Northern Ireland news

Fears of two-tier dental system with half a million patients not seen by dentists since the start of pandemic

All dentistry ceased during the first wave of Covid-19 as surgeries struggling to source personal protective equipment

HALF a million patients haven't been seen by dentists since the start of the pandemic. With a two-tier system emerging due to pressures on practices in deprived areas, Bimpe Archer talks to Chief Dental Officer Michael Donaldson.

"THE very nature of dentistry is up close, face-to-face, lots of aerosol generating procedures and when you have a virus which is a respiratory virus, which can be transmitted by aerosol - dentistry was just right in the centre of the storm for something like this. The impact has been profound," the Chief Dental Officer explains.

All dentistry ceased during the first wave of Covid-19 as surgeries struggling to source personal protective equipment.

"In general practice it is very much driven by how many patients they can see. Back prior to the pandemic it was possible to see a million patients per year or thereabouts."

"At 40 per cent or so activity levels which we are now, scaled up to a year, you're talking about half a million patients that haven't been seen and I think it will be a while yet before activity levels start to go back to pre-pandemic levels."

However even this limited recovery has not been evenly spread across Northern Ireland, with "variation from practice to practice".

Mr Donaldson points to "quite a variation in oral disease in Northern Ireland".

"There are some practices where disease levels are relatively low, so they're less likely to get patients who have developed a toothache or are in pain... (and) their working pattern is less distorted by that. They are now probably in a position to be calling patients in for routine check-ups.

"There are others where the levels of disease in the practice population is such that they're still fire-fighting, they're still dealing with patients who are in pain or with swellings and dental infection - urgent dental cases."

There, he says, "now more patients registered today than there have ever been", and the system is grappling with "social causes" of dental problems.

"The big one is deprivation. Children in deprived parts of Northern Ireland, in families where there is deprivation, their snacking, their sugar consumption would tend to be higher."

Mr Donaldson said while "these are generalisations", statistics show diets "higher in sugar" and less frequent toothbrushing and lower dental attendance - what he describes as a "triad of risk factors".

In 2019, 38 per cent of five-year-old children in the deprived one-fifth of Northern Ireland have dental decay - compared with just 10 per cent in the most affluent one-fifth - almost four times higher.

Dentists in deprived areas are correspondingly under more pressure than colleagues in richer postcodes.

"Practices - even prior to the pandemic - serving a population with higher levels of disease (are) going to find their patients have slipped into having pain and infection, whereas the practices where there is a lot lower levels of disease (will) find they're not having to devote as much time to patients in pain and they can revert to their normal processes easier."

The Chief Dental Officer says well-documented increases in alcohol and sugar consumption in response to pandemic stress will have increased poor oral health, but an imminent increase in treatments is unlikely.

"At the moment, I think with current levels of disease in the population and the concerns with the Indian variant, I don't really see anything on the horizon - and by that I mean anything in the next two or three months - that would suggest a lessening of those infection prevention and control restrictions.

"Beyond that it's very difficult to say because as we know the one thing about this pandemic is it's entirely unpredictable."

However, he said decades of improvement in dental health will not be completely reversed by the pandemic.

From society's greater interest in the appearance of teeth driving toothpaste use to prevention programmes targetting 70,000 children in deprived communities and dentists own efforts - "from 2003 to 2019 the dental decay figures for five-year-old children halved from 60 per cent to 30 per cent".

"We had the highest levels of decay in the UK by a fair bit, now we would be on a par with Wales, maybe slightly behind Scotland. England are a bit better.

"It's a bit like a supertanker, it has been a long road to get to where we are now, over decades the figures have come down and down and down to their lowest ever.

"A year of unmet need... it's likely there is a fair amount of disease there which we're going to need to catch up on and treat, we probably have drifted back a bit, but not to the same scale."

He paid tribute to community dentists "who are giving their all" and urged the public to take care of their oral health "to try and minimise the pressure".

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