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​Scotland: Latest data highlights dental access crisis and widening inequalities

The British Dental Association Scotland has called on the Scottish Government to strongly support NHS dentistry to address the large reduction in patients visiting the dentist, as new data reveals further decreases in attendance and ever-widening inequalities.

Registration rates remain high due to lifetime registration – over 96% of the Scottish population were registered with an NHS dentist in September 2021 – but the percentage of children registered fell from 91.4% in 2020 to 87.7% in 2021.

Participation rates – contact with a dentist within the past two years – continued to fall during the pandemic due to ongoing restrictions imposed on dental practices. On 30 September 2021, just over half of registered patients (52.6%) had seen an NHS dentist within the last two years, a considerable reduction from almost two-thirds (65.1%) in 2020. The participation rate among children was higher than for adults (63.9% compared to 50.2%).

Oral health inequalities between the most and least deprived areas in Scotland continue to grow, with the new data showing record gaps in participation rates. In September 2008, the gap between the child participation rates for the most and least deprived areas was three percentage points; this had increased to seven percentage points by 2010, and eighteen percentage points (55.3% compared to 73.1%) in September 2021. Similarly, in September 2008 the gap among adults was three percentage points; this had increased to six percentage points by 2010, and eleven percentage points (45.1% compared for 56.4%) in September 2021.

The BDA has repeatedly warned that lower levels of participation will inevitably translate into a higher disease burden, with deep oral health inequalities expected to widen even further given the cumulative impact of limited access to services, the suspension of public health programmes, and the impact of lockdown diets. Lower participation will reduce the chance of picking up early signs of decay and oral cancers at routine check-ups, and delays in treatment will mean higher costs to the NHS and worse outcomes for patients.

Free NHS dental care at the point of use remains a central Scottish Government policy. The stark results of a recent BDA survey showed that Scottish Government plans to revert to pre-COVID models of care risk sparking a flight of dentists from the NHS, with potentially devastating consequences for patient access across Scotland. BDA Scotland has long warned that a return to a 'business as usual model' – low margin and high volume – will put practices under unsustainable financial pressure and will likely lead to closures or movement to the private sector. BDA Scotland repeats its assertion that the Scottish Government must, in the short term, develop a suitable interim funding package to support dentists and their teams as they work through the backlog, and begin work on a new, sustainable long-term model for NHS dentistry.

Robert Donald of the British Dental Association's Scottish Council said:

"Today's figures provide further evidence of the devastating effect of the pandemic on dental services.

"Plummeting participation rates and the record gap in oral health inequalities present a bleak picture which will take a real commitment of time and resource to fix.

"The Scottish Government needs to heed the concerns of the profession. It's not just their signature policy of free dentistry that risks becoming unattainable. Failure to act risks sparking an exodus from the workforce that will leave families across Scotland losing access to NHS dentistry for good."