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Dentistry (Nottingham, North)

I congratulate my hon. Friend the Member for Nottingham, North (Mr. Allen) on securing the debate. He takes a keen interest in the challenges faced by commissioners of primary care dental services for Nottingham. I offer him my sympathy on his tonsillectomy, which comes at a most frustrating time, and means he is not able to make as detailed a contribution to the debate as he might like, but I certainly admire his fortitude in speaking when his throat is somewhat raw. Before I deal with some of the issues relating to dental services in Nottingham, I shall set out the national context for dentistry. I certainly share my hon. Friend's view that children throughout the country should regularly be using toothbrushes and toothpaste well before they are six years old. Children should be taught at an early age how to clean their teeth, and I hope that we can reach a level of improved dental care. We have increased spending on dentistry; it was up 11 per cent. in 2008-09 and 8.5 per cent. this year. Funding is running at a record £2.25 billion, net of patient charges. Since 2004, funding for dentistry has gone up by 70 per cent., which is an additional £900 million. As a result of the increased investment that we have made since then, 850 dental students are expected to graduate next summer—an increase of 25 per cent. As part of our expansion programme, two new dental schools opened in 2007, in the south-west and in central Lancashire, thereby reversing the Conservative closure of two dental schools in 1991. The number of dentists working in the NHS rose last year by 528, on top of an increase of 655 in the previous year. More dentists in the NHS meant that last year an extra 1.4 million courses of treatment were delivered. We believe that the best decisions are made as close to those affected by them as possible, so in 2006, in line with the rest of the health service, we reformed NHS dentistry. The new system gave power to primary care trusts to commission the right dentistry services for their communities. PCTs have provided incentives to encourage prevention and improve quality, but in some areas—I suspect Nottingham is among them—progress has been slow and sometimes much too patchy, so in December 2008, the then Secretary of State asked Professor Jimmy Steele to conduct a review of the new contract, and that was published in June. I am delighted that the review has joined the Select Committee on Health in supporting the principle of local commissioning and providing a firm basis for the future of NHS dentistry. The review also showed the range of services that are needed; that different generations need different types of dental care; that simply drilling and filling is no longer acceptable; that we need to improve oral health; and that preventing decay and disease must become a real priority for NHS dentistry. We wholeheartedly welcome Professor Steele's review, and we will rigorously test its recommendations in a series of pilots throughout England over the coming months. I am very pleased that the British Dental Association, patient groups and other stakeholders have welcomed the review. In the years since the foundation of the NHS, we have seen substantial improvements in our dental health. Half of adults in 1948 had no teeth at all; now, we are about to carry out the latest national adult dental health survey and we expect the figure to have fallen to about 6 per cent. Whereas 35 years ago more than 90 per cent. of all 12-year-olds in England had tooth decay, today the figure is less than 40 per cent. We are making substantial improvements, and it is arguable that our children have the lowest rate of tooth decay in Europe and are comparable with the best in the world, including countries such as America. The association between social deprivation and tooth decay is clear, and we know that the link can be broken. Sandwell in the west midlands has only a slightly better socio-economic profile than Nottingham city; however, according to the most recent British Association for the Study of Community Dentistry survey of dental decay in the milk teeth of five-year-old children, from 2005-06 the average number of decayed, missing and filled teeth among such children in Sandwell was about one third of that in Nottingham. My hon. Friend may be interested to know that the North West Public Health Observatory will publish the latest figures, for 2007-08, next week. Apart from rates of tooth decay, what are the differences between Sandwell and Nottingham? For a start, fluoride is added to Sandwell's water supply to bring it up to the 1 part per million level at which it can help to protect people's teeth. I realise that fluoridation is controversial, which is why no new schemes can be introduced until a strategic health authority has consulted the local population, but it offers one way of reducing inequalities in oral health which does not require individual parents and families to take action, because fluoride is in the water supply. In addition to population-wide measures such as fluoridation, dentists and members of their team can intervene to improve oral health. For example, we have developed the Brushing for Life scheme, which targets young children in areas with the highest levels of tooth decay. When their families visit child health clinics or Sure Start centres, they get a free pack of fluoride toothpaste, a toothbrush and a leaflet containing advice on oral hygiene. Many such interventions will take place before children are six years old, and we need to ensure that at an early age they are able to get the benefits of fluoride toothpaste, a toothbrush and an explanation of the best way to protect their teeth and ensure that their full adult set of teeth is healthy. Parents or carers are also given a demonstration of how to brush their children's teeth, or of how to teach their children how to brush their teeth—obviously far better. In June last year, Nottingham city primary care trust started the City Smiles programme to combat poor oral health in children. Its main objectives were to reduce tooth decay; to ensure that children received appropriate dental care; and to increase knowledge about oral health. The three principal messages were to improve diet, for example, by limiting sugars to meal times; to improve oral hygiene habits, for example, by brushing teeth twice a day; and to promote better access to dental care so that children saw a dentist at least once a year. Those messages are being given to all pregnant women and pre-school and school-age children in the Nottingham area. In similar places to those where Brushing for Life applies, families with young children are given the opportunity to have their children's teeth treated with fluoride varnish, as recommended by the Department of Health. Then, because the varnish needs to be reapplied at six-monthly intervals, the families are advised about how they can access a high street dentist for their continuing dental care needs. That provides the initial contact with a dentist that some families need to ensure that they are subsequently in regular contact. The regular application of fluoride varnish is one of the most effective ways in which to deal with dental health and prevent future dental problems. Where that has happened, it has reduced tooth decay in young children's primary or milk teeth by a third, and by 46 per cent. in adult, permanent teeth. We know that if children have healthy milk teeth, the chances are that they will have healthy adult teeth. If they have decayed milk teeth, that may well lead to problems with their adult teeth. Getting to children early—certainly well before they are six—is an important part of improving oral health in this country.