committee hearing was that prevention was the key to solving the problem, but that there was little incentive to deliver this within the primary care contract.

The existing pilots and the future prototypes aim to put prevention into the GDS contract perhaps for the first time ever, but hold your breath until 2017/18.

Mention was made of the Childsmile scheme in Scotland, which has resulted in a significant decline in decay amongst five-year-olds from 50% to 32%, as well as a saving of £6 million.

Looking on the Childsmile website, two points struck me: ‘Childsmile is aimed at children from birth’ and ‘aim to register your baby with a dentist soon after birth or by the time they are six months of age’.

Yes the NHS dental systems in Scotland and England are different; no we cannot import Childsmile in its present form south of the border.

But, 20% of units of dental activity (UDAs), and thus 20% of funding, are delivered to under-18s, amounting to nearly £500 million.

We need to ask, before someone else does, what this half a billion pounds, perhaps £30-40,000 per dentist, is being spent on.

If ‘just doing UDAs’ is the answer, I suggest that is not good enough to deal with what is recognised as a crisis.

I would also say that it is no use waiting for a Government or NHS England to impose yet more regulations or contractual obligations on us.

It is time for the profession to take the lead and say how dentists in general practice can do something better for the money they are paid.

Tell the powers that be that practices can start to see children from six months old, taking referrals from health visitors or general practitioner practices.

Tell them that practices can employ dental nurses with additional training to deliver prevention, not just in the practice but in schools.

For too long dentists have been passive recipients of contractual rules; it is time to tell NHS England how the profession can deliver a good preventive service for children.

And let the new chief dental officer work out how to align this with the contract regulations.

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