The number of people with no natural teeth was falling and a new generation of people were emerging whose teeth were decayed but were being restored instead of being taken out and replaced. This was a switch from dentures to fillings, caps and other restorative dental procedures. These trends were confirmed by analysis of the 1998 Adult Dental Health Survey data.
At the same time, further changes started to emerge in young adults that showed a sustained reduction in decay rates.
Substantial reform required
It became clear to policymakers that substantial reform of NHS dental services in England would be required if the projected future needs of the population were to be met.
In 2009, Newcastle University's Head of Dentistry Professor James Steele was asked by the Secretary of State to carry out a review of the NHS dental contract.
Recommendations being piloted
From this, a set of recommendations for public policy reform were put forward, many of which have now been adopted into a prototype NHS dental contract which is currently being piloted.
Professor Steele explains: "We were seeing a very clear shift, not just in dental health but also in the treatments being offered to patients by dentists.
"The number of people with complete dentures was getting less and being replaced by a generation of people with mouths full of metal fillings as dentists worked to restore teeth instead of replacing them."
"Then we started to see another change – children coming through with much healthier mouths due to improved diet, lifestyle and education. What was needed now was a focus on prevention, but because the dental contract was designed to pay dentists for the treatments they provide - such as the number of fillings they did - there was a discrepancy between what was being offered and what was actually needed", added Professor Steele.
"Our review suggested a change. A pathway of care that focuses on prevention and advice, and rewards dentists for helping people to look after their teeth so they don't need the fillings – or at least not until much later in life."
The review recommended a number of improvements around better access, prevention and long term patient care and has been piloted at selected dentists around the UK. The recommended changes to the dental contract include:
- linking a significant part of dentists' income to the number of NHS patients registered with them, not just the number of treatments they provide
- making dentists more accountable for providing high quality and long lasting treatments (eg fillings and root canals)
- supporting dentists to take time to advise patients on preventive care
- defining more clearly the rights that patients can expect when they register with an NHS dentist, both for urgent treatment and continuing care
The next step is to use what we learned from the pilots to move towards prototype contracts with a view to a final contract for all dentists in the next few years. This will radically shift dentistry away from invasive treatment and towards preventive care and well-managed pathways.
- NHS Dental Contract Pilots - Early Findings (PDF: 1MB)
- Professor Steele explains his recommendations on the overhaul of dental services to The Guardian
- Read the BBC's report on the recommendations made to dental service reform
- Find out more about Professor Steele's research interests and publications