Health funding in Northern Ireland Contents

5Oral health

Oral health in Northern Ireland

148.Northern Ireland has some of the worst children’s dental health outcomes in the United Kingdom. According to the most recent Children’s Dental Health Survey:

149.The survey went on to reveal the impact that poor oral health was having on children’s lives. Some of these included:342

150.Tooth decay is the number one reason for child hospital admissions in Northern Ireland.343 An analysis by the British Dental Association estimated that, based on 5,122 children aged 18 or under admitted to hospital for the removal of 22,699 teeth in 2016–17, the cost to the health service would have been approximately £9.3 million.344

151.The cost of poor oral health carries into adulthood, with gum disease linked to a number of health problems in later life, including heart disease and heart attacks, diabetes, stroke and rheumatoid arthritis.345 Poor oral health may also have an impact on employment prospects—a recent YouGov poll found that 77 per cent of respondents believed that visibly decayed teeth or bad breath would hinder someone’s chances of securing a public or client facing role.346 This compared with 43 per cent who felt the same way about not adhering to dress codes and 38 per cent about being overweight.347

152.While the proportion of adults who are edentate (have no teeth) has fallen significantly in recent decades,348 the ongoing maintenance of heavily restored teeth poses a different challenge for older people. Brushing twice a day may become more difficult for those with a long-term health condition, reduced dexterity or dementia and many regularly prescribed medications have the side-effect of causing dry mouth, which increases the risk of tooth decay and oral infections.349 Along with pain and the broader impact on a person’s quality of life, poor oral health has been linked with malnutrition and an increased risk of pneumonia in older people.350

Oral health strategy

153.Northern Ireland’s oral health strategy dates back to 2007 and has never been formally reviewed. The targets set out in the strategy extend only to 2013 and are based on data obtained in the 2003 dental health survey.351 We were told that very little information had been shared by the Department on where funds allocated to dental services were being allocated and prioritised and that in the absence of a coordinated plan or any fresh targets to work towards opportunities were being missed and progress was stagnating.352

154.The Committee heard that dentists had an important role to play in health promotion and upstream intervention in areas such as diabetes, obesity and certain cancers.353 Research has also pointed to the effectiveness of dental teams in promoting tobacco cessation354 and even in recognising signs of abuse and neglect—contributing to a multi-agency approach to safeguarding.355 The British Dental Association told the Committee that an acknowledgement of these wider benefits was “badly needed” by the Department and that “much more can be achieved simply by better co-ordination of resources and stakeholders, and a fresh ambitious vision for the improvements we want to make.”356

155.We were provided with examples of initiatives that had the potential to deliver long-term savings for the Department, including a universal nursery tooth brushing programme which the British Dental Association estimates could save the Department £1 million over five years based on results secured using similar models in Scotland and Wales; investment in prevention to bring down the cost of hospital admissions for child teeth extractions under general anaesthetic; and extending the HPV vaccine to boys as a cost-effective way to bring down rates of oral disease and cancer.357 The British Dental Association suggested that some child public health initiatives could be funded using additional monies raised from the Soft Drinks Industry Levy,358 as has been the case in England.359 However, the Department has stated that additional monies raised from the levy have gone into the overall budget,360 raising concern that funds have been used to shore up holes in existing services rather than on preventative or transformative projects.361

156.When asked by the Committee what progress was being made towards developing an up-to-date oral health strategy for Northern Ireland, the Permanent Secretary told us that “a lot of what is in [the 2007] strategy remains fit for purpose, but there are some issues we need to look at.”362 We were told that a meeting had been scheduled with the chair of the British Dental Association to discuss the issue further.363 However, to date, no commitment has been announced by the Department to develop a new oral health strategy for Northern Ireland.

157.Northern Ireland has some of the poorest oral health outcomes in the United Kingdom. The current oral health strategy is based on obsolete data from 2003 and does not contain any up-to-date targets for optimising services and improving outcomes. Fresh direction and impetus are needed to improve Northern Ireland’s oral health. This will not be achieved with a piecemeal approach but requires an overarching, evidence-based strategy with associated targets to work towards. The Committee recommend that the Department commit to developing a new oral health strategy for Northern Ireland in collaboration with the dental profession to be published in draft by early 2021.

340 Ibid., page 16

345 NHS, The health risks of gum disease, accessed 21 August 2019

347 Ibid.

349 The Faculty of Dental Surgery of The Royal College of Surgeons of England, Improving older people’s oral health, August 2017, page 4

350 Ibid., pp. 4–5

351 Department of Health, The Oral Health Strategy for Northern Ireland—June 2007, accessed 28 August 2019

352 British Dental Association Northern Ireland (HTH0021)

354 Alan B Carr and John Ebbert, Interventions for tobacco cessation in the dental setting, 13 June 2012

355 Public Health England, Safeguarding in general dental practice, 3 April 2019

357 British Dental Association Northern Ireland (HTH0021)

358 Ibid.

360 Department of Health, Freedom of Information, DOH/2018–0061, 14 June 2018

361 British Dental Association, Investing in oral health: Northern Ireland’s lost sugar tax windfall, 19 December 2018

363 Ibid.

Published: 2 November 2019