Sir, whilst undertaking my dental core training at an oral and maxillofacial unit, I have learned the truly damaging effect of the lack of NHS dentists on patient health and the additional pressure it is putting on already over-stretched NHS hospitals. Patients attending A&E departments with facial swellings associated with dental abscesses is not uncommon. Often, these patients report not having an NHS dentist, being unable to find an NHS dentist or being on a waiting list for an NHS dentist. Indeed, this is the case for both children and adults alike. Recently, a patient was admitted for IV antibiotics and therefore subsequently occupied a hospital bed. When obtaining a dental history, he reported not attending the dentist since childhood due to being unable to find an NHS dentist and an inability to afford a private dentist.
Patients admitted to hospitals with dental abscesses often require extra-oral incision and drainage and extraction of teeth under general anaesthesia. This obviously has massive cost implications, with theatres being occupied and a need for anaesthetists, theatre staff and dentists to carry out the procedure. This also takes away resources from other potential areas of need. As we already know, dental caries is a preventable disease and its incidence can be reduced by regular dental visits where prevention can be applied and any carious lesions treated to avoid progression to a state where hospital admission is required. Not to mention, the life-threatening nature of neglected dental abscesses which in some situations can cause serious airway concerns as in cases of Ludwig's angina.
Dental statistics from the GP Patient Survey (January to March 2020) found that of 740,000 participants, only 91.6% of those who tried to obtain an appointment with an NHS dentist were successful in doing so, increasing to 93.8% when excluding the 'can't remember' category.1 This leaves a large number of patients without access to dental care. In addition, 13.4% of participants who did not try to obtain an appointment reported 'I didn't think I could get an NHS dental appointment' as their reason for not doing so, demonstrating the known issue of accessibility to NHS dental care.1 This is now likely to be amplified with the COVID-19 pandemic and many NHS practices no longer accepting new patients. Data from the NHS Dental Statistics for England 2019-20 found that, in England, there were 44.1 NHS dentists per 100,000 population.2 Simple maths tells us that there are simply not enough NHS dentists.
This raises the question of why there aren't enough NHS dentists? Are not enough dentists being trained? Is the flawed UDA system pushing dentists out of NHS general practice and into private or salaried posts? And what is being done to tackle this serious issue?
NHS England. GP Patient Survey Dental Statistics; January to March 2020, England. GP Patient Survey Dental Statistics. [online] Available at: https://www.england.nhs.uk/statistics/2020/07/09/gpps_dent_3758-78929/ (Accessed 31 March 2021).
NHS England. NHS Dental Statistics for England - 2019-20 Annual Report. NHS Dental Statistics for England. [online] Available at: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics/2019-20-annual-report#summary (Accessed 31 March 2021).
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Khaled, K. Access to NHS dental care. BDJ In Pract 34, 5 (2021). https://doi.org/10.1038/s41404-021-0762-z