I was very pleased to be asked to give evidence at the London Assembly Health Committee's investigation into child dental health, and to be given the chance to put forward the views of dentists on the ground.
We asked dentists working in London for their views on the situation on the ground and we were deeply saddened, although not surprised, by your responses.
We've been working hard to secure this investigation and get this issue onto the London Mayor's agenda. We've had a number of meetings with Assembly Members, and in December 2017 we responded to their draft strategy on 'Better health for all Londoners' pointing out that oral health appeared to have been left out of the plan and we provided evidence to get the issue of oral health to be taken seriously.
We've also been working to raise the issues in the media, and I told BBC Radio London about the shocking amount of child tooth extractions in London – 35,000 at a cost of £7m over the last four years. The Evening Standard also covered the story, where we urged the London Mayor to adopt a similar campaign to Greater Manchester's £1.5m funded brushing campaign
I told the London Assembly's Health Committee the issues being faced by dentists in London and the reasons for these shocking levels of decay in young children and I used some of your comments to help build our case.
What's the impact of oral health inqualities in London?
Dentists who responded to our survey highlighted some huge gaps and a lot of unnecessary decay in children. The reasons for this appear to be multifaceted:
"I work in access centre and we see children and young people in pain regularly. This is heart breaking and impacts on the child in so many ways including reduced long-term expectations and dental aspirations. Such pain is preventable." survey respondent
Some of you told us about patients as young as two-year olds often needing full mouth clearances, teenagers who are only seeing a dentist for the first time, with a mouth full of problems, teenagers with pre-cancerous conditions due to betel nut consumption from a very young age, reports of high-consumption by young children of fizzy drinks and sweets and parents and carers not understanding how to look after their children's teeth.
"The first patient I saw as a trainee dentist was a 2-year old who ended up requiring a full clearance under GA due to gross decay and resultant infections." survey respondent
Those who have been working in the NHS a long time report that you don't see any improvement, particularly over the last 20 years, saying there is no focus on prevention, a lack of support and funding for dentists to be able to deliver on prevention. Parents are not well educated about good oral hygiene routines and don't seem to know that check-ups and treatment on the NHS are free for children.
"On a daily basis, I see at least two children who have bad decay and need treatment, it's so sad." survey respondent
What dentists need to be able to deliver on prevention
Many of you expressed frustration about the current contract not supporting prevention at all, and the need for positive change. You'd also like better materials to help educate parents. You'd like to see more promotion done to get children into the dental surgery – you don't feel dentistry is given priority, until someone is in pain, and then it is often too late.
These are wide ranging and difficult issues to address, but they are not impossible.
For too long, we have been calling for a joined-up, preventative approach and one that is more than words, that has some real investment behind it.
Nearly all of our respondents supported the introduction of a supervised toothbrushing scheme in early years settings across the capital and there was strong support for an awareness-raising campaign on the importance of regular dental attendance for children.
In the long run it could save the Government money. It would reduce the cost of extractions, let alone the cost of parents taking time off work, and children falling behind in school work due to pain, and absence from school. Schemes like Childsmile in Scotland have made massive inroads. They have shown a good return on investment.
As I said to the committee, Mayor Khan wants London to be the healthiest city in the world - but it isn't going to happen unless we have real joined-up thinking.
Len D'Cruz, member
BDA Princpal Executive Committee
Improving oral health: prevention first