The content of this editorial has not been peer reviewed
Catherine Rutland
The Future of Dentistry?
When you think about how you define general dental practice, what
comes to mind? You might think about our commitment as dental
professionals to the wellbeing of our patients, the daily treatments
and advice we give, or the central role our practice teams play in local
communities. Alternatively, as a dental professional experiencing the
last 12 months or more, you might be tempted to think about growing
patient backlogs, difficulties in patients being able to access dental care,
burdensome and often opaque guidance from regulators, or practices
being excluded from government decisions that impact them.
As Clinical Director at Denplan, I know that many of our member
dental practices will hold many of these thoughts and concerns
simultaneously after the year UK dentistry has experienced due to
COVID-19. But what the pandemic has done is expose the myriad of
issues facing general dental practice – issues created by the pandemic
and a great many that predated COVID-19 and its fallout. While as a
profession we have been well aware of the issues, importantly some of
the problems are gaining wider acknowledgement by the public and
policy makers.
Owing to this, at the end of last year, Denplan undertook an in-depth
study of the current state of dentistry in the UK, which culminated in
the publication in April of 'The Future of Dentistry' white paper.1 This is a
ground-breaking body of research and it comes at a timely juncture for
the dental sector ,which faces numerous challenges across multiple fronts,
regardless of the UK jurisdiction in which you live and work.
With the core of our white paper based on survey responses from our
Denplan member dentists and a specially convened expert roundtable
in February, this is an important read for dental professionals and
policy makers alike, because it highlights issues that have often been
overlooked or ignored in discussions about dentistry in recent years.
From the impact of COVID-19, to the understanding of private dentistry
among policy makers, to the role of dentistry in the wider preventive
healthcare debate, and the importance of training and teams, the
Denplan white paper brings much needed heat and light to the subject.
The experience of the past year has shown the enormous pressure
dentistry has been put under by the coronavirus pandemic. The full
extent of the pandemic’s impact on general dentistry is evidenced by the
fact that some 19 million fewer dental appointments took place during
2020 compared to the same period in the previous year.2 This collapse
in numbers has demonstrated how dental practices have been acutely
impacted by the pandemic through a mixture of the first lockdown
compelling practices to largely close their doors, and subsequent
Catherine Rutland, MA BChD IRMCert CMI Level 7 Certificate in
Leadership Coaching and Mentoring, Clinical Director, Denplan.
email: catherine.rutland@simplyhealth.co.uk
July/August 2021 DentalUpdate 521
GuestEditorial
COVID-19 guidance from the four Chief Dental Officers (CDOs).
However, it has also been the official guidance that has often served to
exacerbate problems.
As the Denplan white paper has identified, most dentists who we
surveyed expressed concerns about the government’s understanding
of, responsiveness to, and support for the private and mixed dental
sector. The opaque nature of official guidance from CDOs, the
poor communication of information about re-openings and overly
burdensome fallowtime regulations have all contributed to practices
struggling to know what they should be doing. Particularly for mixed
dental practices that felt unable to see many of their patients out of an
abundance of caution over falling foul of unclear regulations set by the
CDOs. This stems from the lack of understanding on the part of policy
makers and regulators who have approached the issuing of guidance to
dental practices by viewing any dental practice carrying out a General
Dental Services contract – no matter how small – as requiring the same
level of regulation as fully NHS practices.
This lack of understanding of the sector, highlighted by 'The Future
of Dentistry' white paper, means poor policy decisions and outcomes. For
example in England in June 2020, when many practices and professional
bodies learned about re-opening from the news, with almost no notice
or guidance to prepare a safe return. This deficit in understanding of
the sector is also acting as a major pull factor towards wholly private
practice for many practitioners who have a wish to focus more time on
patient care, and feel more in control of the decisions they make about
their business.
This paucity of understanding of private dentistry is also visible in
the Government’s recently published 'Integration and Innovation' white
paper,3 which has set out an ambitious preventive health agenda and
restructuring of healthcare services, but without reference to the vital
role played by the dental sector in England.
The Department for Health and Social Care’s proposals for the
restructuring of healthcare envisions a more integrated health system
based around integrated care systems (ICSs), the wider adoption of
digital technology in healthcare – from telemedicine to wearable health
monitoring tech – and a greater emphasis on preventive healthcare,
building upon the 2019 prevention green paper4 and the NHS Long-term
Plan.5 As many of those in general dental practice, and as our roundtable
of experts identified back in February, the adoption of digital trends and
preventive health are already key aspects of general practice routines
and have been accelerated by the pandemic.
However, while there are useful proposals around the introduction of
more widespread water fluoridation, there remains little to no mention
of dentistry and its role in improving oral health in the local community.
Combined with a fluoridation policy, dentists can support the shift in
public health policy from just treatment to prevention through their
GuestEditorial

unique position to identify dietary, lifestyle and chronic health conditions

before ill health develops. However, the lack of understanding of

ROCK SOLID
dentistry on the part of policy makers means that, once again, dentists
are excluded from the wider preventive healthcare discussion.
Indeed, as recently demonstrated by comments from government
ministers in Parliament, there remains a poor understanding of the vital

STABILITY role dentistry plays in the early diagnosis and referrals of mouth cancers.6
As the Oral Health Foundation has observed, the 10-year survival rate for
oral cancers is significantly determined by where the cancer occurs and

Effortless Placement
Conical-hex connection
Osteoconductive surface
Tapered body
Double lead thread
how early it is diagnosed.7 The lack of understanding of dentistry’s role in
early diagnosis and referral of oral cancers is emblematic of a wider level
of poor knowledge of how dentistry works and the role it plays in wider
public health.
As Denplan’s 'The Future of Dentistry' white paper draws out to
raise awareness with policy makers, poor oral hygiene has significant
impacts on wider health outcomes, such as heart disease and diabetes.
However, only one in six people realize that having periodontal disease
may increase their risk of stroke or diabetes, and only one-third are aware
of the heart disease link.8 If ministers are genuine in their stated desire to
see dentists performing an enhanced role in preventive healthcare,9 then
there needs to be a sea change in understanding how dental practices
can – and do – form an integral part of the public health landscape,
regardless of how they are funded.
This will require a fundamental change in knowledge and
understanding, first by those in government implementing policies that
impact dentistry, and then by the wider public regarding the benefits of
regular dental visits to their wider bodily health and wellbeing.
While the past 16 months have been so hard for us all, both
professionally and personally, I hope that you will agree that Denplan’s
'The Future of Dentistry' white paper will be an important step towards
better understanding of our profession at a crucial time of transition. We
now need to ensure that we use this increased awareness for the benefit
of the oral health of the nation and to move the profession forward in
the direction that will enable this.
To download and read 'The Future of Dentistry' white paper in full
visit: www.denplan.co.uk/the-core/industry-and-company-news/the-
future-of-dentistry-whitepaper

References
Self tapping tip 1. Denplan. The future of dentistry. 2021. Available at: https://tinyurl.com/49u26fj2
(accessed July 2021).

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2. British Dental Association. Capital funding: the way forward on fallow time. 2020.
Available at: https://tinyurl.com/e2mya42s (accessed July 2021).
3. Department of Health and Social Care. Integration and innovation: working together to
improve health and social care for all. 2021. Available at: https://tinyurl.com/dbayjp4x
4.
(accessed July 2021)
Department of Health and Social Care. Advancing our health: prevention in the 2020s.
2019. Available at: https://tinyurl.com/5xj8y2bu (accessed July 2021).
5. NHS. NHS long term plan. 2019. Available at: https://tinyurl.com/48xy37zx (accessed
July 2021).
6. UK Parliament. Oral cancer: diagnosis. Question for Department of Health and Social
Care. UIN 173233, tabled on 22 March 2021. 2021. Available at: https://tinyurl.com/
r7u89y96 (accessed July 2021).
7. Oral Health Foundation. State of mouth cancer UK report 2020/21. 2020. Available at:
8.
www.dentalhealth.org/thestateofmouthcancer (accessed July 2021).
NHS. The health risks of gum disease. Available at: https://tinyurl.com/s4ydd5bw
(accessed July 2021).
9. Hansard. Covid-19: dental services. Volume 687: debated on Thursday 14 January 2021.
2021. Available at: https://tinyurl.com/ykurny6r (accessed July 2021).

522 DentalUpdate July/August 2021