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When you think about how you define general dental practice, what comes to mind? You might think about our commitment as dental professionals to the wellbeing of our patients, the daily treatments and advice we give, or the central role our practice teams play in local communities. Alternatively, as a dental professional experiencing the last 12 months or more, you might be tempted to think about growing patient backlogs, difficulties in patients being able to access dental care, burdensome and often opaque guidance from regulators, or practices being excluded from government decisions that impact them.
As Clinical Director at Denplan, I know that many of our member dental practices will hold many of these thoughts and concerns simultaneously after the year UK dentistry has experienced due to COVID-19. But what the pandemic has done is expose the myriad of issues facing general dental practice – issues created by the pandemic and a great many that predated COVID-19 and its fallout. While as a profession we have been well aware of the issues, importantly some of the problems are gaining wider acknowledgement by the public and policy makers.
Owing to this, at the end of last year, Denplan undertook an in-depth study of the current state of dentistry in the UK, which culminated in the publication in April of ‘The Future of Dentistry’ white paper.1 This is a ground-breaking body of research and it comes at a timely juncture for the dental sector, which faces numerous challenges across multiple fronts, regardless of the UK jurisdiction in which you live and work.
With the core of our white paper based on survey responses from our Denplan member dentists and a specially convened expert roundtable in February, this is an important read for dental professionals and policy makers alike, because it highlights issues that have often been overlooked or ignored in discussions about dentistry in recent years. From the impact of COVID-19, to the understanding of private dentistry among policy makers, to the role of dentistry in the wider preventive healthcare debate, and the importance of training and teams, the Denplan white paper brings much needed heat and light to the subject.
The experience of the past year has shown the enormous pressure dentistry has been put under by the coronavirus pandemic. The full extent of the pandemic's impact on general dentistry is evidenced by the fact that some 19 million fewer dental appointments took place during 2020 compared to the same period in the previous year.2 This collapse in numbers has demonstrated how dental practices have been acutely impacted by the pandemic through a mixture of the first lockdown compelling practices to largely close their doors, and subsequent COVID-19 guidance from the four Chief Dental Officers (CDOs). However, it has also been the official guidance that has often served to exacerbate problems.
As the Denplan white paper has identified, most dentists who we surveyed expressed concerns about the government's understanding of, responsiveness to, and support for the private and mixed dental sector. The opaque nature of official guidance from CDOs, the poor communication of information about re-openings and overly burdensome fallowtime regulations have all contributed to practices struggling to know what they should be doing. Particularly for mixed dental practices that felt unable to see many of their patients out of an abundance of caution over falling foul of unclear regulations set by the CDOs. This stems from the lack of understanding on the part of policy makers and regulators who have approached the issuing of guidance to dental practices by viewing any dental practice carrying out a General Dental Services contract – no matter how small – as requiring the same level of regulation as fully NHS practices.
This lack of understanding of the sector, highlighted by ‘The Future of Dentistry’ white paper, means poor policy decisions and outcomes. For example in England in June 2020, when many practices and professional bodies learned about re-opening from the news, with almost no notice or guidance to prepare a safe return. This deficit in understanding of the sector is also acting as a major pull factor towards wholly private practice for many practitioners who have a wish to focus more time on patient care, and feel more in control of the decisions they make about their business.
This paucity of understanding of private dentistry is also visible in the Government's recently published ‘Integration and Innovation’ white paper,3 which has set out an ambitious preventive health agenda and restructuring of healthcare services, but without reference to the vital role played by the dental sector in England.
The Department for Health and Social Care's proposals for the restructuring of healthcare envisions a more integrated health system based around integrated care systems (ICSs), the wider adoption of digital technology in healthcare – from telemedicine to wearable health monitoring tech – and a greater emphasis on preventive healthcare, building upon the 2019 prevention green paper4 and the NHS Long-term Plan.5 As many of those in general dental practice, and as our roundtable of experts identified back in February, the adoption of digital trends and preventive health are already key aspects of general practice routines and have been accelerated by the pandemic.
However, while there are useful proposals around the introduction of more widespread water fluoridation, there remains little to no mention of dentistry and its role in improving oral health in the local community. Combined with a fluoridation policy, dentists can support the shift in public health policy from just treatment to prevention through their unique position to identify dietary, lifestyle and chronic health conditions before ill health develops. However, the lack of understanding of dentistry on the part of policy makers means that, once again, dentists are excluded from the wider preventive healthcare discussion.
Indeed, as recently demonstrated by comments from government ministers in Parliament, there remains a poor understanding of the vital role dentistry plays in the early diagnosis and referrals of mouth cancers.6 As the Oral Health Foundation has observed, the 10-year survival rate for oral cancers is significantly determined by where the cancer occurs and how early it is diagnosed.7 The lack of understanding of dentistry's role in early diagnosis and referral of oral cancers is emblematic of a wider level of poor knowledge of how dentistry works and the role it plays in wider public health.
As Denplan's ‘The Future of Dentistry’ white paper draws out to raise awareness with policy makers, poor oral hygiene has significant impacts on wider health outcomes, such as heart disease and diabetes. However, only one in six people realize that having periodontal disease may increase their risk of stroke or diabetes, and only one-third are aware of the heart disease link.8 If ministers are genuine in their stated desire to see dentists performing an enhanced role in preventive healthcare,9 then there needs to be a sea change in understanding how dental practices can – and do – form an integral part of the public health landscape, regardless of how they are funded.
This will require a fundamental change in knowledge and understanding, first by those in government implementing policies that impact dentistry, and then by the wider public regarding the benefits of regular dental visits to their wider bodily health and wellbeing.
While the past 16 months have been so hard for us all, both professionally and personally, I hope that you will agree that Denplan's ‘The Future of Dentistry’ white paper will be an important step towards better understanding of our profession at a crucial time of transition. We now need to ensure that we use this increased awareness for the benefit of the oral health of the nation and to move the profession forward in the direction that will enable this.
To download and read ‘The Future of Dentistry’ white paper in full visit: www.denplan.co.uk/the-core/industry-and-company-news/the-future-of-dentistry-whitepaper