Dentistry Part 1 – Can you access dental care when you need it?


Posted on 15/07/2022 | Last update 07/15/2022 |

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Many people are struggling to get the dental care and treatment they need, says the independent watchdog for NHS Services Wales.

Reports undertaken by Community Health Boards (CHCs) across Wales (e.g. Swansea Bay SCC and Hywel Dda CSC) say finding an NHS dentist for many people is “impossible”. They say it is having a significant impact on people’s dental health, with many feeling pressure to pay privately or receive no treatment.

There will be differing views on what access to dentistry means among professionals and in terms of what the public/patients might mean or value.

In a series of two articles, we will examine access to dentistry from an equity perspective. This first article looks at which groups are struggling to access services. Our second article will focus on prevention and access to community dental programs.

Reduced access to dental care

Access to dental services has been severely impacted by the COVID-19 pandemic, and it will likely take some time to process the backlog of patients requiring dental care and treatment.

According to the British Dental Association (BDA) Wales that nearly two million treatments were lost in 2020-21.

The General Dental Council (GDC) explains that only emergency services were available during the first national lockdown. Since reopening in June 2020, dentists have reported reduced capacity due to further closures and the need for infection control measures, such as additional cleaning and a fallow period.

The media reported cases where patients were forced to perform their own dentistry – buying temporary filling kits and treating themselves because practices could not provide appointments.

Figure 1 (below) shows the impact of the pandemic on dentistry. The BDA warn that:

…patients in Wales will now inevitably face worse outcomes, with lost opportunities to act on early signs of tooth decay, gum disease and even oral cancer.

But it also shows that only around 55% of the population could access NHS dental care, even before the pandemic. It is unclear which groups of the population were receiving regular check-ups and which groups had difficulty accessing services and treatment.

Figure 1: Percentage of population with access to NHS dental care over the recommended 2-year control period ¹

Source: Stats Wales, NHS patients treated for adults and children by the local health board.
¹ Data are provided quarterly and refer to the percentage of the population that has visited the dentist at least once in the previous two years.

Dental treatments are divided into tranches according to the level of complexity, which also determines the cost:

  • Band 1 includes simple examinations and treatments, such as X-rays, scaling and polishing;
  • Band 2 includes more clinical procedures such as fillings, extractions and root canals;
  • Band 3 includes more complex treatments (eg crowns, bridges and dentures); and
  • Urgent refers to short-term emergency treatment to stop pain or prevent further deterioration.

Figure 2 shows that dental services have been slow to recover. Between October and December 2021, the number of Band 1 cures (which includes routine examinations) was 70% lower than the 2009-2019 average for the same period.

Figure 2: Number of dental treatments provided to adults quarterly 2009-2021 by treatment bracket

The graph shows that the number of dental treatments in each group (1, 2, 3, Urgent and Total) given to adults remained broadly stable until April-June 2020, when it fell during the first nationwide lockdown of Covid-19.  Urgent treatments had recovered in the second quarter of 2020 and were higher than before.  Treatment prices in other bands have been very slow to recover and from October to December 2021 were still much lower than before the pandemic.

Source: Stats Wales, Course of treatment by treatment band, type of patient, local health board and neighborhood.

The impact is also felt in secondary care, where there is a range of dental specialties. The Welsh government publishes data on this via StatsWales (see Figure 3):

  • Oral surgery; concerned with surgery of the teeth, jaws and gums;
  • Pediatric dentistry; caring for the complex dental needs of children;
  • Orthodontics; provide dental appliances to straighten teeth and primarily provide services to NHS children;
  • Restorative dentistry; focused on the management of diseases of the oral cavity, teeth and supporting structures; and
  • dental Medicine; a branch of oral health

The latest data shows that the number of patient journeys awaiting treatment increased for all specialties except reconstructive surgery between April 2021 and April 2022. While the percentage of patients awaiting treatment longer than 36 weeks decreased for most specialties (excluding dental medicine) over this period, waiting times remained high for orthodontic, dental medicine and oral surgery treatments. In April 2022, 50% of patients had been waiting more than 36 weeks for oral surgery.

Figure 3: Number of patient journeys awaiting hospital care in April 2022 compared to April 2021 by dental specialty and waiting time.

The content of this graphic is explained in the text.  There were more people waiting for orthodontic treatment (4,236) than pediatric dentistry (1,287) or restorative dentistry (823) in April 2022.

Source: StatsWales, Journey of patients waiting to start treatment by month, grouped weeks and treatment function, from January 2021

Resumption of dental services

Two years after the start of the pandemic, Swansea Bay SCC reported in February 2022 that a significant number of people still do not have access to NHS dental care and treatment. It says practices do not have appointments available or are not taking new NHS patients.

The Welsh Government has set expectations for 2021/22 that all NHS dental practices have a responsibility to see new patients. But there is limited data on the services offered to the public and to patients. In plenary on July 5said the Prime Minister;

… our ambition is to ensure that NHS dentistry is accessible to all who wish to adopt it.

Oral health inequalities

There is very little information on the segments of the population who are unwilling or unable to access dental services. Some people may choose to access private dentistry.

Research published by the GDC points out that dental professionals are concerned that the decrease in dental capacity has most likely affected:

  • Those who were clinically extremely vulnerable to COVID-19 (54%);
  • People unable to afford dental care (48%); and
  • The elderly (43%).

The data shows that 16 NHS dental practices in Wales closed between July 2021 and June 2022. Due to the closure of practices, some people will have to travel further to access dental care, creating particular difficulties for people in rural areas, with reduced mobility or low income.

Figure 4: Proportion of the population at different travel distances to the nearest dentist according to rurality and level of deprivation

The graph highlights the differences in travel distance to dentists between rural and urban areas and the most deprived and least deprived areas.  A greater proportion of people in rural areas and less deprived areas live more than 3 miles from the nearest dentist than in urban areas and more deprived areas.

Sources: Data from general dental practices, Mid-year 2020 population estimates, Welsh Multiple Deprivation Index 2019, ONS Rural-Urban Classification.

Figure 4 (above) shows that most people in Wales (61%) live within 1 mile of their nearest dental practice. Unsurprisingly, rural residents tend to live farther from the nearest dental office, with 25% of rural residents traveling more than 8 km to get to the nearest dental office. Residents of the most deprived areas, which are generally found in urban areas, have better physical access to dental practices than residents of less deprived areas.

Figure 5: Travel distance to nearest NHS dental practice

The map shows the location of NHS dental practices in Wales and highlights the area within certain travel distances from them.  There is a greater concentration of dental practices in South Wales and along the North Wales coast.  Dental practices are sparsely distributed across Mid Wales.

Sources: General dental practices , Mid-year 2020 population estimates, Welsh Multiple Deprivation Index 2019, ONS Rural-Urban Classification, Road network. The distances reflect the actual distance traveled along the road network.

Beyond simple measures of distance, analysis by population groups in terms of who can access and pay for dental care is not possible. The data also does not include vulnerable groups who can access dental care through community dental services (explored in more detail in our second article). To better understand access to dental care from an equity perspective, integrated databases and analyzes from General Dental Service (GDS) and Community Dental Services (DCS) are needed.

Article by Katie Devenish, Sarah Hatherley and Sam Jones Senedd Research, Welsh Parliament


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