Patients are facing a hidden national dentistry crisis, fuelled by the pandemic, that will lead to a rise in oral cancer in coming months and years, dentists and patient advocates say.
People who need urgent dental treatment are struggling to find any NHS treatment in all parts of England, according to Healthwatch, the independent patient watchdog. Senior dentist leaders say surgeries are being incentivised not to deal with the most serious cases and that the profession has been affected by EU dentists leaving the UK.
Nine in every 10 calls to Healthwatch Cumbria are from someone trying to find an NHS dentist, a problem mirrored in most parts of the country, the organisation said. Last year the number of calls and complaints about dentistry rose by 452%. Before Covid-19, one in 10 people could not access dental services. “Since the pandemic, we have been hearing about access to dentistry from people in all parts of the country, and I think that’s quite a significant change,” said Imelda Redmond, national director of Healthwatch. Previously, there were hotspots such as Hull and south-west England with particular shortages, she said. “Now access is an issue everywhere.”
Paul Mitchell, a 48-year-old office manager from Wimborne in Dorset, had a painful two months after a crown on his front tooth came loose while eating a sandwich. He paid £110 for a temporary crown, but was told a replacement would cost £2,000.
“I spent the next week ringing every dentist in Dorset and no one would see me on the NHS,” he said.
He developed an abscess and had to take three courses of antibiotics to deal with the infection. Other private dentists quoted him £3,000. He eventually gave up on the NHS and has paid £700 – a substantial part of his monthly salary – for treatment that is due to end next week.
“I was eating soup for weeks. It was the only thing I could eat because I couldn’t open my mouth to chew – it was too painful,” he said. “What I struggle with is that it’s not a problem if you pay. If you go private, they’ve got no problem seeing you. In my experience, the NHS dental service doesn’t exist.”
After the lockdown began last March, dentists in England were shut until 8 June. Urgent dental-care hubs were set up by April, but the range of treatments was limited, Redmond said, with patients offered extractions rather than treatment that might save a tooth.
The result was 19m fewer NHS dental procedures by the end of October, according to the British Dental Association. Ian Mills, dean of the Faculty of General Dental Practice, the membership body for dentists, said there was still a substantial backlog. “We’re still operating at a fraction of our normal capacity,” he said. “We need to accept that in the current circumstances we need to prioritise the care that we have available to deliver.”
Although dentists want to treat those most in need, they may be penalised if they do, Mills said.
Dentists are paid by the NHS according to a points system, but may get the same number of points for someone needing three hours of treatment as they would for another patient needing 15 minutes, he added.
If dental practices do not hit their target, they risk losing a substantial part of their NHS funding. Most dental practices have a mix of NHS and private patients and have faced the same financial difficulties as other businesses during the pandemic, Mills said.
The lack of access could have serious consequences for some people.
“There’s a group with high needs who need regular care and regular support to maintain their oral health, and if they haven’t been seen for 12 to 18 months, they’re the ones that start having real problems,” Mills said. “They start having abscesses, they need emergency care, they might need to go to hospital, they will lose teeth. And some will get oral cancer.”
A recruitment crisis is compounding the problem of access, according to Neil Carmichael, the chair of the Association of Dental Groups.
“We’ve got a big recruitment problem, and this is going to get even bigger as a result of Covid,” he said. “We need to double the number of dental-school places. And Brexit is also looming into view, because a large number of practising dentists are from the EU. Some of them are going back and not many are coming here. So we need to extend mutual recognition for dentists.”
