Nationality and Borders Bill

Written evidence submitted for The Nationalities and Borders Bill by The British Dental association.

(NBB02)

About the British Dental Association

The BDA is the professional association and trade union for dentists practising in the UK. BDA members are engaged in all aspects of dentistry including general practice, community dental services, hospitals, academia and research, and our membership also includes dental students.

Key points:

1. Clause 5 8 of t he Nationality and Borders Bill gives the Secretary of State the power to make provisions about the use of scientific methods in establishing the age of migrants claiming to be children. According to media reports, the Government’s intention is to introduce dental X -rays as a means of assessing age in such cases.

2. The British Dental Association is vigorously opposed to the use of dental X -rays to establish the age of migrants . This is an inaccurate method for assessing age. The BDA also believes that it is inappropriate and unethical to take radiographs of people when there is no health benefit for them.

3. Dentists are health professionals, not border guards. They should not be put in a position of having to make judgements that are clinically and ethically inappropriate.

4. Back in 2016 , the Home Office ruled out the use of X -rays to establish the age of childhood migrants and the BDA is seeking assurances that despite media reports this method of assessing age will not be brought into use.

Lack of accuracy of dental X -rays for assessing age :

5. D ental X -rays are not a reliable way of establishing age. X-rays can fairly reliably estimate age in younger children, but as young people mature at different rates , this method becomes much less reliable in adolescents and the potential margin of error gets ever larger with age. For example, wisdom teeth – the last permanent teeth to develop – can form any time between the ages of 16 and 23, and some people never develop them at all.

6. Numerous studies have shown that, despite improving technologies, the use of dental X-rays can over- or under-estimate the age of adolescents significantly , which clearly makes the use of dental X-rays inappropriate for judging whether a person is just over or just under 18 years of age. For example , a 2010 study of 300 young people aged between 11 and 25, whose age was determined based on dental x-rays, showed this method of testing consistently over- or under-estimated age. In this study the mean difference between dental and known age ranged from 1.5 to 2 years, and 95% confidence interval of estimated age was ± 4 years.

7. The rate of dental maturation can be affected by factors such as nutritional status, infections and vaccination against some diseases, all of which are highly variable among migrant populations in particular. Genetic factors and e thnicity can also cause variation. Many of the subjects in dental X-ray data banks are not from the same ethnic groups as migrants and do not, therefore, provide an appropriate benchmark for age determination.

Lawfulness and e thics of performing X -rays for non-medical purposes :

8. T he process of radiography is a medical procedure that should be carried out only for medical purposes, and where the patient stands to benefit. Exposing children to radiation when there is no medical benefit is simply wrong.

9. X-rays might not be considered an invasive procedure , but they do carry a small risk of possible long-term physical impact . This risk is cumulative: successive exposures increase the risk, which means that each exposure over a lifetime must be clinically justified. For this reason best practice in this area dictates that exposure to radiation should be kept as low as reasonably possible over a lifetime. X-rays should be carried out sparingly and only where there is a well-defined potential clinical benefit, which must always outweigh the potential clinical harm.

10. Clinicians taking radiographs in the UK must follow the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) which ensure patients are protected from the risk of harm when being exposed to ionising radiation. These regulations specify that a clinician performing an x-ray has the responsibility to:

o minimise unintended, excessive or incorrect medical exposures

o justify each exposure to ensure the benefits outweigh the risks

o optimise diagnostic doses to keep them "as low as reasonably practicable" for their intended use.

As taking X -rays to determine the age of an individual carries no clinical benefit, it is not appropriate to expose a patient to the potential clinical harm it can cause.

11. It is also a legal principle that before practitioners carry out any medical procedure, the recipient – or someone who can consent on their behalf – must be given a full understanding of the nature of the procedure, its significance, impact and potential consequences before signing up to it.

12. For many migrants arriving in the UK , this would be a difficult task given English is usually not their first language , and they might not be accompanied by a suitable adult able to consent on their behalf . In these cases t he need for valid consent and protecting the child’s best interests cannot simply be ignored.

13. The need for consent is a requirement that can only be compromised where the urgency and necessity of the circumstances demand rapid action in a patient’s best interests. Given that taking X -rays in order to determine age is not medically justifiable in the first place, the urgency justification really doesn’t come into play. And that means dentists could find themselves performing an act that is not just inappropriate and unethical, but even constitutes criminal battery.

Thursday 19th August 2021.