2024-II Editorial
The year 2024; a time of change and a time for change.
Welcome to the second issue of SAAD Digest Volume 40. The Editorial Board decided to increase the number of issues per year to two due to the number of submissions we are receiving. We hope that you will welcome this change, and having the online CPD in two tranches, rather than all at once. As well as benefiting the reader, this change will mean a shorter turnaround time for the authors who submit just after the deadline for an issue. Those with long memories, a euphemism for being members when Digest was published in its previous format, will remember multiple issues per year, and I am delighted that we can increase the frequency of our communications with our members. We are going to continue to publish the newsletter online twice per year.
As I sit to write this editorial, the results of the 2024 election are still coming in, although it is clear that we will have a new government for the first time since 2010. Inevitably, the state of the National Health Service has been a topic for debate and an area where electoral promises have been made. I was particularly interested in a story on the BBC website on 11th June, where the Labour Party was said to have pledged to introduce 100,000 extra children’s dental appointments in England to clear the backlog and ‘put a smile back on kids’ faces.’1 The appointments will be in the evenings and at weekends for ‘urgent and emergency care.’
Whilst we would welcome greater investment in NHS dentistry in the UK as a whole, there is no detail as to how this will be achieved, or how treatment for the large amount of untreated caries will be managed.
The BBC report quotes unreferenced figures of 48,000 tooth extractions being carried out in NHS hospitals on children aged up to nine. The authors quote that the primary diagnosis for two-thirds of cases was dental caries.
No timescale is given for these 100,000 additional appointments. Is this per annum or a one-off over an unspecified period of time? If this were 100,000 appointments per year, that is almost 2,000 per week. This sounds like a daunting task, however, data from the NHS2 shows that 24,151 dentists ‘performed NHS activity during 2022-2023.' Some basic arithmetic suggests this averages about four appointments per dentist per year. How is this to be achieved? Asking some or all dentists to undertake additional or longer clinical sessions? Are we going to increase the number of dentists? Are we going to increase the number of dentists carrying out NHS-funded care? The NHS figures show that 121 fewer dentists provided NHS care in 2022-23 than in the previous year. How can we reverse the trend of dentists leaving the NHS?
SAAD’s motto, ‘Abolish Fear to Conquer Pain’ is one we should not forget as we look forward to the potential change in healthcare that the new government brings. The new government’s pledge of these 100,000 appointments for urgent and emergency care, are no doubt, a step in the right direction. The aim should, however, be to reduce the need for emergency appointments. We all know that attending emergency appointments does nothing to decrease dental anxiety and phobia, in fact, it tends to increase it. The challenge for dentistry in the UK is to improve the population's dental health and to reduce the need for urgent and emergency care. As part of SAAD’s charitable status, we should continue to lobby for improved preventative dental care for the population, adult and child, with the availability of high-quality care including pain and anxiety control so that we can improve the attendance of the population.
In this issue, we explore a number of areas related to pain and anxiety control including the use of music as an anxiolytic adjunct to behaviour management. The Department of Health’s (DoH) publication ‘Clinical standards for dental anxiety management’3 emphasises the importance of non-pharmacological techniques to be a significant part of the armamentarium available to the dental team managing anxious patients.
It is timely that the new edition of ‘Cognitive Behaviour Therapy for Dental Anxiety: A Manual for the Dental Team’ was published at the end of 2023, as this therapy is referred to in the DoH’s standards. We have often commented on the lack of availability of psychological services to support dentistry in the management of our patients, and this initiative will assist the profession to further develop the portfolio of anxiety management skills we can offer our patients.
The environmental impacts of providing dental care are also continuing to attract significant interest. Inevitably inhalation sedation with nitrous oxide is a continual target for environmental campaigners. We all know that inhalation sedation is a proven safe and effective way of providing conscious sedation for mildly and moderately anxious dental patients and the provision of such services can significantly reduce the need for general anaesthesia. As such, whilst striving to reduce the effects of nitrous oxide on the environment, it is important to preserve the use of this technique within dentistry.
We must also remember that the highest proportion of emissions from dental care is caused by travel (67.5%).4 This figure included travel by both patients attending appointments and staff commuting to work. It is thus logical to look at how we can reduce patients’ need to travel to appointments, both in terms of distance and frequency. One way would be to reduce treatment needs, with enhanced, non-surgery-based preventative care. Another would be to tailor the frequency of recall to disease susceptibility. It is interesting to note that figures from England show that examinations are the dental procedure that contributes most to the environmental impact of the provision of dental care, simply due to their volume, and that the travel is the same regardless of care provided.4
Many practising dentists in the UK will have no experience of previous administrations, or of attempting to influence new administrations. There is no doubt that the provision of healthcare needs to be looked at, thus the obligation is on the dental profession to campaign for improved care for all as the NHS moves forward to cope with the demands of an era when COVID-19 is part of the landscape, and the population continues to age, retaining natural teeth into old age. Geriodontics and Special Care Dentistry will increase in importance as we strive to ensure quality dental care is available to all.
SAAD must continue to exert its political influence on the national and international stage at this time of change. Any time of change can be viewed as a time when things are threatened but should be viewed as a time of opportunity to influence that change for the better.
Carpe diem is perhaps the phrase and approach that we should be looking to adopt for the opportunities we now have before us.
Nigel Rob, Editor
References
1. BBC. Labour pledges 100,000 urgent child dental appointments. 2024. Online information available at https://www.bbc.co.uk/news/articles/crgglpvze3no#:~:text=Labour%20has%20promised%20to%20create%20100%2C000%20extra%20dental,Labour%27s%20plan%20if%20they%20win%20the%20general%20electionhttps://www.bbc.co.uk/news/articles/crgglpvze3no#:~:text=Labour%20has%20promised%20to%20create%20100%2C000%20extra%20dental,Labour%27s%20plan%20if%20they%20win%20the%20general%20election. (accessed 4th June 2024).
2. NHS Dental Statistics for England, 2022-23, Annual Report. London: NHS England, 2023. https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics/2022-23-annual-report (accessed 4th June 2024).
3. Clinical standards for dental anxiety management https://www.england.nhs.uk/long-read/clinical-guide-for-dental-anxiety-management/
4. An estimated carbon footprint of NHS primary dental care within England. How can dentistry be more environmentally sustainable? Duane B, Berners Lee M, White S, Stancliffe R, Steinbach I. Br Dent J 2017; 223: 589-593.