Editor in Chief Ian Peate Editor Sophie Gardner sophie.gardner@markallengroup.com Subeditors Carolyn Crawley carolyn.crawley@markallengroup.com Janet Perham janet.perham@markallengroup.com Vicqui Stuart-Jones vicqui.stuart-jones@markallengroup.com Clinical Series Editor Barry Hill Commerical Manager Nicholas Barlow nicholas.barlow@markallengroup.com Circulation Director Sally Boettcher sally.boettcher@markallengroup.com MedEd Manager Tracy Cowan tracy.cowan@markallengroup.com Production Manager Kyri Apostolou Production Assistant Larry Oakes Designer Hal Bannister Publishing Director Andrew Iafrati andrew.iafrati@markallengroup.com Managing Director Anthony Kerr Chief Executive Officer Ben Allen

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The crisis in dental care Ian Peate FRCN OBE, Editor in Chief, British Journal of Nursing

As our NHS came into being in 1948 this meant, for the first time ever, that dental care was free at the point of use.This led to a dramatic change in the way in which people were able to gain access to good oral health care and an understanding of how to look after their teeth. In 1948, there was a school dental service, as well as a special priority service that was set up for expectant and nursing mothers and young children, organised by local authorities.The initiative was such a success and there was such a demand for dentures that a far higher proportion of the allocated budget was spent on this than had been expected (British Dental Association (BDA), 2022).

In 1948 the nation’s dental health was in dire straits: decay, pyorrhoea and sepsis were rife. More than three-quarters of the population over the age of 18 years had complete dentures.When the NHS opened for business it was estimated that just over a quarter of practising dentists had signed up to work in the NHS.The requirement for dental care on the new NHS was overwhelming, with dentists seeing around 100 patients a day when the NHS was established. Prior to this, they were seeing 15 to 20 patients per day. In the first 9 months of its existence, NHS dentists provided more than 33 million artificial teeth.This figure rose to 65.5 million for the year 1950-1951. Extractions formed a large part of dentists’ work with 4.5 million in the first 9 months, as well as fillings – 4.2 million in the same period (BDA, 2022).

As dentists’ work increased, so too did their incomes and the NHS became a more attractive proposition. Official figures claimed that by November 1948, 83% of practising dentists had signed up to work in the NHS (BDA, 2022), with more people being treated than ever before.This success, however, came at a huge financial cost, with

dentists concerned about its sustainability. By 1951, the NHS was running out of money.To help ease this situation, charges were made for dentures.

In 2022, 74 years after the formation of our NHS, Healthwatch (2022) has warned that people in England are struggling to access dental treatment as practices are closing to new NHS patients. Some people are living in pain or unable to eat properly because they cannot find treatment. Lack of access to dental appointments is increasing, promoting further health inequalities, with the poorest suffering most as it is they who are the least able to afford to pay for private dentistry. A long-standing shortage of NHS provision has been made even worse by more dentists closing their lists to NHS patients during the pandemic, as well as some staff retiring (Healthwatch, 2022). Access to NHS dental care had been an issue long before the pandemic. There are, however, clear signs that the problems have been intensified by COVID-19. Between 25 March and 8 June 2020, NHS dental practices in England stopped routine dentistry in response to the pandemic. Around 600 urgent dental care hubs were created to deliver care for patients. Over the course of the pandemic, it has been estimated that more than 38 million dental appointments have been missed (Kulakiewicz et al, 2022).

An additional £50 million in funding is being made available to help deal with the backlog (Kulakiewicz et al, 2022). It is anticipated that this will secure up to 350 000 additional dental appointments for those in most urgent need, with priority given to children, those with learning disabilities, autism or severe mental health problems.

There is an urgent need to reform the dental system, ensuring that the service is fit for purpose, with access for all. NHS dental services have the potential to be a world leader, providing everyone with access to dental care and good oral health outcomes, regardless of where they live or their financial situation.These beliefs reflect the founding aspirations of our NHS in 1948. BJN British Dental Association.The story of NHS dentistry.

2022. https://tinyurl.com/4vjmkuz6 (accessed 31 August 2022) Healthwatch. Lack of NHS dental appointments widens health

inequalities. 2022. https://tinyurl.com/cv578273 (accessed 31 August 2022 Kulakiewicz A, Macdonald M, Baker C; House of Commons

Library. Access to NHS dentistry. 2022. https://tinyurl. com/3cxmhezm (accessed 31 August 2022)

British Journal of Nursing, 2022, Vol 31, No 16