Dental Health: Children

Lord Colwyn Excerpts

Thursday 18th January 2018 Grand Committee

[Lord Colwyn (Con)]

My Lords, I declare my interests as a retired dental surgeon, a fellow of the British Dental Association and vice-president of the British Fluoridation Society.

I thank my dental colleague, my noble friend Lady Gardner, for securing this debate. This is very timely, considering the extensive coverage that children’s tooth extractions received in the media just last weekend. This came after the number of youngsters admitted to hospitals to have rotten teeth removed hit a new high. Despite tooth decay being an almost entirely preventable disease, we now see 170 children undergo an unnecessary general anaesthetic because of it every single day. Such operations have cost the NHS £165 million since 2012. As someone who performed thousands of tooth extractions under a general anaesthetic in my dental career, I know as well as anyone that the cost of these procedures goes far beyond the financial impact on our health service: think of the pain and distress for the child, the lost sleep and school time, and the stress and time off work for the parents. Children in many parts of the country have to wait up to a year for their operation, and many kids end up spending months and months on painkillers and antibiotics. This really is not good enough in the 21st century in one of the richest countries in the world.

As the Minister will know, Scotland and Wales have achieved unprecedented improvements in their child oral health outcomes in recent years by introducing the pioneering national programmes, Childsmile and Designed to Smile. The British Dental Association has been calling for England to follow in the devolved Governments’ footsteps for years so that English children can benefit from these simple, tried-and-tested solutions.

Dentists welcomed the first step made in England with the recently launched Starting Well programme, but I share the BDA’s concerns that this new scheme is currently limited to some 13 local authorities in England. I understand that in London only 12 practices in Ealing are taking part in the scheme. This is in the context of well over 4,000 national dentists practising in the capital. So, although the scheme will reach some children in the areas with the worst outcomes, there will still be millions of others across England who will miss out. Will the Government look into expanding the scheme beyond the 13 initial sites so that more children in England can benefit from it?

The other scheme that has recently started is Dental Check by One, which is being championed by the British Society of Paediatric Dentistry and is supported by the Chief Dental Officer. As the name suggests, the scheme aims to ensure that young children are taken to see a dentist before their first birthday. This is important so that the child becomes comfortable in a dental environment from an early age and so that parents can be given advice on how to take care of their offspring’s teeth. If a child’s first visit to a dental practice is traumatic—if they need a filling or an extraction—in many cases this will deter them from going to the dentist later in life. Therefore, it is crucial that their first check-up is a positive experience. With just 20% of children under the age of two having been to the dentist in the last year, it is certainly important that we raise awareness among parents of the importance of taking them as soon as their first teeth come through. However, we need to remember that the total amount of NHS dentistry commissioned in England is limited, and in fact NHS England commissions only enough of it to cover just over half the population. In many areas of the country, people are still struggling to find a dentist who is able to see new NHS patients.

According to a recent study by the BBC, 48% of NHS practices in England are not accepting new adult patients while 40% are not accepting new child patients. Saying that all parents should take their children to the dentist as soon as their teeth erupt is a great idea, but it will not become a reality until the Government ensure that enough NHS dentistry is commissioned for those who need it.

It is important that any national preventive programme is properly and sustainably funded. I understand that the Starting Well initiative will not be receiving any new funds, with all the money coming from existing dental budgets. Underfunding NHS dental services is similarly pointless. NHS dental budgets have gone down in real terms by 15% in the past seven years while patient charges have been going up at an inflation-busting pace. The effect is that every year hundreds of thousands of patients waste precious NHS resources seeking free help with dental pain at GP surgeries and A&E departments, along with an ever-increasing bill for children’s hospital tooth extractions.

Finally, I should like yet again to point out to the Committee that a cost-effective way of improving outcomes and reducing oral health inequalities is the wider use of water fluoridation. Colleagues will know that I have favoured this solution for many years, and we have heard about it from my noble friend Lady Gardner. The evidence for fluoridating water supplies is indisputable. It is safe and good for teeth, particularly in childhood. While the ultimate decision on whether to introduce fluoride into the water supply lies with local authorities, central government could do much more to facilitate local conversations about this and assist those councils which think that this is a measure that would work well in their area. I know that the Minister will have heard all these arguments before, but I hope that she will take them on board and pass them on to her colleagues in the department. Child tooth decay is preventable and it is high time that we started doing a better job of preventing it.