Reduced access to NHS dentistry to blame for dramatic increase in dental abscesses?

The number of people admitted to hospital with dental abscesses has doubled in the past ten years, according to a study published ahead of print on bmj.com. The authors of the study say they were prompted to look at the issue after seeing three complicated cases of dental abscesses in a six month period in 2006. In each case the patient arrived at the Accident and Emergency department suffering from an undiagnosed abscess (a collection of pus) in the mouth.

One 48 year old man was twice advised to find a dentist, but unable to do so, he was admitted to the Hospital’s Critical Care Unit when he was found unconscious by his partner. He spent three weeks in the unit. In another case, a 48 year old woman spent 44 days in hospital after being referred to the Emergency Unit by her GP. None of the patients were registered with a dentist.

The authors from the University of Bristol say these cases prompted them to look at the data for the frequency of hospital admissions for dental abscesses from the years 1998/99 to 2005/6. They found that the total number of admissions and bed days due to drainage of a dental abscess almost doubled during this time.

On average patients spent approximately two days in hospital. The mean age was 32.

The authors say the oral health of the population has improved during this time so the reason for this dramatic increase is most likely to be changes in the provision of dental care in the UK.

Changes to dentists’ pay in the 1990s led many to reduce their NHS workload. At the same time this has been accompanied by a drop in the number of people registered with an NHS dentist—from 23 million in 1994 to 17 million in 2003/4.

The authors say it is possible that changes in service provision have resulted in routine and emergency dental care becoming less available and that this explains the rise in surgical admissions for dental abscesses. They also point to a recent survey which found one in five people had declined dental treatment because of cost.

However, they do say that some of the changes to dental practice occurred before 1998 and advise some caution in drawing causal inferences from the data.

They add: “We believe that a doubling in a preventable condition that can have major consequences and that can even result in death constitutes a major public health problem that requires urgent action.”

The authors conclude that there needs to be a review of routine and emergency dental care.

In an accompanying editorial, Professor Ruth Freeman from the University of Dundee suggests that the NHS dental contract, introduced in 2006, led to misunderstandings between the public, patients, and the profession. “The government’s sensitivity regarding professional anxieties slipped away and the profession’s sensitivities for patient’s anxieties were forgotten”, she writes.

Freeman points out that only 4% of dentists actually left the NHS after the contract was introduced, despite media stories to the contrary, such as reports of difficulties in accessing NHS dentistry and of deregistered dental patients queuing outside new dental surgeries to register for NHS dental care .

The government now recognises the need for better communication between stakeholders and this should “pave the way to accessible NHS dentistry for all”, she concludes.

Source: BMJ-British Medical Journal