An article in this weeks Sunday Times (p10 of the News section, “Eat Sweets and NHS might not fix your teeth” by Sarah-Kate Templeton, Health Editor) highlights comments made by Professor Jimmy Steele, Dean of Newcastle Dental School regarding the role of the NHS in funding dental care for patients who resist advice to curb the dietary habits that contribute to their decay.
Prof Jimmy Steele has been heading the group that are reviewing the provision of NHS dentistry in England and is in consultation with the new government about what changes to the dentists contract should take place so his views are very important. His remarks echo other similar debates in medicine about how far we should go (and how much we should spend) on caring for people who consistently fail to alter their lifestyle and habits in ways that would dramatically improve the outcome of their care. Clearly, although the argument is the same in medicine, the outcome is potentially much more severe, especially when we consider smoking and heart disease for example where we are being asked to decide if one life is worth more than another. In the dental field we are not asked to make such impossible decisions but we do see the endless cycle of restorative failure where fillings are placed to treat decay, which returns leading to replacement fillings, then crowns, then root fillings, then extraction followed by dentures and bridges followed by decay of adjacent teeth and so it continues. If this care is entirely self funded then I guess individuals can argue that it is up to them how much they care for their teeth and whether they should moderate their habits to improve the possible outcomes. When a second party is picking up some or all of the bill of course the question returns to when should the treatment be withheld.
For my part, the role of personal responsibility is a tricky moral dilemma, especially as I am at least 2 stone the wrong side of my ideal weight! I guess I will always come down on the side of a society that tries it’s very best to provide every level of care, whilst making clear at all times to patients (and their loved ones) when the disease is being worsened by lifestyles and habits. StoneRock is a prevention centered practice, which we take to mean that disease risk and causes are established right from the start and patients are given all the necessary information to allow them to reduce or eliminate their need for dental treatment. Their recall system is based around clinical need rather than randomly set dates of 6 month reviews. Despite this I see repeat dental decay and worsening gum disease when there would be none if our advice was followed. This is disappointing and frustrating and can make for a strained relationship between the dental team and the patient but would never cause me to give up on that person.
It is inevitable that NHS dental funding will reduce in the next few years despite assurances of “ring fencing” so this debate will not go away. I hope we never reach the stage where we deny care fully but I can see a time where patients are made to “jump through more hoops” before the more advanced (and more costly) treatments are made available. At the very least a willingness to clean ones teeth effectively on a daily basis and recorded diet analysis to show an alteration in sugary food intake may be insisted upon and it would be hard to argue against this. We are very clear on the causes of dental decay and gum disease and have an exceptionally high level of evidence to show how moderating our habits can impact massively on the extent and recurrence of these diseases; it is a primary role of the profession to make it clear to every individual that they treat that the management of the health of their mouth is ENTIRELY in their hands, not ours!