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We need a revolution in children’s dentistry – their smiles depend on it

Practical, immediate reforms, supported by targeted investment can help, but it needs political willpower to be successful.

By Mark Allan

Founded in 1947, Bupa lives by our purpose to help people live longer, healthier, happier lives and make a better world.

As the general manager for Bupa Dental Care, I am proud to lead a business providing access to quality dental care to more than a million NHS patients, including 400,000 children, across our 390 practices in the UK and Ireland.

However, in recent years providing access has posed issues for operators across the sector, including Bupa, as we face a national shortage of NHS dentists.

Figures from the World Health Organisation found that the UK has the lowest spending per person on dental care (including public and private treatment) in the G7, alongside the bottom-most oral health workforce ratio.

Despite NHS guidelines stressing that the highest-need patients, including children, must be prioritised for treatment, the situation is worst for the very young. Less than half of all children in England saw an NHS dentist in the last year, and in the past five years, the number of children aged 0-4 years seen by a dentist fell by almost 20 per cent. That is more than 220,000 of our children under five not getting the dental care they need over the past five years; an average of 44,000 a year.

According to the latest NHS figures, age is a key barrier to our children accessing dental care. Only three out of ten 0-4-year-olds saw a dentist in the past year. In contrast, two in three 10-17-year-olds were seen by an NHS dentist over the same period.

The National Dental Epidemiology Programme for England found that the health of our children’s teeth has flatlined in recent years. Almost one in four of five-year-olds has dentinal decay, meaning roughly one in six of their teeth are decayed, increasing their risk of long-term health issues.

Where children live also affects their access to care. Since 2015, those living in the poorest parts of the UK are three times more likely to experience dental decay than those in the richest. In 85 local authorities, less than half of all children saw an NHS dentist in the past year.

The problem is clear. We need a revolution in children’s dentistry to preserve it for our families and future generations.

Transforming dental treatment for children hinges on tackling the chronic workforce shortages across the entire sector. A lack of dentists means that the system is not delivering for all patients – from the youngest to oldest. From 2018 to 2023, units of dental treatment (a measure of the amount of work done during dental treatment) delivered in England fell by nearly a fifth.

The NHS is set for a record £400m underspend of its dental budget this year. With this available cash, local commissioners should be given the power to create child-only dental contracts with enhanced rates of pay for dentists. 

Proposed changes to enable dental hygienists and dental therapists to give more treatment types are a start. They are vital in delivering preventative treatments, like fluoride varnish, at an early age to head off problems in later life. Empowering more dental workers to do preventative care is a critical first step in giving our children access to quality dental care. 

Responding to chronic shortages of NHS dentists, the NHS Long-Term Workforce Plan seeks to increase dental training places by 40 per cent over the next decade. We must also establish new dental schools in areas without one to train the dentists for future generations, like the east of England and the south-east (outside of London).

However, this is not enough: we cannot give our children the access to quality dental care they deserve without investment.

A Future Oral Health Fund would ensure that every child who needs to see an NHS dentist can. It would be used to fund extra treatment capacity for the very youngest, recruit more children’s dentists and therapists, and educate parents and their children about caring for their teeth.

And more training places are needed in children’s dentistry; the number of teaching slots for specialist paediatric dentists is just half of those for orthodontics.

There will be some who say: can we afford this?

The cost is not billions. The average annual cost of dental treatments delivered to children since 2018 has been just over £300m, only 10 per cent of England’s dentistry budget. The broken dental system could waste £100m more than that in underspending this year alone.

The five main oral diseases cost the UK economy more than £11bn in lost productivity in 2019 alone. Fixing children’s dentistry and focusing on early intervention and prevention of long-term health concerns in young children is integral to our future prosperity and broader public health.

The question must be: how can we afford not to? Our call for investment in children’s dentistry must be heard by those in government after the next election – their smiles depend on it.