The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, before I respond to the particular points raised by my noble friend on the issues to which she drew our attention, I begin by paying tribute to the way she has consistently championed the commitment of members of her profession to improving the oral health of the population and the quality of dental care provided in this country.
The oral health of the nation has been transformed since the creation of the NHS in 1948, and the rate of improvement has picked up pace since the introduction and widespread use of fluoride toothpaste in the late 1960s and early 1970s, and the growing awareness of the need for good oral hygiene.
The coalition made two key commitments in relation to dentistry in 2010: to increase access to NHS dentistry and to improve oral health by reforming the NHS dental contractual system. We are making solid progress on that reform. As noble Lords know, there is currently an engagement exercise aimed at dentists and the wider dental community. As part of this I took part last month in a web chat, and I was encouraged by the positive—though, of course, rightly robust—questioning and debate from those dentists who took part.
However, we are not waiting for this more fundamental reform before starting to tackle access and oral health. We are already making progress on delivering on those commitments. The people of this country appreciate the ability to access dental care when it is needed, and the number of people seeing a dentist under the NHS since May 2010 has increased by 1.5 million. We are also committed to working with our partners, including those in the profession, to improve the oral health of the population—with a particular focus on children. The latest epidemiological data published by Public Health England demonstrates that progress is being made. Like the noble Lord, Lord Hunt, I follow with interest the decisions being taken locally about fluoridation of water.
These decisions are best taken locally and the arrangements we made under the Health and Social Care Act 2012 are intended to increase democratic legitimacy of decisions on fluoridation; I am pleased that the noble Lord attended the 50th anniversary of the city of Birmingham’s fluoridation scheme. Dental caries continues to affect a sizeable proportion of the population and is a common cause of children being admitted to hospital, as my noble friend mentioned, for the removal of decayed teeth. Public Health England recently published a health monitoring report which showed lower rates of tooth decay and hospital admission in fluoridated areas compared to non-fluoridated areas. In March, Public Health England published guidance for local authorities on improving oral health for children and young people. That guidance advises on the range of measures, including water fluoridation, that local authorities might consider as part of their oral health improvement strategies.
One of the real drivers of this improvement in oral health has been the greater appreciation by the public of the value and importance of both good oral health and acceptable appearance. With this value now placed on oral health has come significant technological development, and again the dental profession must be congratulated on the way it has researched and developed new techniques and procedures to improve oral health and functionality; the use of implants, which my noble friend focused on, is a case in point. We recognise that inequalities still exist and my officials are working with colleagues in Public Health England, NHS England and local authorities to tackle those inequalities; nevertheless, the overall trend is positive.
My noble friend pointed out that smokers are more at risk of peri-implantitis. Public Health England’s Smoke-free and Smiling guidance supports dentists to make brief interventions to help patients who want to stop or cut down to access dedicated stop-smoking services. Dental surgery is a key opportunity to get across brief messages of issues that have implications for oral health—and in this case, of course, the patient’s wider health.
Dental implants can be used in a range of situations. They can play a key role in reconstruction, post-trauma or major surgery. They can sometimes be used, as my noble friend mentioned, as a support for a more extensive prosthesis following surgery for head and neck cancer, and can also be used to retain restorations in the mouth where teeth are missing. I know that the vast majority of cases where implants have been used to replace missing teeth have historically been provided in the independent sector, outside the auspices of the NHS. There are, of course, many other treatment options to be considered, including bridges or dentures, depending on the individual clinical circumstances.
The NHS has a duty to commission services which are both clinically appropriate and cost effective and it is important when discussing the replacement of missing teeth that all those options are discussed. We also need to be aware, as my noble friend mentioned, that some patients choose to travel abroad to have implants fitted because the initial treatment might be available abroad at a lower cost. The General Dental Council has good guidance available on its website for members of the public considering travelling abroad for dental treatment. It is important that people travelling abroad for this sort of treatment understand that, without the ongoing clinical care and support that this type of treatment requires, what looks like a low-cost option initially might ultimately turn out to be high-cost—both financially and from a health outcome perspective.
I am aware that NHS England is providing a series of commissioning guides to give clarity to commissioners and clinicians when discussing treatment options with patients. For dentistry, four such guides are in development, focused on specific areas of dental care. One of these is a restorative commissioning guide and the appropriate use of implants is, I understand, included as part of that work. As my noble friend quite rightly mentioned, appropriate post-placement care is vital if these restorations are to be successful in the long term.
There has been a significant increase in the placement of intra-oral implants in the last 20 years and, although the immediate result can be instantly impressive, it is vital that patients receive good aftercare, including the periodontal checks my noble friend referred to and instruction on how to maintain a healthy interface between the implants and natural tissue. Indeed, in the third edition of Delivering Better Oral Health: An Evidence-Based Toolkit for Prevention, published recently by Public Health England, there is a section on peri-implant health which focuses on these very issues. This provides detailed guidance for clinicians on what they should do at each visit for patients who have had implant treatment. We would expect clinicians to carry out procedures only where oral health is good enough to support the treatment being provided—the point made by our noble friend Lord Colwyn, who cannot unfortunately be with us—and to provide aftercare advice to patients, including advice on self-care and the need for regular check-ups.
However, we know that there is more to do. My noble friend will also, I hope, be pleased to hear that my officials and the Chief Dental Officer have already recognised the issue she raises as a potential area for growing concern. A UK-wide working group, which includes representation from the dental faculties, has been established. Chaired by the Chief Dental Officer, it will look at developing clear and consistent cross-system guidance relating to treatment planning prior to the placement of implants, the education and training required by the clinicians—a point raised by the noble Lord, Lord Hunt—and best practice for aftercare, as referred to by my noble friend. It will also look at how appropriate, easily understood information can be made available to members of the public considering this form of treatment. I am pleased that this group has been set up and understand that it met for the first time earlier this month.
I hope that my noble friend is reassured by the fact that we have already recognised this as an area where public awareness needs raising and that we are taking action to address this. At the end of her excellent speech, my noble friend mentioned the recent data regarding the admission of young children for the administration of a general anaesthetic for removal of teeth. This is unacceptable as dental caries is a preventable disease which can be almost eliminated by the combination of good diet and correct tooth-brushing, backed up by regular examination by a dentist. NHS England is working with colleagues within and outside the profession to educate and inform the parents of these young children so that they are not subject to this extremely unpleasant experience at such an early age.