There is a scandal brewing, but it is not this one Mathew Parris

Mathew Parris is usually some one you can rely on for sensible comment but on this occasion (Saturday’s edition of The Times 16.07.2011) he is guilty of rehashing a disappointingly familiar misconception of dentistry. In his article “The Next 20 Scandals” Mathew states –

Dentistry and the NHS are a murky business where the service and private practice appear to live in a baffling symbiosis on which dentists thrive and for which patients, both paying and would-be NHS users, choose between the queue and financial ruin. Dentistry should be like car repair: it’s only teeth, for God’s sake. Where’s the market?

This statements contains all you need to know about a lot of peoples feelings about dentists and dentistry but it really does not stand any degree of scrutiny.

1) “a baffling symbiosis”. The symbiosis between private and NHS is not in the least bit baffling. You either pay privately or you pay for NHS (unless you are exempt NHS charges). This is hardly baffling. Dentists are required to explain their fees before treatment begins and must indicate if work is being provided on a private or NHS basis. If they fail to do this it is not a fault with the system, more a fault with the dentist.

2)”On which dentists thrive“. Maybe its me being paranoid but the implication seems to be that dentists thriving is a bad thing. If it is a bad thing then lets look at a world where dentists don’t thrive- a world where they employ less people, generate less taxable revenue, invest less in training and technology, reduce the time and money invested in improving services for patients, spend less time on treatments to help them boost falling revenues, take fewer risks in expanding their businesses, leave the profession for alternative employment, give less freely of the time for teaching of students and their peers- is this really a better world?

3)”Choose between the queue and financial ruin“- really is that the only two choices out there. Are none of us offering staged treatment plans, payment options, prevention advice to lower disease activity, mixed practices to try and offer all service levels?

4) “dentistry should be like car repair” – what we after here- grubby surroundings, wildly unrealistic estimates, unlicensed premises with no regulator bodies, no compulsory post graduate training (no undergraduate training for that matter)? Would our patients be happy with no comfortable relaxing waiting areas, no highly trained and efficient reception teams, written treatment plans and estimates derived from careful discussion of their needs? Would they really prefer us to take one look inside their mouths, do the ubiquitous sharp intake of breath and say the immortal words “it’s gonna cost ya”?

5) “it’s only teeth for gods sake” Perhaps the most telling comment of the lot and certainly the saddest. How an intelligent and educated man such as Mathew Parris can give voice to this view is beyond me. They are only teeth until they go wrong- then they are a source of pain, infection (potentially fatal), misery, social embarrassment, childhood teasing and bullying. Oral health and general health are intimately linked and the treatments are carried on people who often have complex medical and psychological concerns that need our expertise and understanding.  We help people with these problems on a daily basis and are happy to do it.  No one with tooth ache will tell you they are just teeth; no one who struggles socially and is desperately unhappy with their smile will say they are only teeth; no one who’s child has fallen of a bike and smashed their front teeth will say-don’t worry they’re only teeth.

6) “where’s the market”– Our market is the entire population who need our help, advice, treatment and care throughout their entire lives.

The saddest thing of all is that Mathew is right, there is a scandal coming but it is not the one he alludes to. You can take your pick from the effects of an ever increasing burden from unnecessary and restrictive bureaucracy (do MPs really need to discuss whether people should be allowed to have whiter teeth) , the continuing chaos in the General Dental Council (the fitness to practice panels struggling to cope) , the massive cuts in hospital based dentistry( multiple unit closures and reductions in consultant posts in London alone), the spiraling costs of providing care, the exponential increase in litigation fueled by “no win;no fee” lawyers……etc. I doubt these will be given much voice in the press as these require a more sympathetic view of dentists and their teams but these are the ones that will really shape the future for dentists and their patients. Lets start discussing these now, before it’s too late.