aOn a crisp winter morning in early December 2018, I had taken the train from London to Winchester. I don’t know the cathedral city of Hampshire very well, though what I’ve heard – opulent and stubborn middle-class lists, list of best places to live – certainly had nothing to do with poverty.
It didn’t take long for a more complex picture to emerge. I had come to stay with the dental charity Dentaid, whose volunteers had parked their mobile treatment truck in front of a local homeless center where a flat line had already been formed. Some of the people I spoke to admitted that they were in such desperate need of treatment that they turned to their own brand of “make-it-yourself dentistry”. This means exactly what it sounds like. Self-care – including extractions and fillings – without proper anesthesia or professional training. This was simply the reality for the rapidly growing number of people across the country who found themselves excluded from affordable dental care.
Shocking enough, the situation has only gotten worse in recent years. The outbreak certainly did not help. During the first nationwide lockdown, 25% of households in the UK resorted to some form of dentistry (from dentistry to large-scale tooth extractions), while Boots reported staggering sales of at-home dental care kits. The acute surreal upheaval of Spring 2020 exacerbated existing conditions and lengthened NHS waiting lists even further. It’s a situation that has shown few signs of improvement since then. Current horror stories abound. Middle-aged woman who had super gum and metal coils placed in her mouth after waiting 12 months for NHS treatment. The man in Suffolk who could no longer stand the pain before he pulled out two of his teeth with his own hand. From the same county, salutes the woman who had at least five of her teeth removed after a series of mishaps and is unlikely to be able to afford £2,000 for new dentures.
It is not new that Britain is facing an urgent dental crisis. However, like many other problems, the severity depends on who you are and where. For those who can afford the special treatment, stories like the above are likely to remain a cruel abstraction. For the large number of people who can’t, the threat of DIY dentistry is a looming problem. This is no exaggeration. We live in a country where the term “dental desert” has somehow become a part of public discourse. Where entire regions in one of the world’s richest countries have absolutely no affordable dental care. Only a third of adults in England have access to an NHS dentist, according to the Association of Dental Groups. For children, this number is less than half.
The choice is difficult for more and more people. A Welsh mother of two put it succinctly in a conversation with the BBC. There was no doubt that he could afford the £1,000 that a private root canal would have cost. Instead, she opted for the much cheaper – albeit completely avoidable – extraction. With the house bills soaring, she literally faced a choice between saving her teeth or heating the family home.
The severity and scale of the problem can no longer be ignored. Dr. Nigel Carter is CEO of the Oral Health Foundation. “For many, being in pain is a terrifying situation even if they are considering a dental procedure at home. We don’t guess [it] Apart from short-term repairs with temporary fillings.” The foundation calls on “the government to increase funding for dental and dental education to reduce the burden and provide better dental care to the public.”
Both are urgently required. Last week, the British Dental Hygiene Association released the factual results of a major new survey of street dentists in England. Nearly half of the 2,204 respondents admitted they had significantly reduced NHS obligations to their practices, while 75% said they would reduce or reduce their own supplies. About 3,000 dentists in England have completely withdrawn from NHS work since March 2020, with the BDHA warning of an “unprecedented” collapse that could lead to termination unless major government intervention is made. Not because of the indifference of practitioners. It didn’t happen overnight. Years of divestment (it would cost £880m a year just to bring services back to 2010 levels) neglect has led to this point, combined with the continuing impact of the 2006 NHS Dental contract long discredited under the circumstances, regardless of Duration of treatment, lump sum fee. A single fill pays up to 10, which reduces the incentive to “hard” work. Despite considering the change for a long time, nothing close to a concrete solution or timeframe has been confirmed.
I remember thinking in the weeks after my visit to Dentaid in 2018 that the situation I saw must definitely be kind of rock bottom. The fact that so many people are waiting for basic, and often urgent, treatment cannot be allowed to continue unchecked. And the idea of forcing others into the seemingly medieval “solution” of DIY dentistry cannot be tolerated in any country that values the health of its citizens. I was naive. At that time, the dentist only had a mobile dental unit. According to a recent report, a fifth will be added.