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Orthodontic Treatment For Children

Volume 620: debated on Thursday 14 December 2000

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3.10 p.m.

asked Her Majesty's Government:

What plans they have for the orthodontic treatment within the National Health Service of children with crooked teeth or defective bite.

The Parliamentary Under-Secretary of State, Department of Health
(Lord Hunt of Kings Heath)

My Lords, the Government want to ensure that dentists can identify appropriate cases for treatment and use the most clinically effective and cost-effective approach while maintaining high quality standards. That will be achieved by concentrating NHS resources more on cases of true clinical need and less on minor cosmetic work.

My Lords, I thank the noble Lord for that Answer. Does he therefore deny reports in two national newspapers which say that the provision of orthodontics to children is to be removed from the National Health Service? Is he aware that at present there are 650 specialist practices which do nothing but tooth straightening but half of the straightening of teeth is carried out by 8,000 ordinary dentists in practice?

The British Dental Association is extremely concerned about what will happen to general practitioners and the role they play in straightening teeth. Does the Minister not agree that aesthetics are very important but in this case it is more than aesthetics; it also a question of a child's bite and his whole mouth arrangement?

My Lords, that was an extremely instructive question. I certainly agree that aesthetics are important for many people. However, I do not think that we should go down the route of certain countries where there seems to be a fashion for everyone to have orthodontic treatment and they all seem, to me at least, to end up looking as though they are wearing false teeth.

On the specific matter which the noble Baroness mentioned, she is right that many general dental practitioners undertake the work that she described. Certainly, under the new arrangements, many of them can continue to do some limited orthodontic work. We are trying to ensure that the most pressing treatment is delivered as quickly as it possibly can be because at present we have a situation were people who really need treatment are having to wait too long, and we must put that right.

My Lords, children's teeth are very important and I share many of the concerns of the noble Baroness, Lady Gardner. Fluoridation is a matter of some controversy in this context too. Can the Minister give an indication of the Government's response to the York University study into fluoridation?

My Lords, fluoridation had a very good ride in the debate on health yesterday. York University undertook a very thorough review. It found that evidence showed that fluoridated water helps to reduce tooth decay. It found no clear evidence of other adverse effects on general health associated with water fluoridation, other than the increased risk of dental fluorosis. The report also identified the need for more good quality research. We have asked the Medical Research Council to suggest where it might be possible to strengthen the evidence. We have said also that we consider that, in those parts of the country where dental disease is a particularly serious problem, fluoridation is one policy which health authorities may consider.

My Lords, does my noble friend accept that what he described as minor cosmetic work could be of very great importance to a young teenage child? Is he suggesting that under the new regulations—and I apologise for not knowing what they are—many children will have to put up with minor irregularities which may become very important in their lives?

My Lords, we are talking about very minor cosmetic treatment which it would be unnecessary for dentists to provide. At the moment, we reckon that 20 per cent of children have orthodontic appliances every year and about 120,000 of those will have work done in the GDS. It is expected that there may be a reduction of about 20,000 in the number of children who will have orthodontic appliances. However, I assure my noble friend that in those cases where a child might not need treatment for a clinical reason but there was a particular problem in relation to appearance, application can be made to the Dental Practice Board for approval in those circumstances.

I should say that this matter is out for consultation and we are at present considering the comments that we have received.

My Lords, what yardstick is it intended to apply in determining what is cosmetic and what is a necessary straightening of teeth for the child's future?

My Lords, it is all very straightforward. There is an index of orthodontic treatment need which attempts to rank those matters in terms of dental health need. That consists of ranking that on a scale of one to five. That is based on reasonably objective measurements. There is a separate aesthetic component on a scale of one to 10 where number one is the most attractive and 10 the least attractive. Essentially, it is considered that grades 1 and 2 need either no treatment or little treatment and grade 3 is borderline but it will be tipped into treatment need when associated with an aesthetic component of six or above. Grades 4 and 5 all benefit from treatment on health grounds alone. So there is a very careful scheme under which those judgments are made.