Ministers need to act as covid sees child tooth extractions backlog surge
The British Dental Association (BDA) has warned government must act decisively to deal with the backlogs for child tooth extractions, as new figures show the number of treatments more than halved during the pandemic.
Data from the Office for Health Improvement and Disparities show 35,190 extractions were performed on decayed teeth in children aged 0-19 in 2019/20, falling to 14,615 in 2020/21.
Dentist leaders have stressed this collapse will not reflect any change in the demand for these procedures, which take place in hospitals under general anaesthetic. Figures show the proportion of extractions as a result of decay is virtually unchanged from levels seen a decade ago. Tooth extractions have been the number one reason for hospital admissions among young children for a generation.
The BDA has said full disclosure is now required on waiting times for these procedures alongside a properly funded plan to address the backlog, stressing that tens of thousands of children will be left in pain, facing difficulties learning, eating and sleeping for over a year. NHS England has acknowledged there are significant gaps in official data, owing to wide-ranging coding and reporting issues. The Hospital Dentistry GIRFT Programme National Specialty Report states “We found gaps and anomalies in the collection of data through Hospital Episode Statistics, which limits our understanding of both patient need and the people doing the work, which, in turn, affects our ability to measure outcomes, assure quality and plan the workforce we need.”
The union joined with sector leaders and learning disability charity Mencap early in the pandemic to press former health secretary Matt Hancock to develop an urgent action plan, and commission a review into the true scale of extractions under general anaesthetic. No plan has been delivered to date.
The data shows children from the poorest areas are three times more likely to have extractions than those from the most affluent communities. Oral health inequality is expected to grow owing to the scale of backlogs in primary care, which limit the chance to catch problems early. Over 12.5 million NHS dental appointments for children have been lost in England since lockdown.
Charlotte Waite, chair of the BDA’s England Community Dental Services Committee, said, “Tooth extractions among children have collapsed, but the level of demand hasn’t gone anywhere. Covid has simply left tens of thousands in pain, potentially waiting years for treatment they desperately need.
“Government has yet to offer real clarity on the scale of the backlog, or a credible plan to tackle it.”
Meanwhile, Nigel Carter OBE, chief executive of the Oral Health Foundation, says, “To report that childhood tooth extractions in England have shrunk is a smokescreen towards the reality of what is happening. Tooth decay in children has not simply disappeared over the last year which means that thousands of young people are going without the treatment they need.
“It is unfair and unjust for just one child, let alone thousands, to be put in pain because they are unable to access the care they deserve.
“There now needs to be an urgent and decisive plan from government about how they plan to tackle the backlog in dentistry," adds Nigel.
“We also need open and transparent clarity about the scale of the backlog and which NHS dental practices are able to take new patients.
“NHS dentistry is in dire needs of a new contract. We also need to be training far more dentists. All in all, the provision and funding for NHS dentistry falls well below the threshold that is needed for the needs of the population.”
In addition to the Oral Health Foundation seeking clarity on access to NHS dentistry, they are urging government to move forward with plans that can drastically improve rates of childhood tooth decay.
The charity is calling for the widescale implementation of a national water fluoridation scheme. Currently, as little as 11 per cent of the UK’s water supply has fluoride added to it.
Nigel says, “Water fluoridation is one of the single most credible and impactful polices that can have a significant impact on tooth decay. The data on children’s hospital extractions and community water fluoridation is staggering – in fluoridated areas, hospital admissions fall by as much as 68 per cent.”
The charity also believes there should be further extensions to the sugar tax.
“Since it was introduced, the sugar tax has done a remarkable job at removing sugar from soft drinks,” adds Nigel. “It is now time this was widening to include other sugary foods and drinks. These measures would be highly effective alongside junk food advertising bans.”