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The state of oral health in Wales: what dentists' think

Blog Author Tom Bysouth

Blog Date 05/09/2018



​Following the announcement that the Welsh Assembly's Health, Social Care and Sport Committee would be undertaking an inquiry on dentistry in Wales, we asked for you views on the state of people's oral health, what your experiences are of practicing dentistry in Wales and what needs to be done to help improve things.

Thanks to all those who took time out to respond – we will use your comments in our official response to the Government.

Here's a summary of what you said:


What's the state of oral health in Wales today?

The majority of those responding were GDPs (68 per cent), with a smaller amount of community dentists giving views (19 per cent) and 12 per cent working in hospital or other dentistry roles.

Across the health boards, the largest response came from dentists in the Betsi Cadwaladr University Health Board (24 per cent of respondents), closely followed by Cardiff & Vale University Health Board (21 per cent), but we receive responses from dentists working in all the health boards.

Despite the great success of the Designed to Smile initiative, it was disheartening to hear that 24 per cent of you reported you are still seeing 50 per cent (or more) visible signs of tooth decay in patients under five-years-old.

And 39 per cent said you were seeing between 20-40 per cent visible signs of decay in under-fives.

That tells us that although inroads have been made, we are far from where we should be.

You said that extending the Designed to Smile programme to children aged 5-12, would help address the concerning levels of tooth decay - 90 per cent of you agreed or strongly agreed with this statement, and it is something we hope the inquiry will consider.


Prevention needs real funding

"Everybody seems to agree that we should focus on prevention, yet prevention is simply not ' recognized' in the UDA system as an ' activity' and therefore it is not remunerated. We are expected to deliver prevention to each and every one of our patients for free while trying to meet UDA targets in order to keep our practices afloat. Most of us are doing it because we care about our jobs and our patients, but we feel the government is taking this for granted. Money is being taken away from us (through clawback), NHS dental practices are struggling to survive, there is a huge recruitment crisis all over the country because the value of our work is not being recognised, and the highly-skilled work that we do is not fairly remunerated." – BDA state of oral health in Wales survey respondent

We asked what other preventable problems you were seeing in younger patients– you reported tooth loss, erosion (including acid erosion caused by fizzy drinks, or perceived 'healthy' fruit juice drinks by parents), gingivitis and abscesses.

Dummy usage up to school age for some appears to continue to be a problem, causing oral health problems, and poor oral hygiene and poor diets were flagged, as well.

As dentists, it's part and parcel of our job really that we do oral health promotion work with our patients, so it's unsurprising that 86 per cent of you said that you do promotion work in you practice (e.g. putting up posters or doing school visits). More surprisingly is that you do this unpaid – as there is no way under the current contract for this sort of activity to be remunerated.

And yet prevention is the buzz word of the moment.

The message from dentists is clear: they want more investment for dentistry in Wales, to improve access and address the oral health inequalities that continues to hold us back, especially compared to the other UK countries - 96 per cent of you agreed or strongly agreed with this statement.

The stats show that over one third of five-year-olds are suffering from visible dental decay and  22 per cent of the five- to fifteen-year-olds who live in Wales show extensive tooth decay (dmft of 5+), which is 10 per cent higher than that seen in England.

Perhaps it is time some of the money that disappears from NHS dentistry due to clawback, is reinvested back into dentistry – 97 per cent of dentists agreed or strongly agreed with this idea, for us, it's a no-brainer really.


Dental contract reform: it can't wait

"Remove the UDA system. It's hugely demoralising and penalises dentists who want to provide preventative advice and care." – BDA state of oral health in Wales survey respondent

Nearly all our respondents expressed frustration at the current dental contract. Eighty-seven per cent of you agreed, or strongly agreed, that there is need to provide a prevention-based NHS dental contract that makes a decisive break from targets.

Many of you also expressed frustration at the length of time it is taking to change the system, and are asking – I think quite reasonably – why can't it be now?

Those working in high-needs areas, were particularly vocal about the need for change, to enable all patients to be treated appropriately:

"The system needs to change. We are penalised when we see patients with high-needs. This is a disincentive to opening the books to new patients. It's also a ticking time bomb for the older generation with heavily restored mouths. The system will not recompense sufficiently to treat this considerable group, many of whom had the original treatment at different practices (and countries) years ago. So, despite what the CDO may say, I think oral health and dental care for the majority is on the slide unless, we move away from a targeted based system and concentrate on patients need; which will vary between areas." - BDA state of of health in Wales survey respondent

Some of you asked for the removal of target-driven contracts from under-fives and getting more GDPs working in deprived areas or treating vulnerable patients:

"There needs to be a fairer rate of pay for those dentists working in higher-need areas. It is unfair to pay an average UDA value when you are fighting a sea of decay and periodontal disease in a high need area. More funding is needed for elderly care, such as domiciliary contracts. Also provide funding for services such as sedation which aim to help those who often have a high need but are too anxious to seek treatment." - BDA state of oral health in Wales survey respondent


Recruitment and access to dentistry: a looming problem

"Funding and recruitment of dentists in Wales is proving increasingly difficult. Yet, we are told they are training enough dentists, and yet we seem to have a 'brain drain', when our students choose to go to work in England, or increasingly want to work part-time, due to lack of career satisfaction." - BDA state of oral health in Wales survey respondent

Many of you felt that there is a looming problem with recruitment for dentistry in Wales. Eighty-six per cent of you felt that more needs to be done to encourage younger dentists to work in Wales.

The issue of access for emergency dental patients was also raised, one dentist said there is a need for the provision of an emergency service for 12-18 hours every day, to cater for those who require appointments at short notice.

Another felt that there really needs to be more public education about the importance of attending regular dental appointments – to help stop the problem of those only seeking treatment when an emergency arises, and those who book and then fail to attend.

Prevention: the wider role of public health information

As dentists, we know that sugary foods and drinks aren't good for teeth. The state of children's teeth in Wales show that parents don't always seem to be getting the message or aren't understanding it properly.

Ninety-six per cent of you agreed or strongly agreed, that we need to do more to inform parents of young children about the dangers of sugary food and drinks for good oral health.

Dentists cannot do this alone.

Prevention cannot be done without continuing investment and without a coherent programme to ensure all the relevant health and social care agencies are involved, along with schools and parents/carers.

The messaging needs to be consistent and sustained. 


Many of you feel more needs to be done to educate parents regarding oral health and health diets for children – and that schools should have a mandatory remit to educate on the importance of good oral health.

Ninety-four per cent of you agreed that we need to limit the marketing and promotion of sugary foods and drinks to young.


What dentists' need

"Environment. Litigation. Bureaucracy. Not be judged on numbers. Feel valued." BDA state of oral health in Wales survey respondent

At the end of our survey, we asked for your comments on what you felt you needed to treat patients more effectively – nearly all of you replied to this.

Most focused on the need for more funding for dentistry, fair remuneration (especially for preventative work), many highlighted the problems with the current NHS dental contract and the need for urgent change.

The message is clear – our dentists are doing a fantastic job in the face of much adversity, but they know they more could be done – I will relay this to the Inquiry committee, alongisde your comments, when I present our oral evidence in September.

It's up to the Welsh Government to step up and agree to invest, support and value our dentists, to ensure the levels of good oral health in Wales improve, rather than decline.

Tom Bysouth, Chair

Welsh General Dental Practice Committee

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