Phil McCafferty looks for the detail in the Oral Health Improvement Plan.
Launched on 24 January, the day after a self-congratulatory double salvo of propaganda in the press from Scottish Government, misleading the public about so called ‘record registrations’ coupled with a simultaneous symposium extolling the success of Childsmile, the Government gave us the Oral Health Improvement Programme (OHIP). The fanfare of the champagne launch quickly turned to flat beer as the profession poured over its content.
Dental public health should always be evidence-based and patient-centred. It should not be manipulated to mislead the public.
The myth of record attendance at the dentist and the claim that Childsmile has caused a reduction in dental disease fail on every test of an evidence base.
Patients are not attending the dentist in record numbers. The numbers are actually falling. While over 90% of people are registered as NHS dental patients, only around 70% of people in Scotland have actually attended a dentist in the last two years.
In old money, 1.4 million of the patients they call ‘registered’ would have been considered ‘lapsed’ if they hadn’t introduced continuous registration over a decade ago.
And as for Childsmile, that is another smokescreen. I have seen graphs of the falling rates of disease in primary school children, held up as evidence of the success of Childsmile. On every occasion the graph starts in 2006, the year of its introduction. What they don’t tell you is that these rates have been falling steadily for nearly 40 years and the rate of fall is in no way affected by the introduction of Childsmile.
In the opening pages of the OHIP document is the declaration that: ‘Effective policy making relies on strong evidence.’ An evidence-based approach may be defined as ‘helping people make well-informed decisions about policies, programmes and projects by putting the best available evidence… at the heart of policy development and implementation.’ I challenge the Government to justify this claim with respect to my comments above.
All filler, no thriller
The OHIP is conspicuous by its absence of any detail of how precisely the issues facing the profession are to be addressed.
Most of us flicked through the document and wondered if perhaps some of the pages were missing, such was the dearth of ideas and specifics relating to the main challenges we face. Mind you, what else could we expect when it was drafted by people who don’t know what it is like to deal with the flood of patients on the NHS treadmill? I maintain that they are devoid of ideas of their own, and only seek the counsel of people who either sit in offices of NHS Boards, or hide in the corridors of dental hospitals and PDS clinics, and they refuse to listen to the views of those of us who work on the front line of the profession.
Fluoridation is the elephant in the room in Scotland. It would solve so many of the problems we still encounter, particularly in disadvantaged areas. We can talk ‘til the cows come home about the preventative message, but the evidence in deprived areas is that when you’re dealing with parents and carers in dysfunctional domestic situations, the message isn’t getting through and it’s the children who suffer. Fluoridation of the water supply would reduce caries in these children by 50% at a stroke and it would not cost the earth. It would be a responsible use of public money.
Gas and alcohol
There are more than 10,000 paediatric general anaesthetic admissions a year in Scotland for the extraction of teeth, almost a third of all GA admissions. The cost to the taxpayer is around £20 million a year.
The Government has yet again shirked its public health responsibility on fluoridation because it fears the protest and the voters who may be influenced by the ill-informed, but vocal, anti-fluoridation lobby.
This is a Government that has, ironically, taken on the drinks industry over minimum pricing for alcohol on the grounds that it is in the interests of the nation’s health, but does not have the same stomach for the fight against dental disease.
Another glaring omission in the OHIP is any mention of extra funding for ambitious and, I have to admit, well-intentioned initiatives such as the Oral Health Risk Assessment (OHRA). The OHRA is a responsible approach to long-term treatment planning. That said, it has to be properly resourced.
I cannot help but notice how swiftly the OHIP questions the need for six-monthly check-ups and routine scalings.
With less than 70% of the population attending regularly and serious oral conditions such as squamous cell carcinoma worryingly on the rise, we should be encouraging more regular attendance, not the opposite. Cancer Research UK reports that there has been a 25% increase in oral cancer in the last decade. Early detection is essential for survival.
The debate about how regularly patients should attend should be about a responsible preventative approach to one’s health, diagnosing disease early. We should not be gambling with the nation’s health to save money.
It is obvious there is no extra cash. There will be more form-filling, more data collection, more bureaucracy and it’s all just a rearranging of the deckchairs on the good ship OHIP. Meanwhile the iceberg looms ahead and many of us will be heading for the lifeboats to escape from NHS dentistry. However, I suspect there will not be enough of them.