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:
150.Tooth decay is the number one reason for child hospital admissions in Northern Ireland. 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.
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. 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. This compared with 43 per cent who felt the same way about not adhering to dress codes and 38 per cent about being overweight.
152.While the proportion of adults who are edentate (have no teeth) has fallen significantly in recent decades, 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. 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.
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. 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.
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. Research has also pointed to the effectiveness of dental teams in promoting tobacco cessation and even in recognising signs of abuse and neglect—contributing to a multi-agency approach to safeguarding. 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.”
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. The British Dental Association suggested that some child public health initiatives could be funded using additional monies raised from the Soft Drinks Industry Levy, as has been the case in England. However, the Department has stated that additional monies raised from the levy have gone into the overall budget, raising concern that funds have been used to shore up holes in existing services rather than on preventative or transformative projects.
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.” We were told that a meeting had been scheduled with the chair of the British Dental Association to discuss the issue further. 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.
339 NHS Digital, , 19 March 2015, page 12
340 Ibid., page 16
341 NHS Digital, , 19 March 2015, page 5
342 NHS Digital, , 19 March 2015, page 35
343 Department of Health, , 17 October 2018, page 16
344 British Dental Association, , 12 March 2018
345 NHS, , accessed 21 August 2019
346 , accessed 21 August 2019
348 NHS Digital, , 24 March 2011, page 5
349 The Faculty of Dental Surgery of The Royal College of Surgeons of England, , August 2017, page 4
350 Ibid., pp. 4–5
351 Department of Health, , accessed 28 August 2019
352 British Dental Association Northern Ireland ()
354 Alan B Carr and John Ebbert, , 13 June 2012
355 Public Health England, , 3 April 2019
357 British Dental Association Northern Ireland ()
359 HM Treasury, , 5 April 2018
360 Department of Health, Freedom of Information, , 14 June 2018
361 British Dental Association, , 19 December 2018
Published: 2 November 2019