UK - Something is rotten in the state of dentistry
From The TimesJuly 7, 2008
Something is rotten in the state of dentistry
Early oral health is vital - yet children's teeth are being neglectedPeta Bee
Now that teeth can be lasered, whitened and treated with high-tech gadgetry to remain at their twinkling best, you would not expect dentists to be yanking them out at the first sign of trouble. Yet last week it was suggested that, because of failed NHS reforms, a growing number of dentists are extracting teeth rather than carrying out complex repairs. It seems that dentistry has stepped back in time, employing the kind of quick-fix measures popular in the 1940s and 1950s to save time, money and professional angst.
According to an investigation by the House of Commons Health Select Committee, the shake-up of NHS dentistry that promised improved access and more preventive treatments has failed both patients and the profession. In the two years since dental reforms were introduced, 900,000 fewer people saw an NHS dentist than under the previous system, and the volume of complex work such as crowns, bridges and dentures fell by almost 60 per cent.
Of particular concern is the impact of all this on a young generation whose dental health is already under threat. Recent statistics from the British Association for the Study of Cosmetic Dentistry indicated that more than a third of children have fillings, missing teeth or tooth decay by the age of 5, and that in some parts of the country 75 per cent of pre-school children have rotting teeth.
Although under-18s qualify for free dental treatment, parents are struggling to find a dentist to treat them. Many practitioners are shunning NHS work for more lucrative private practice, and according to Janet Clarke, of the British Dental Association, loopholes in the system mean that parents are often forced into a corner regarding costs.
“Although dentists are obliged to treat children free, quite a few now insist that they will do so only if the parents pay privately for their own treatment,” she says. “It is a catch-22 situation because some people simply can't afford to do this, so they are stuck dentist-less.”
In the last Dental Health Survey, in 2003, a quarter of parents of 12 to 15-year-olds and a fifth of parents of five to eight-year-olds claimed that they had difficulty in finding a dentist for their child - and there are regional variations in the availability of NHS dentists. For instance, while 73.4 per cent of children in the North East saw an NHS dentist in the two years to December 2007, only 64.8 per cent of London children did so. Professor Jimmy Steele, of the school of dentistry at the University of Newcastle, says that the repercussions of this could be disastrous. “Poor dental health in children can have a profound effect until the day they die,” he says. “Good oral care habits need to be practised from as early an age as possible.”
Many dentists blame dietary changes - too many pre-packaged foods, fizzy drinks and bottled water (because it lacks fluoride) for the rise in tooth decay. There is also, says Janet Clarke, a trend for parents to neglect the care of their children's milk teeth, wrongly believing them to be of only temporary significance. “A lot of people think that baby teeth don't matter but they are hugely mistaken,” she says. “Children can have severe pain in milk teeth, which then have to be removed. Because baby teeth hold a space open for adult teeth to come through, if they have decaying or removed teeth, that space gets smaller and there isn't enough room. This can lead to growth problems later, and mean that they have to wear a brace.”
Other long-term risks are associated with poor oral health. Gum disease, from which most British adults suffer, is considered a powerful predictor of someone's chances of dying prematurely from heart disease, diabetes or stroke. It is thought that, over time, inflammation in the mouth accelerates the formation of fatty deposits in the arteries, clogging circulation. One German study suggested that middle-aged men with severe gum disease were four times more likely to have a stroke than their peers with healthier gums, while other research has indicated that poor gum health doubles the likelihood of heart disease. There is even a suggested link with tumours of the lung, kidney and pancreas - yet few people are aware of the link between oral health and general wellbeing.
“When children get their permanent teeth between the ages of 7 and 11, that's it for 70 to 80 years,” says Professor Steele. “If they keep their teeth healthy with good oral hygiene and diet, they will reap the benefits into old age.”
Peta Bee is the Medical Journalists' Association Freelance Journalist of the Year
How to keep your child's teeth healthy
Encourage children to avoid brushing their teeth immediately after consuming acidic products such as fizzy drinks, fruit smoothies and citrus fruit, when tooth enamel is at its softest. Brushing teeth before breakfast is a good habit. During sleep, bacteria and plaque form on the teeth. These bacteria are multiplied by the sugar and acid in breakfast foods, which increases the risk of tooth decay.
Twice-daily brushing with a fluoride paste, for two minutes at a time, preferably once in the morning and again at bedtime, should begin as soon as baby teeth erupt.
Brushing should be supervised by an adult until a child is at least 6. A recent survey suggested that one pre-schooler in five was left to brush his or her teeth alone.
For under-threes, use a smear of 1,000ppm fluoride paste. For those aged 3 to 6, use a pea-sized blob of 1,350 to 1,500 ppm fluoride paste, available from pharmacists. Children should use a small-headed brush with soft nylon bristles.
Fizzy drinks should be consumed through a straw placed towards the back of the mouth, away from the teeth, and parents should try to avoid covering food with too many acidic sauces and dressings.
Regular visits to the dentist should begin when children get their milk teeth. Getting them used to the surroundings of the surgery can help to reduce any anxiety that they might feel about dental visits.
Something is rotten in the state of dentistry
Early oral health is vital - yet children's teeth are being neglectedPeta Bee
Now that teeth can be lasered, whitened and treated with high-tech gadgetry to remain at their twinkling best, you would not expect dentists to be yanking them out at the first sign of trouble. Yet last week it was suggested that, because of failed NHS reforms, a growing number of dentists are extracting teeth rather than carrying out complex repairs. It seems that dentistry has stepped back in time, employing the kind of quick-fix measures popular in the 1940s and 1950s to save time, money and professional angst.
According to an investigation by the House of Commons Health Select Committee, the shake-up of NHS dentistry that promised improved access and more preventive treatments has failed both patients and the profession. In the two years since dental reforms were introduced, 900,000 fewer people saw an NHS dentist than under the previous system, and the volume of complex work such as crowns, bridges and dentures fell by almost 60 per cent.
Of particular concern is the impact of all this on a young generation whose dental health is already under threat. Recent statistics from the British Association for the Study of Cosmetic Dentistry indicated that more than a third of children have fillings, missing teeth or tooth decay by the age of 5, and that in some parts of the country 75 per cent of pre-school children have rotting teeth.
Although under-18s qualify for free dental treatment, parents are struggling to find a dentist to treat them. Many practitioners are shunning NHS work for more lucrative private practice, and according to Janet Clarke, of the British Dental Association, loopholes in the system mean that parents are often forced into a corner regarding costs.
“Although dentists are obliged to treat children free, quite a few now insist that they will do so only if the parents pay privately for their own treatment,” she says. “It is a catch-22 situation because some people simply can't afford to do this, so they are stuck dentist-less.”
In the last Dental Health Survey, in 2003, a quarter of parents of 12 to 15-year-olds and a fifth of parents of five to eight-year-olds claimed that they had difficulty in finding a dentist for their child - and there are regional variations in the availability of NHS dentists. For instance, while 73.4 per cent of children in the North East saw an NHS dentist in the two years to December 2007, only 64.8 per cent of London children did so. Professor Jimmy Steele, of the school of dentistry at the University of Newcastle, says that the repercussions of this could be disastrous. “Poor dental health in children can have a profound effect until the day they die,” he says. “Good oral care habits need to be practised from as early an age as possible.”
Many dentists blame dietary changes - too many pre-packaged foods, fizzy drinks and bottled water (because it lacks fluoride) for the rise in tooth decay. There is also, says Janet Clarke, a trend for parents to neglect the care of their children's milk teeth, wrongly believing them to be of only temporary significance. “A lot of people think that baby teeth don't matter but they are hugely mistaken,” she says. “Children can have severe pain in milk teeth, which then have to be removed. Because baby teeth hold a space open for adult teeth to come through, if they have decaying or removed teeth, that space gets smaller and there isn't enough room. This can lead to growth problems later, and mean that they have to wear a brace.”
Other long-term risks are associated with poor oral health. Gum disease, from which most British adults suffer, is considered a powerful predictor of someone's chances of dying prematurely from heart disease, diabetes or stroke. It is thought that, over time, inflammation in the mouth accelerates the formation of fatty deposits in the arteries, clogging circulation. One German study suggested that middle-aged men with severe gum disease were four times more likely to have a stroke than their peers with healthier gums, while other research has indicated that poor gum health doubles the likelihood of heart disease. There is even a suggested link with tumours of the lung, kidney and pancreas - yet few people are aware of the link between oral health and general wellbeing.
“When children get their permanent teeth between the ages of 7 and 11, that's it for 70 to 80 years,” says Professor Steele. “If they keep their teeth healthy with good oral hygiene and diet, they will reap the benefits into old age.”
Peta Bee is the Medical Journalists' Association Freelance Journalist of the Year
How to keep your child's teeth healthy
Encourage children to avoid brushing their teeth immediately after consuming acidic products such as fizzy drinks, fruit smoothies and citrus fruit, when tooth enamel is at its softest. Brushing teeth before breakfast is a good habit. During sleep, bacteria and plaque form on the teeth. These bacteria are multiplied by the sugar and acid in breakfast foods, which increases the risk of tooth decay.
Twice-daily brushing with a fluoride paste, for two minutes at a time, preferably once in the morning and again at bedtime, should begin as soon as baby teeth erupt.
Brushing should be supervised by an adult until a child is at least 6. A recent survey suggested that one pre-schooler in five was left to brush his or her teeth alone.
For under-threes, use a smear of 1,000ppm fluoride paste. For those aged 3 to 6, use a pea-sized blob of 1,350 to 1,500 ppm fluoride paste, available from pharmacists. Children should use a small-headed brush with soft nylon bristles.
Fizzy drinks should be consumed through a straw placed towards the back of the mouth, away from the teeth, and parents should try to avoid covering food with too many acidic sauces and dressings.
Regular visits to the dentist should begin when children get their milk teeth. Getting them used to the surroundings of the surgery can help to reduce any anxiety that they might feel about dental visits.
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