It is not disputable that dentistry is an integral part of a person’s overall wellbeing and

health.The provision of a free dental service has been a matter not without its critics,claiming
it is not possible because of funding issues.The divergent opinions on this matter underscore
the complexity of the issue.However a free dental healthcare system has social,cultural and
economic benefits and cannot be overlooked as it is a basic human right.Currently

Research suggests that low-income households may face challenges accessing dental care
within the NHS due to financial barriers, which can limit their ability to seek timely and
appropriate treatment.In a survey conducted by the National Association of Citizens Advice
Bureaux, 43% of patients stated that they had avoided a dental check-up in the preceding 12
months because they could not afford the cost(Citizens Advice Bureaux,2001) . An extended
period of time where a dentist is not visited could also increase dental anxiety in patients
because of a gap that is created in the patient-dentist relationship.Ideas of fear could be
associated with a dentist’s image because of this anxiety which ultimately makes the general
public more hesitant to visit the dentist. In these cases, the lack of dental care might have
given rise to more serious diagnoses which require more invasive procedures to solve
,ultimately supplementing the fear in the patient-enabling the vicious cycle of dental fear
detailed in ( Armfield, Stewart & Spencer,2007)

Free NHS dentistry allows for more frequent visits to the dentist without financial constraints.
The patient enters the clinic with a positive state-of-mind and sees the dentist as a
trustworthy figure as opposed to the perception of greed attached to dentists that has gained
currency in recent years due to media portrayal.[1]

A more sustainable alternative to a completely free of charge NHS system would be to

encourage the education of oral health. Instead of attracting the public by offering to treat
their teeth for free, we can help them understand the importance of oral hygiene and the
various comorbidities associated with it. This would be cheaper to implement(through
posters and social media) and also promotes a healthier mindset about dental hygiene that
is autonomous.

By employing an economic lens, the lack of free healthcare can incur further costs that are
felt at large by the economy. Firstly when oral health conditions are not prevented and
intervened at an early stage ,because of infrequent visits to the dentist, further complications
can occur which may lead to complex procedures that need to be funded by the NHS. The
complication could also result in absence from employment due to sickness which can cause
productivity losses for the general economy.

Dental wellbeing plays a large role in the overall wellbeing of an individual. Arguably the
most relevant connection between the mouth and body is the bidirectional relationship
between diabetes and periodontal disease. Periodontal disease limits the ability of the body
to utilise insulin “Periodontal disease further complicates diabetes because the inflammation
impairs the body’s ability to utilise insulin," says Pamela McClain, DDS, president of the
American Academy of Periodontology. High blood sugar also provides ideal conditions for
infections to grow which causes gum infections.
Lack of dental care can result in the onset of various other diseases such as cardiovascular
disease [2] , respiratory problems [3] and generally a weaker immune system, making them
more susceptible to communicable diseases. Hence, NHS dentistry assumes similar
importance to general NHS and one could argue that it should also be free of charge.

The World Health Organization advocates that “the right to health for all people means that
everyone should have access to the health services they need, when and where they need
them, without suffering financial hardship” [4]. Healthcare can, therefore, be seen as a
fundamental human right. A paid national healthcare service treats oral hygiene as a
commodity that is only available to those who can afford it. It defies the medical pillar of
Justice which states that all patients must be treated fairly and equitably, regardless of their
circumstances or individual characteristics. The idea of a free dental healthcare service
closes the socioeconomic disparity to sustain a just system.

For example, a divide is created by the lack of dentists in some areas but a surplus of
dentists in others :the City of Westminster having over six times the number of NHS dentists
per 1000 of population compared with Ashfield, the area with the lowest number in the
country. Therefore, the citizens of Ashfield suffer more dental disease which can lead to the
onset of other comorbidities such as diabetes which in turn reduces life expectancy . The
productivity of the town also decreases and a psychological decline is felt by the general
public with signs of low self esteem and depression that accompanies poor oral hygiene. As
a result, the economic output of the town becomes lower with the GDP per head of Ashfield
being £24,760(5) but the GDP per head of Westminster being £282,093(Office for National
Statistics (2019). Regional Economic Activity by Gross Domestic Product, UK - Office for
National Statistics. [online] www.ons.gov.uk. Available at:
https://www.ons.gov.uk/economy/grossdomesticproductgdp/bulletins/regionaleconomicactivit
ybygrossdomesticproductuk/1998to2018.).It demonstrate how inaccessability to healthcare
can amplify inequality in the country.

My arguments for a free dental service in the UK are made hypothetical by a major factor
that has tormented the NHS for a few years: funding. I understand that prompt suggests a
more ethical-based approach instead of plausibility attributed to the use of the modal verb
‘should’ rather than ‘can’ but I believe that funding plays an imperative role in the discussing
the sustainability of a free NHS.Reports state that there is already a £400 million underspend
and there is only enough NHS dentistry commissioned for 50% of the population. If we were
to make the NHS free of charge for all we must find another way to fund the service. Since
2010, dentistry is the only part of the NHS that hasn’t increased in funding. The effect of this
compounds over many years due to 2 main factors: inflation and population growth.
According to the BDA, dental inflation is now 11% which is further broken down into 35% for
utilities and lab bills increasing by 15%. The failure to keep up with rising costs has made it
very difficult for the remaining practice owners to provide sufficient care for their NHS
patients.The proposition of a free NHS dental system was a reality in 1948, vastly changing
people’s access to healthy oral healthcare. The idea,however, was not sustainable and first
started to charge patients for dentures in 1951 to alleviate the lack of money in the NHS.

As the population grows the demand for dentists also increases which unfortunately cannot
be fulfilled because of the number of foundation dentists that can be trained.In the current
economic climate, the cost of training dentists in their foundation year for each practice is
£8,030., however the funding for the training has been frozen since 2010 at
£5,347.Consequently, the number of qualified dentists in the future decreases and the
proportion of dentists to people decreases as population grows ,adding further stress on the
remaining dentists and their resources, preventing them from providing satisfactory care for
their patients. The fee that is collected from the patient is part of what helps to finance these
future dentists and if it is removed while government funding stays the same, more dentists
would be inclined to join private dentistry.

Another major issue with a free NHS dental system is an inadvertent decline in personal
responsibility for one’s oral hygiene. While free NHS treatment may seem like a force that
improves overall dental health,under closer inspection, it might encourage the public to
disregard preventative methods such as brushing their teeth and flossing because of a
‘safety net’ of free healthcare without any monetary consequences. One study published in
the Journal of Dental Research found that individuals who received free dental care were
less likely to take preventive measures such as brushing and flossing compared to those
who paid for their dental care (Fiset, L., Grembowski, D., Del Aguila, M.A., et al. (2014).
Does receipt of dental care moderate the effect of preventive oral hygiene counselling in
reducing untreated caries among children with low socioeconomic status? Journal of Dental
Research, 93(7 Suppl), 58S-64S. DOI: 10.1177/0022034514537363.).However, it's important
to note that these studies have limitations and should be interpreted with caution. For
example, the study by Fiset et al. only included a small sample of individuals and did not
control for other factors that could influence dental health behaviour.

To conclude, the idea of a free NHS system has many benefits yet holds many drawbacks
and obstacles.Therefore instead of trying to make the whole system free, the limited funding
must be funnelled to schemes to promote dental awareness and help people living in
deprived areas.

Bibliography:

1. Poulter, S. (2015). Greedy dentists fleece families. [online] Mail Online. Available at:
https://www.dailymail.co.uk/news/article-3125533/Greedy-dentists-fleece-families-Un
dercover-investigation-reveals-hide-prices-restrict-NHS-treatment-force-patients-costl
y-work.html.
2. 2. Humphrey LL, Fu R, Buckley DI, Freeman M, Helfand M. Periodontal disease and
coronary heart disease incidence: a systematic review and meta-analysis. J Gen
Intern Med. 2008; 23(12):2079–86
3. Isaac S. Gomes-Filho,1,* Johelle S. Passos,1 and Simone Seixas da Cruz2 ,
Respiratory disease and the role of oral bacteria. J Oral Microbiol. 2010; 2:
4. World Health Organization. Health Is a Fundamental Human Right. 2017. Available
online:
https://www.who.int/news-room/commentaries/detail/health-is-a-fundamental-human-
right (accessed on 26 July 2021).
5. Varbes. (n.d.). Ashfield Economy | Labour Market & Industries. [online] Available at:
https://www.varbes.com/economy/ashfield-economy [Accessed 10 Apr. 2023].
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