Update: the mainstream media is finally waking up to the impact of Brexit on dental care provision. We were writing about this more than a year ago.
Exeter MP Ben Bradshaw (Labour) posted a tweet drawing attention to the astonishing statistic that 78,000 people in Devon and Cornwall are waiting to get onto an NHS dentist’s books and face a two year waiting list to do so.
Immuno-compromised and forced to go private
Jane Cartlidge retired to Exmouth with her husband in 2020 and assumed, as so many of us would, that she would be able to find an NHS dentist near her. She had been with the same practice in Rugby for 30 years and, in fact, her dentist for 20 of those years, went on to be the Chief Dental Officer of England.
Jane is a passionate supporter of the NHS. Her mother and sister were both nurses and her daughter is an NHS neurosurgeon. Jane has a condition which leaves her immunity compromised and makes her
particularly susceptible to oral infections requiring antibiotic treatment. She already has a number of implants as a consequence of losing teeth to infection. Missing out on dental treatment puts her at
risk.
When she began her search for an NHS dentist she was told there was a two year waiting list, no matter how far she was prepared to travel, confirming Ben Bradshaw’s tweet above.
“Basically, I had no choice but to go private. I am lucky. I have savings and I am fortunate to have found a very good dentist. My treatments have so far cost about £2000, which wasn’t in our retirement budget calculations but we’ve just had to rejig things to take account of this. I worry about the people who cannot afford to go private. What will happen to them? Dental plans won’t be the answer for anyone with a pre-existing condition, either. I would have had to have the most
expensive policy and it was actually more expensive then the pay-as-you-go option I went for. And, yes, it’s free for those on very low incomes but that doesn’t matter if you can’t even get on an NHS dentist’s list. What all this means is that if you don’t have the money, you won’t get dental treatment.”
Appointments repeatedly cancelled by the dentist
Jamie Kemp is a stay at home Dad, looking after three kids aged six, four and two. The closest dentist for them is in Exeter – in practice, a one hour bus journey away. He and his wife take their children’s dental health very seriously but the four year old and six year old have only seen the dentist twice in their lives because of appointment problems.
“The last family check up appointment was two years ago. Unfortunately , we arrived five minutes late and were told that our appointment was cancelled as a consequence and would have to be rescheduled. Since then, the practice has cancelled that rescheduled appointment four times. Staff shortages, lack of cover for our dentist have been the main reasons. Obviously, the pandemic has made things difficult, but all the same two years is a long time to go without a checkup. I think all the dentists at the practice were from the EU so Brexit won’t have helped, either. Maybe some have gone home.
As a one income family, going private isn’t an option. We just can’t afford it. Dental check ups are like eye tests…an important way to pick up other problems early like heart disease or cancer and children’s mouths need monitoring as they get their adult teeth. It’s not good.”
Threat to life
Sometimes the inability to access a dentist puts a life in danger. I have a personal experience of this. My father was visiting me when I lived in Dorset. He had had some issues with one molar and had seen a dentist the previous week who told him to ‘keep an eye on it’. He felt a bit unwell and went to bed within hours of his arrival, skipping supper – unheard of! He was ordinarily a super fit and sharp-witted man but he was clearly not himself. I felt he should see a dentist and rang mine… but it was the weekend and out of hours. No chance.
My father was evidently feverish and going downhill fast. I gave him some paracetamol and rang the on-call doctor to be told that, as a dental issue, it was for a dentist to deal with.
By 2 am my father was beginning to ramble, talking rubbish and clearly delirious. I rang for an ambulance (which was initially refused on the grounds that it was a dental issue…again!). It arrived two hours later. My father spent 3 days in intensive care with sepsis. He was lucky to survive. (He would later be failed – fatally – by another hospital who missed his case of encephalitis and wrote him off as senile, but that’s another story.)
Two hundred years ago, the leading cause of death was infection from dental abcesses. OK. We aren’t returning to that environment (I hope!) but inability to access a dentist makes it a risk. In most cases, tooth infections are easily treatable. However, a person who delays or, more likely, cannot access or afford treatment is at risk of developing the following complications:
- Osteomyelitis: An infection of the bone surrounding the tooth.
- Cavernous sinus thrombosis: An infection of the blood vessels within the sinuses.
- Cellulitis: An infection of the skin and fat directly beneath the skin.
- Parapharyngeal abscess: An abscess at the back of the mouth.
- Sepsis: A serious medical condition in which the immune system severely overreacts to an infection in the blood.
None of these is trivial and their treatment is much more costly to the NHS than a dental check up.
Staffing levels/EU dentists working in the UK
Jamie made reference to the staffing of MyDentist in Exeter. I am also searching for a dentist in central Devon, having had an excellent NHS dentist from Lithuania in East Devon where I lived until 2019. According to the British Dental Association, around 16-17 percent of the UK dentist workforce is registered on the basis of an EU/EEA degree; this includes UK citizens who have studied in Europe. They say:
We do not know what impact a more hostile environment (whether perceived or evidenced) might have on EU citizens who have lived in the UK for some time, and may have trained here, but hold citizenship of another EU country – some may choose to leave the UK. The changes, and a lower exchange rate for Pound Sterling, may also make the UK a less attractive place to work for dentists in the future and have an impact on the dentist workforce in the UK.
We received this quote from MyDentist:
“We support over 4m patients each year with the full range of dental treatments and continue to do so across our practices. In a small number of areas however we, like many other dental practices, are struggling to recruit enough dentists. We are doing everything we can to minimise the impact of this and to continue providing high-quality, timely care to all of our patients. Last year, 75 per cent of the UK’s dental practices that tried to recruit struggled to do so, and this problem is only going to get worse unless this issue is addressed.”
In summary, it is all very well being aware of the risks to our health from issues with our teeth, but if we cannot get to see a dentist or cannot afford one, what do we do, apart from add to the demands on A&E departments – if we even have one near us?
The British Dental Journal reported that the Conservatives have cut spending on dental services by £12 per person since 2010 ( figures up to 2019). This is incredibly short-sighted. The consequences will be borne somewhere…in higher demand for A&E or in avoidable long term illness or fatalities. Something has to change…and fast.
