A Westminster Hall debate, initiated by Steve McCabe MP raised the issue of dental decay in children and the large numbers admitted to hospital for extractions. 14 MPs took part before junior health minister, Steve Brine MP, replied saying that prototypes would be extended for another two years before a new contract was rolled out.
The debate was opened by Steve McCabe, Labour MP for Birmingham Selly Oak, who had been well briefed by the BDA prior to the debate. He said that child tooth decay represented a much bigger public health issue than appeared to have been recognised so far. It was a problem affecting millions of children, including some of the most vulnerable. “It should be a real concern to us all,” he said.
He told MPs of the shocking statistics about child oral health and the impact that subsequent extractions had on the patients and the cost of the NHS. He said there seemed to be three crucial steps to addressing the problem: “getting children to brush their teeth twice a day; ensuring they see a dentist regularly from a young age; and reducing the amount of sugar that children consume”.
He said “We may need to reconsider certain elements of existing dental contracts to see if we can better incentivise some dentists to pursue a preventative dental strategy with children.” He reminded MPs that there had been a clawback of £95 million through undelivered units of dental activity in 2013-14, rising by 36% to £129 million in 2016-17.
He concluded by saying that childhood tooth decay was a problem that affected millions of children. “Addressing tooth decay is not complicated; we know what works, and the actions I have outlined today could make a real difference,” he said.
He was followed by Sir Paul Beresford, Conservative MP for Mole Valley and a practising dentist, who said the statistics on child dental health were horrific. Prevention must be the way forward, he said. We needed a national oral health programme, such as that in Scotland, which should target poorer areas and areas of poor health, although this is not about poverty—it is about education. He acknowledged the work that CDO England, Sara Hurley, and her team were doing to promote better oral health in children.
He also said that far and away the biggest proven method of reducing tooth decay among children, and ultimately adults, was water fluoridation. He concluded by saying that the answer to the problem of child tooth decay had to be a combination of fluoride in the water supply, fluoride in toothpaste and using the opportunity to get out into schools and teach the kids. “If we teach the kids, we teach the mothers. Dental decay is preventable; let us prevent it,” he said.
Among the other contributions to the debate was one from Dr Phillippa Whitford, the SNP MP for Central Ayrshire and a member of the House of Commons Health Select Committee. Speaking about Childsmile in Scotland, she commented that it had transformed dental health in Scotland, with extractions having gone down by a quarter. She also mentioned the Childsmile practice programme, which involved all NHS dentists in Scotland. It linked dentists with health visitors and public health nurses and ensured that from the age of three months children could attend a Childsmile-registered dentist. It was crucial that in England numbers seeing a dentist must improve. Having described the UDA system in England she said that dentists were not rewarded for prevention, whereas dentists in Scotland are paid for doing fluoride varnishing and fissure sealants.
Replying to the debate, junior health minister Steve Brine MP answered many of the questions that had been raised by MPs in the debate. He said that dental diseases were preventable. He wanted to put on the record that children’s oral health was better than it has been for years, but there was clearly a long way to go.
He spoke about the extensive work being led by Public Health England as well the wide range of activity nationally in reforming the dental contract, and locally, in initiatives such as “starting well” run by NHS England. He acknowledged “the vital role that dentists play in this. They are a brilliant part of the NHS.”
He said that the sugar levy addressed some of the root causes of dental disease, and the “red book” that all parents receive after the birth of a child has clear messages about the importance of good oral hygiene and early dental attendance.
He spoke of prototype contracts where a “new way of delivering care and paying dentists” was currently being trialled in 75 high-street dental practices. He said: “At the heart of that new approach is a prevention-focused pathway that includes offering all patients an oral health assessment and advice on diet and good oral hygiene, with follow-up appointments where necessary to support patients’ self-care and carry out further preventive treatments.”
He added that the new approach “aims to increase patient access by paying dentists for the number of patients cared for, and not just for treatment delivered”. An evaluation of the prototype agreement scheme was due by the end of this year, and it would set out detailed findings from the first full year of testing that new system. However, they had decided to extend the prototype agreement scheme to allow it to run for a further two years, to allow for further testing.
He ended by saying: “I hope that in setting out some of the work done by Public Health England, the Department of Health and NHS England, I can reassure Members about our commitment to improving children’s oral health for the future.”