Dentistry (Wales) – consultation response

We welcomed this consultation which looked at whether the Welsh Government is doing enough to bridge the gap in oral health inequalities and rebuild dentistry in Wales following the COVID-19 pandemic and in the context of rising costs of living.

Our response (in brief)

• A recent BBC investigation highlighted the scale of the problem in accessing NHS dentistry across the UK. Their investigation found that, UK-wide, 80% of dental practices were not taking on children, 10% of local authorities did not have any practices taking on under-16s for NHS treatment and about 200 practices said they would take on a child under the NHS only if a parent signed up as a private patient
• It is unclear how these figures align or differ across the UK’s nations. However, if access to adult services provide any guide to access for children, Wales would appear to have a particularly acute challenge.
• The Welsh Government’s recent ‘Programme for Transforming and Modernising Planned Care and Reducing Waiting Lists in Wales’ notes some of the challenges and outlines the approach being taken.
• There is much in the statement on dentistry in the plan that we welcomed, including the focus on children and young people; and on reducing heath inequalities.
• Despite tooth decay being largely preventable, it is the leading reason why children aged five to nine require admission to hospital. Multiple tooth extractions can also result in the need for a child to go under general anaesthetic. In pre-pandemic years, our State of Child Health report showed that children from lower socioeconomic groups were significantly more likely to be at risk of tooth decay prevalence and severity.
• The good news is that between 2008 and 2016, prevalence of visually obvious tooth decay among 5-year-old children in Wales fell from 47.6% to 35.4%. From 2014/15 to 2017/18, among 0- to 2-year-olds in Wales, the rate of general anaesthetics performed for dental reasons fell from 2.8 to 1.7 per 1,000. It should be noted that this still placed Wales as having a significant problem compared to Scotland and England
• In the last available survey results Welsh Oral Health Information Unit  indicated progress in Wales in the years before the pandemic. In addition to the data on five-year-olds, we noted that the most recent survey of 12-year-olds in Wales reported a 15% reduction in prevalence of dental decay from 45% in 2005-06 to 30% in 2016-17.

Our recommendations

• Welsh Government should commission a review into the factors affecting access to primary, secondary and emergency dental care, with a view to addressing inequalities in Wales.
• We welcomed Designed to Smile, which provides support programmes for children and families to enable them take up positive oral health habits (e.g. through supervised tooth brushing schemes). Welsh Government should ensure funding and resource for Designed to Smile to continue; and provide ‘catchup’ resource if that is required to enable the programme to recover from the impact of the pandemic and associated school closures. 
• The Welsh Government and partners such as Designed to Smile should provide a public health campaign to raise awareness of factors contributing to poor oral health (ie diet / tooth brushing) and to ensure that parents and carers know when their children should access dental services (by one year) and how to do so.
• Welsh Government should review and publish clear targets and timescales for children’s access to dentistry services as part of its programme to reduce waiting times and transform services – and report against these annually.
• The Welsh Government, working with partners, should provide resource to ensure annual capture and publication of data on children’s dental health including tooth decay and hospital treatment including general anaesthesia. These data should be comparable over time and broken down to enable analysis of what is working and the impact of inequalities.
• NHS Wales, Welsh Government and Health Education and Improvement Wales (HEIW) should ensure that all health care professionals, including dentists, can make every contact count by having conversations with their patients (whatever their age) about reducing and replacing high-sugar foods and drinks.
• To reduce economic inequality in oral health, Welsh Government should resource and support fluoridation of public water supplies, particularly for areas where there is a high prevalence of tooth decay.
• Given the ongoing disruption to dentistry services resulting in only half of pre-pandemic activity being delivered when the recent ‘Programme for Transforming and Modernising Planned Care and Reducing Waiting Lists in Wales’ was published, the Welsh Government should urgently provide a more detailed explanation of these ‘recovery phases’ in dental services and set out a plan for ensuring that its own targets and ambitions for children being seen by dentists are being met
• Before the pandemic, we called on the Welsh Government and its partners to deliver a public health campaign to ensure children and families are aware of factors contributing to poor oral health (i.e. diet / tooth brushing) and to ensure that parents and carers know when their children should access dental services (by one year) and how to do so. 
• It would be helpful for the Welsh Government to publish clear and updated targets and expectations; and to publish reporting against this annually (with inequalities measured), to enable better understanding of access and the success of measures put in place to improve it.
• To understand both the impact of tooth decay on children and young people and the inequalities that exist in children’s oral health, we would recommend that the Welsh Government reviews its data collection and reporting structures.