Services Dental Crisis - Neglect Mirrors GDC Decline

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Published: Wednesday, 13 March 2024 10:17
Written by Peter Ingle
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Services Dental Crisis - Neglect Mirrors GDC Decline

It is not unusual for the papers to carry stories about the poor state of the UK’s defences. Misfiring missiles, broken down rusty aircraft carriers, and the Ajax armoured vehicles now expected to arrive a decade late, over budget, and which in trials made their occupants deaf, are just some examples. 

Dental care in the Forces appears to have become similarly inadequate. With total numbers hovering at around 150,000 and an Army that is the smallest since the Napoleonic wars, they cannot afford to lose scarce personnel to dental issues. Yet that has been allowed to happen, and a similar template is likely to be applied to civilian dental care.

There is a serious occupational health issue for the forces over their poor dental condition. Not only can it incapacitate personnel, but there will be an added difficulty, risk, and cost, in transporting affected individuals from field sites when urgent treatment is needed.

The Telegraph has published a story revealing just how bad things are. Headlined “Thousands of British troops have rotten teeth and bad gums,” it goes on to reveal that more than 10% of serving personnel across all three Forces require urgent dental treatment. The nearly 27,000 troops affected may face a long wait before they are deployable. Released in response to a Freedom of Information request, the latest MOD figures reveal that the number needing urgent care has increased by 5000 in 12 months.

For the BDA, Eddie Crouch commented that the situation is, “An utter disgrace.” He referred to the same “casual indifference to dentistry” that has affected civilians also affecting British troops. On X the BDA linked to the Telegraph story commenting: “When we’re living in such a dangerous world it’s utterly perverse that dental problems are incapacitating our troops.”

Difficulties such as those that the forces are now facing, just like the access crisis the general public are familiar with, do not develop overnight. Both civilian and military dental failings have been years in the making. Ironically some of the contributing reasons for the forces current difficulties are now being proposed as solutions for NHS dental challenges. If commissioners really want to know how funding cuts, reducing provision, and using a less skilled workforce in primary care will turn out, they could look at the military experience.

The decisions whose consequences are now playing out in the military, were made 10 or more years ago. Budgets changing regularly, add to the challenges of fixing the structural problems in dental provision both in the Forces and the High Street. Things have come to a head as Forces dental teams are required to place all personnel into one of 3 NATO categories. Those who are dentally fit, are allocated to category 1, those who may have problems in the next 12 months to category 2, and those who will have problems in the next 12 months, category 3. It would seem that the Telegraph figure of 27,000 applies to categories 2 and 3. If one were to apply the same criteria to the civilian problem it could be that as many as 60% would fall into categories 2 and 3.

The major reshaping of military dental care occurred under the Forces CDO Sara Hurley as part of project MOLAR (Military Oral Liability Army Recruits). It has now been in place since 2006 with the claim that it would improve and maintain the whole forces exposure to dental risk. Following her next post as CDO with NHS England, she is now setting out her vision for the future of primary dental care at the University of Suffolk CIC.

Another key figure was Sarah Ramage who was involved with implementation of MOLAR and whose long military service culminated in being CDO Defence for two years prior to her departure in July 2019.

GDPs will be familiar with one of the efficiency improvements described in a presentation entitled “Managing the impossible, lessons from the defence dental services” which she gave in 2014. Questioning the need for protected time for admin it was suggested that instead time could be found for it between patients, or during lunch. After leaving the forces Sarah Ramage moved to BUPA Dental Care where she is a Clinical Director.

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