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Dentistry (vCJD)

I shall say more about costs and further work later. The Department has now received some early findings from the Health Protection Agency from research on mice, which is still in progress. I will write to the hon. Gentleman with some of the details that he requested. The early findings suggest that infectivity can be found in several dental tissues and support the possibility that endodontic files and reamers could pose an effective route for transmission of vCJD. Therefore, the findings at this stage support SEAC’s view that these instruments should be restricted to single use on a precautionary basis in order to reduce any potential risk of transmission. After we had obtained the advice from the HPA, we considered that it would be prudent to act immediately on SEAC’s precautionary advice to make endodontic files and reamers single use. That decision was supported by both the HPA and SEAC. The studies are ongoing and I will give the hon. Gentleman as much information as I can, but I have to say that some of the studies will be subject to peer review before publication. I am sure that he will appreciate the need for that added check. The hon. Gentleman mentioned some of the concerns about cost implications for those dentists who were not already using single-use instruments. That is a complex area and one that we could not address fully when the announcement was made. The paramount concern at that point was to act swiftly and responsibly in terms of safeguarding public health. However, we have now analysed the cost implications in more detail and we will issue advice to primary care trusts this week on how to recognise some of those additional costs. I am sure that the hon. Gentleman will accept that the data show that the incidence of root canal treatments is variable. Our figures show that a typical dentist carries out only about 25 root canal treatments a year. For those dentists, the additional costs, which I will detail later, will be marginal and could well be offset by other expenses moving in the opposite direction. We have to be clear about how to approach the issue of expenses that are paid to dentists. We cannot make adjustments every time for different costs that might occur for one instrument as opposed to another. It would be difficult to do that on a yearly basis, so there will be swings and roundabouts in the costs. However, a minority of dentists carry out more treatments. About 10 per cent. of dentists carry out an average of 180 treatments a year. Even for those dentists, it is important not to exaggerate the additional costs. As the hon. Gentleman suggested, some of the cost estimates have tended to focus on the use of the more expensive nickel titanium instruments, but the evidence from suppliers is that stainless steel instruments make up some 70 to 80 per cent. of the market. Many cost estimates have also ignored the extent to which the previous multi-use instruments had to be replaced; and, importantly, following the announcement dental suppliers have responded swiftly by making single-use instruments available at much lower prices than before. The Department of Health is also working with NHS Supply Chain—an NHS-based purchasing initiative—to enable NHS dentists to take advantage of the significant buying power of the NHS, which should also result in lower expenses across the board. Information from dental suppliers indicates that dentists have responded in a very professional manner to the announcement and are now ordering sufficient quantity of these instruments to enable them to be treated as single use. Taking all those factors into account, our best estimate is that practitioners undertaking 25 treatments a year are likely to incur additional costs of about £80 on average per year. Practitioners undertaking 180 treatments a year will, we think, incur additional costs of about £1,000 per year. As I said, this week we will issue PCTs with advice that will recognise that the NHS needs to make arrangements to discuss those higher costs with contract holders.