
A water fluoridation review and NHS contract reform are among the recommendations made to the mayor of London following a new investigation into the state of the capital’s dentistry.
Carried out by the London Assembly’s health committee, the report argued that water fluoridation could benefit ‘in all sectors of society, irrelevant of age’.
Titled Decay and delay: The state of dentistry and oral health in London, the City Hall investigation put forward a series of recommendations after looking at the state of dentistry and oral health in London.
These include:
- Lobby the government to start reforming the dental contract
- London’s Integrated Care Boards (ICBs) to carry out assessment of dental needs in their area
- Introduce a supervised brushing scheme for three- to five-year-olds
- Prioritise the oral health of Londoners in the next Health Inequalities Strategy Implementation Plan.
Statistics suggest that one quarter of five-year-old children in London have experience of tooth decay. On top of this, 25.8% of five-year-olds in London experienced tooth decay in 2021-22 – which is higher than the English average of 23.7%.
Water fluoridation ‘part of a suite of interventions’
During a discussion at the committee’s second meeting about the benefits of water fluoridation, Charlotte Klass, a consultant in public health, said: ‘The evidence base around water fluoridation is that it successfully reduces caries prevalence in all sectors of society, irrelevant of age, and most importantly it does not require a sustained behavioural change at an individual level.
‘As with all community-based oral health interventions, it benefits those individuals from more deprived backgrounds and therefore does reduce health inequalities and oral health inequalities. However, we need to think that water fluoridation alone will not eliminate dentinal decay but would be part of a suite of interventions and preventative strategies.’
Water fluoridation was included in last year’s NHS dental recovery plan, with some moves being made to widen its scope, including a water fluoridation consultation in the north-east of England.
NHS dental contract ‘disincentivises’
The report also highlighted the importance of pushing for NHS contract reform.
It read: ‘The current NHS dental contract is severely flawed and needs fundamental reform. As well as disincentivising dental professionals from taking on NHS work, the evidence received by the committee suggests that the contract disincentivises them from targeting work towards those with the highest needs and is not designed to focus on prevention.
‘Funding for NHS dentistry has not kept pace with inflation. There is currently not sufficient commissioned NHS activity to meet the needs of London’s population.’
The British Dental Association (BDA) contributed to the findings, calling for the mayor to support London’s ICBs ‘to work creatively and collaboratively with dental providers through greater use of flexible commissioning approaches’.
BDA chair Eddie Crouch said: ‘Sadiq Khan has a powerful voice. On free school meals the mayor has already gone further and faster than the UK government.
‘By using his powers and his influence he can do the same to ease London’s dental crisis.’
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