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Oral Health Services

Volume 551: debated on Wednesday 17 October 2012

Motion made, and Question proposed, That this House do now adjourn.—(Anne Milton.)

I am pleased to have this opportunity to raise the question of oral health in the UK. Oral health is given far too little attention, in terms of what practitioners can bring to improving a population’s general health, as well as how it can be used to prevent the development of disease. Rather like opticians, our dentists are undervalued, in terms of what they can bring to the table to help to improve our nation’s health. Perhaps it is because dentists are not the most popular group in society—although I suspect that they are outdone by politicians. Why is going to the dentist not seen as a pleasurable experience? I will leave that to others to judge, but although going to the dentist may not be pleasurable, it is absolutely essential, and good practice starts right at the beginning, with the emergence of milk teeth.

Here in the UK we can be proud of many of our successes in achieving a good quality of oral health. The UK is one of the top-performing countries for oral health in Europe, but there is still much we can do. In fact, a recent joint report by Wrigley and GlaxoSmithKline suggests that Britons love their teeth and take very good care of them compared with our European neighbours. More Britons have more of their natural teeth than people in any other European country, and since the 1980s Britain has cut its decayed, missing and filled teeth score by two thirds. That is an impressive step, but there is certainly still room for improvement—I should explain, Mr Speaker, that Wrigley is based in my constituency.

I recently attended the launch of the report and listened with great interest to Professor Ken Eaton talking in detail about the work that has been going on across Europe looking at patterns of dental health. Other speakers included Dr Nigel Carter from the British Dental Health Foundation and Juliette Reeves, a dental hygienist and nutritionist with over 30 years’ experience. All the speakers set out clearly the importance of dental checks in the early identification of a number of diseases, particularly cancers, which we know are growing in prevalence, mouth cancers in particular. There has been a 48% increase in mouth cancers in the last 12 years. Early identification can make all the difference, in terms of the treatment required and the survivability of the patient. Dental health problems can also be indicative of other diseases, such as diabetes. All those issues are easily picked up during a dental health check. One of the good things in the new contract for NHS dentistry is that it recognises the importance of prevention. This will be challenging for some in the profession to implement, as they will have to change the way in which they work, but most dentists will learn to accept that prevention should be a priority.

The report’s evidence showed that although a majority of us in the UK keep to the suggested practice of brushing twice a day, only half of us brush for two minutes or longer—the rest of us just whizz around and hope that is sufficient—and that almost two thirds of us eat or drink between brushing and going to bed at night. There is clearly space to improve our personal oral hygiene practices, and there is scope for policy and campaigns to achieve that.

Personal oral hygiene is essential. Dental disease is completely preventable, and so, therefore, are those occasionally uncomfortable visits to the dentist when invasive treatment is necessary. These diseases constitute a significant public health problem across the UK and Europe. I cannot stress strongly enough that prevention is the key, and it needs to be encouraged. Many will say that the treatment is expensive. Yes, it can be, but when set against the money saved by regular dental checks reducing the likelihood of more complex treatment, the expense looks like good value for families. The prevention of debilitating diseases will certainly reduce the social and economic costs for the country and the individual.

Curative dental care is a significant economic burden across Europe, with spending close to €9 billion. In the UK, the cost is substantial. An estimated 0.5% of gross domestic product was spent on oral health care services in 2010, and that figure is rising. Expenditure on treatment for oral diseases often exceeds that for other diseases, including cancer, heart disease, stroke and dementia, yet the simple fact is that the causes of most oral diseases in the UK are preventable through cost-effective measures that would ultimately save the taxpayer money. Brushing, flossing, using mouthwash and chewing sugar-free gum—a much-maligned practice that is actually quite effective—could all be more effectively promoted to help to keep dental costs down in Britain, and the sharing of good practice should be encouraged.

Policy needs to be designed and implemented to improve research into oral health promtion. There is currently a lack of comparable data across Europe, although the report goes some considerable way towards addressing that problem. To tackle the burden of oral disease we also need to consider taking action in various ways, some of which have been suggested in the report on the state of oral health in Europe, which I hope the Minister has had an opportunity to read. The report suggests the need to address increasing oral health inequalities, improve the data and knowledge base and support the development of the dental work force.

We should be proud that Britain is a high achiever when it comes to oral health in Europe, but there is certainly room for improvement. Despite our successes, oral diseases remain a burden for much of the population, and the economic impacts are significant. There needs to be a greater focus on prevention rather than treatment, and improvements in education and awareness are also needed.

I am proud that we have the Peninsula dental school in Plymouth. I was asked by my local media why I had chosen oral health as the subject for this debate when so many other issues could have been raised. That was a good question. Having the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), here to respond is of course a good reason. There is also the small question of the ballot for Adjournment debates. MPs often put in for a number of debates over the Session, and we cannot tell which one will be lucky enough to come out of the ballot. I was lucky on this occasion.

Also, one of the first major campaigns that I was involved with when I was first elected to Parliament was to get a dental school sited in Plymouth. I remember fighting tooth and nail—the pun is intended—for that, alongside my former colleague, Linda Gilroy, and experts such as Sir John Tooke. It was during that campaign that I began to understand just how important good dental health is, and how essential it is that we train our dentists and technicians to the highest standards. My subsequent involvement in the all-party parliamentary group on dentistry, which is chaired so well by the hon. Member for Mole Valley (Sir Paul Beresford), has maintained my interest in the subject.

The groundbreaking training offered by Peninsula in Plymouth closely links the trainee dentists and technicians to local communities that have historically had very low levels of contact with dentists, and it is making a difference. This was one of the strong points of the case we made for a dental school in Plymouth.

We have an excellent community development team at the dental school who ensure that the training includes opportunities to go out into these communities, taking dentistry to “places it has never gone before”. Some of the projects included highlighting the impact of high-sugar drinks for professional rugby players at Plymouth Albion; making mouth guards for them; offering oral health advice to local schools; and letting children enjoy and play in a clinical environment to make it less scary. The dental school also works alongside experts to support people with drug and alcohol abuse issues, and is certainly doing some excellent work around oral cancer and smoking cessation with young adults and teenagers.

There continues to be concern about access to dentists in some parts of the country. In Plymouth, we have good months and bad months. Since the start of 2012, however, improvements have been made, with an additional 6,500 NHS places coming on stream in our city. This is possible in part because the graduate dentists from the dental school are staying in the area—yet another reason why we so wanted a dental school in Plymouth. I was pleased that the then Labour Government recognised the importance of dental training—unlike the last Tory Government, who closed dental schools.

There continues to be an issue about the cost of dental care and treatment for many families, particularly in the recession. That cost is still not easily met by some families.

I thank the hon. Lady for giving way and for bringing this matter to the House for discussion. Oral health is a big issue right across the whole of the United Kingdom. In Northern Ireland, some plans have been mooted to introduce fluoridation in the water. That has been resisted by the Northern Ireland Assembly and resisted by the population of Northern Ireland. A new consultation process has started, but it will again be resisted. Does the hon. Lady feel that the best way of addressing tooth decay is, as she has already indicated, by regular brushing and diet, and not by fluoridation of the water?

I know that the hon. Gentleman feels strongly about this issue. I feel equally strongly about it, but I disagree wholeheartedly with him, not least because a lot of toothpaste has fluoride in it in any case. Neither of my daughters, now 30 and 26—they will probably kill me for revealing their ages—has any fillings, and they have lived in an area with full fluoridation. They have had no side-effects at all either.

The hon. Lady is generous in allowing me to intervene again. There are statistics and information showing that fluoridation of water leads to osteoporosis and other diseases. Is it not important to be careful before pursuing a policy that could affect people’s health negatively rather than help them?

I understand the hon. Gentleman’s concerns, and I am sure the population in his area will continue to have that debate, but I am convinced by the data and information that I have seen that, on balance, fluoridation of the water is a good thing. I was intending to touch on it later, but I shall now skip around it.

I will come back to the issue of families and the cost of dental care. Brushing teeth from an early age is certainly something we should all be doing; it has no significant cost and has positive outcomes. Dental treatment can be expensive, so a dental contract that focuses on prevention, works with people identified as having a higher risk of dental decay and takes a more risk-based approach—patient by patient—could lead to some families spending less on their visits to the dentist each year. That would obviously be a good thing for those families. Those people who have no visible issues of tooth decay—an increasing number in the UK, thanks in part to fluoridation—do not need a service focused on drill and fill. They need a system that rewards dentists for the preventive work they do, which should lead overall to less expensive treatments.

The wider use of expert dental hygienists to monitor and advise patients as well as to carry out treatments could have a significant benefit, although there will be some dental practices—these issues have been raised—that are not currently suitable and do not have enough space to accommodate the additional clinics. Some of the proposed changes could be problematic for them. I would welcome an update from the Minister about whether he is picking up concerns from some of the pilots as to whether or not this is an issue. The result of the contract pilots will be crucial when it comes to deciding whether the patient, as well as the dentist, benefits from the change in emphasis. The wider health benefits of preventive work will also save the NHS money, if other health problems are caught early. Preventive work can save lives, which is obviously hugely important.

I urge the Minister to consider whether, as well as the pilot schemes, further public information campaigns are needed to make the general public aware of the growing number of oral cancers that are linked to smoking and alcohol consumption—particularly among young women—and the importance of brushing babies’ first teeth. It should be emphasised that dental care can be preventive, rather than something that we all have to suffer when we have toothache.

I know that companies such as Wrigley run their own campaigns linked to their products and support wider campaigns such as Keeping Britain Smiling, but, given the massive cost to the NHS of poor dental health and linked ill health, the Government also have a role to play. I hope that the Minister will not only take on board the concerns raised by me and by others, but will tell me about the steps that are currently being taken, and about those that may be planned. I invite him to come down to Plymouth, visit the dental school and look at some of the outreach work that it is doing in deprived communities, because I think that there are some very good lessons to be learnt.

We should all speak to and lobby our health commissioners to ensure that those who are involved in the new health commissioning system understand what dentists can contribute to an overall reduction in poor health and the early identification of health problems. I hope that the Minister will note that plea.

I congratulate the hon. Member for Plymouth, Moor View (Alison Seabeck) on securing the debate. I do not think that she needs to justify her pursuit of this issue to her local press, because it is an important issue, and we should all pay tribute to her long campaign. The need to improve dental health is often underestimated, and it is not discussed enough in the context of the health service. I am sure that the hon. Lady will continue to campaign strongly, as a member of the all-party group, in the Chamber and in her constituency, where she supports the medical and dental schools. I should be delighted to take her up on her invitation: I intend to go to Plymouth in the near future, and I hope to be able to visit the dental school then.

The hon. Lady rightly observed that, in health care generally, we do not talk enough about the fact that prevention is much better than cure. In many parts of the health service, payment systems have not properly rewarded staff in line with the recognition that good health care is about preventing people from becoming unwell in the first place, rather than picking up the pieces when they have developed cancer or other problems. The new dental contract makes it easier to identify key prevention issues. It focuses on the desirability of spotting early symptoms of ill health—in this instance, oral ill health—rather than spotting them much too late, when a patient’s cancer is already well advanced.

The hon. Lady also referred to important public health concerns about smoking and alcohol consumption. She was right to draw attention to the problem of binge drinking, not just among young men but nowadays increasingly among young women, and to the effects of excessive smoking and drinking on oral health. The links between high alcohol consumption and smoking and a number of cancers—particularly throat cancer and other cancers in the mouth—are well established. I am optimistic about the possibility that the new dental contract and the important focus on preventive care will enable us to identify cancers, and those who are at risk of developing them, much earlier, rather than waiting to treat people later when they are very unwell. The health service in general needs to be geared up in order to do that better, particularly in the context of oral health.

The hon. Lady also raised the issue of the European platform on oral health. I believe that the all-party group hosted a reception on that recently, praising its work. All the work we have been doing in this country has been rightly highlighted in that report, and I shall discuss that a little later. It is worth dwelling on how over the past 20 or 30 years, under consecutive Governments, we have had a record of improving oral health and improving access to dentistry, particularly in the past few years. If we are taking oral health seriously, it is important that we improve access, and we are beginning to do that well.

As the hon. Lady knows, in 1973 the average 12-year-old in England and Wales had five decayed, missing or filled teeth, but by 2003 the UK average was 0.7 fillings. So we have made great strides in the past 30 or 40 years. That improvement was partially due to the introduction of fluoride toothpaste in the 1970s—that brings me to the issues raised by the hon. Member for Strangford (Jim Shannon) in his interventions—and to the hard work of dentists up and down the country. They, along with dental hygienists, highlighted the importance of good tooth care and preventive measures through effective tooth brushing using toothpaste.

Adult oral health has improved in a similarly impressive manner. In 1968, the first adult dental health survey found that 37% of the adult population of England and Wales had no remaining natural teeth, but the 2009 survey found that the proportion had dropped to 6%. Again, that is a mark of how this country is taking this issue seriously, and we must continue to do so. Access to NHS dentistry has grown steadily, with more than 1 million more patients having been seen by NHS dentists since May 2010.

The hon. Lady rightly highlighted the European platform on oral health report and outlined some of its recommendations. I have read the report and it rightly identifies the promotion of good oral health as one of the most significant health care challenges facing EU countries. However, as she said, England’s oral health compares well with all the countries surveyed in the report, and we are especially pleased that it highlighted the “Delivering Better Oral Health” toolkit, which was a guide to prevention in practice published jointly by the Department of Health and the British Association for the Study of Community Dentistry as an example of good practice. Notwithstanding the fact that we have made good progress historically and that the European platform on oral health report highlighted the good things we do in this country, we must never be complacent. We must continue to ensure that we drive further improvements and reduce the inequalities in access and in oral health that still exist and are very real in some parts of the country.

The hon. Lady raised the issue of the new dental contract. The reforms of the contract focus on a number of things, including improving access to care. There is an important focus on preventive dentistry—preventing bad things from happening to people and on picking up things early. As she is aware, the new contract that we are introducing will be based on registration, capitation and quality, rather than a more payment-by-results system. Such an approach will allow more focus to be put on those preventive measures, rather than on the more reactive measures that a payment-by-results system tends to deliver. The new contract will replace the existing model that rewards units of dental activity rather than taking a more holistic view of what is good for the patient. We can learn from this approach as a good model of health care as we develop tariffs throughout the health care system. Such a model is already being used well in some parts of the country—in stroke care and other areas of preventive care, for example, where a more holistic, joined-up approach to what happens before hospital admission and afterwards in rehabilitation is as important as immediate treatment in a hospital setting.

Elements of that contract are being tested in 70 practices at the moment, and we are rolling them out to an additional 20 to 25 practices as part of the pilot to make sure that that contract is fit for purpose. When the further results from those are available, I will be happy to share them with the hon. Lady, so that we can ensure that we design the best contract.

Perhaps it might be appropriate to share some of that information with the all-party group, rather than one to one.

Absolutely, and I would be very happy to do so. The hon. Lady’s commendable focus on this area of health care would, of course, lead me to wish to share that information with her, but of course I would be delighted to share it with the all-party group, too. The work done by a number of all-party groups, including hers, helps to ensure that many of these important issues are never forgotten and that they are kept at the forefront of the minds of our fellow parliamentarians.

Of course, as the hon. Lady rightly highlighted, there are some inequalities across the country and, as we know, among different socio-economic groups. Improving access to care will play an important part in addressing those health care inequalities. I draw the attention of the House to our progress in preventive care, in addition to the new contract. The number of adults being treated with fluoride varnish, which is one of the most effective preventive treatments available, rose by 43% last year. Among children the figure was 64%. By investing in preventive treatment, we are ensuring that future generations will enjoy good oral health throughout their lives. In addition to promoting the application of fluoride varnishes, we will seek to promote the learning of lessons from the best performing areas of the NHS and to work with the devolved Administrations and local and regional government to iron out inequalities across different geographical areas. It is important that in all areas of health care, including dentistry and oral health care, we learn from things that have gone well so that we can roll out that good practice elsewhere and ensure that it is learned from. We should also be open and honest when things have not gone so well, so that we can learn lessons and improve services for the benefit of patients.

The hon. Lady mentioned the Peninsula dental school and rightly stated that it was opened in 2007, under the previous Government, as a joint venture between Plymouth and Exeter universities. The school has been a great success. I know that she has been a great advocate for it and is rightly very proud of what it has achieved and of what it is doing in Plymouth. Earlier this year, the two universities announced changes in how the school is run. Exeter will now operate a medical school of its own while the teaching of both medical and dental studies will continue in Plymouth. I know that it is important that her constituents are reassured about that and that as we have a successful dental school we should recognise that and support its continuing function. Many of the changes were purely administrative, rather than to front-line services.

I acknowledge the concerns expressed by the hon. Lady tonight and elsewhere, but both universities have stated that the split will improve the administration of medical education in the south-west and we expect the changes to have no negative impact on the dental school. I know that she will ensure that the voices of the dental school and her constituents are heard loudly both locally and in Parliament, and I am happy to support her in that.

Let me finally make a few points about dentistry in the south-west of England. The hon. Lady talked about NHS dentistry in her constituency, including the case of an individual constituent who had problems accessing it. We know that we have further to go in improving access, but the Government have made good strides in that direction, as did the previous Government. We have made significant progress and the latest NHS figures show that since March 2010 the number of people who accessed an NHS dentist in the south-west over the previous 24 months has increased by almost 150,000. That is a strong step in the right direction.

In Devon, £500,000 was invested in four practices in March to provide a further 6,500 dental places, which will become available over the next 12 months. I understand that at the same time a further two practices have increased their capacity and will provide an additional 3,000 places over the next 18 months. We are continuing to ensure that we widen access to dental services in the south-west.

In the south-west, as in the rest of England, we are making vital improvements to access to NHS dentistry and putting in place the measures needed to continue the improvements in this country’s oral health. Access is rising, rates of decay have fallen and continue to fall, and we are piloting a new contract designed further to increase access and improve oral health, focusing on prevention as a key part of our efforts to improve people’s oral health and general health, and to keep them well. We are committed to ensuring that NHS dentistry is available to those who want it, and improving oral health is at the heart of what dentistry does.

Of course challenges remain. We must make sure that pilot studies are effective and that we listen to any concerns that emerge from them, so that we can improve the new contract accordingly. The fundamental focus is on moving away from a reactive service to a preventive care service. That will both improve oral health by reducing the incidence of cancer, and give children the best start in life by engendering good dental health habits through the involvement of hygienists and other practitioners. Our aim is to move dental care on to a more stable footing. This Government are committed to continuing the progress that consecutive Governments have made in widening patients’ access to dental services, particularly those patients who have had difficulty accessing such services in the past.

Question put and agreed to.

House adjourned.