Over the Easter weekend, reports from various sources claimed that DIY dentistry was on the rise in Britain. The Mirror first brought us news of Gulf War veteran, Ian Boynton, who took drastic action to alleviate his toothache. He could not find a dentist to take on NHS patients and, being unable to afford private treatment, is said to have removed 13 of his teeth with a pair of pliers. This extreme case led many outlets to report on the rise of DIY dentistry in the UK. The Independent commented that “if it’s down to a choice between £51.30 for an NHS filling or £4.65 for DenTek kit from Amazon which claims to do the same job, then the skint and the frugal shouldn’t be gasped at for saving pennies.” The Guardian also commented that “both poverty and inequality are blocking access to healthcare for the poorest people in the UK, and grim tales of a black economy are on the rise.”
Similarly, a survey commissioned last year by the British Dental Health Foundation found that one in five people would remove their own tooth, or ask a friend to do so, if they could not afford the dental treatment. Commenting at that time, Dr Nigel Carter OBE, Chief Executive of the BDHF, said: “DIY dentistry is both dangerous and unnecessary. There are too many senseless examples of people either pulling out the wrong tooth or ending up with an infection… I urge those considering self-treatment to think again.” Most of the news outlets commenting on the issue also quote Emma Richardson, who runs a charity to strengthen local communities in Paisley, Renfrewshire, called the Star Project. She said: “DIY dentistry is fairly common round here. They sell a lot of those first aid kits – you can buy them in Boots and Asda as well, and you’ve got people taking care of their whole family’s teeth with them.”
Many have noted that reports on DIY dentistry are mainly anecdotal in nature and contain little concrete facts on the matter. Others have noted that facts and figures are elusive because health data is gathered by surveying patients or dental surgeries. So what’s really going on here?
Do we believe in the facts, or in the lack of them?
The election coverage is nothing if not exasperating. George Osborne comes out and tells of the “facts” which show that Britons are so many hundred pounds better off under the coalition than the previous Government. Ed Balls then comes out and points to “facts” which he says show us that, in fact, British people are now worse off since 2010. Trying to listen and consider all sides can be a confounding experience. Facts, it seems, depend on who’s telling them.
Looking at the official figures concerning dentistry is a similar experience. The Guardian quote an NHS spokesperson who said: “Official figures show that more people than ever are getting NHS dental treatment, which is completely free for almost everyone receiving income-based benefits and subsidised for low earners.” They point to the lack of research concerning DIY practitioners as giving weight to their claim that the majority of people requiring dental treatment are able to access it on the NHS. They also highlight statistics that show that a majority of people across the UK (56% in England, 65% in Scotland and 55% in Wales) had been seen by a dentist in the 24 months to 31 March 2014, which they count as proof that those who require a dentist are able to avail of one. Dr Nigel Carter OBE, commenting on the survey on DIY dentistry last year, added: “The scandal of these results is that access and affordability of good quality NHS dentistry has never been better.” Cases like Ian Boynton’s, then, would be described as a relative once-off and a completely unnecessary and unacceptably painful experience for the man.
Karen Oates, of the Dental Health Foundation, commented that the affordability of the treatments should be, but isn’t always, a major incentive to go to the dentist to make sure you’re in good oral health. She said: “The majority of people would think these prices are relatively reasonable if you need work doing. It’s about prioritising £50. They probably would go and get their nails done or their hair, and don’t consider that the dentist is high enough on their need list, whereas for other people it is a priority to regularly go to the dentist.”
Many critics have pointed to the very fact that there aren’t any concrete facts concerning those who are unable to visit the dentist, for a variety of reasons, and may turn to DIY dentistry. John Wildman, professor of health economics at Newcastle University, said: “People at the lower end of the distribution curve – on big housing estates in the north-east, for instance, are effectively completely unreported. They don’t take part in surveys and they don’t go into GP surgeries. Which is why you have a situation where people in the north-east have gaps in their teeth and are resorting to DIY dentistry.”
The issue of oral health inequalities was highlighted in a recent survey on children’s oral health. This survey found a wide gap between the oral health of children from poorer backgrounds and those from more well-off backgrounds. Children from poorer backgrounds were almost 33% more likely to suffer from tooth decay. Similarly, commentators are pointing to the poor oral health of those from more deprived backgrounds as evidence for the rise in DIY dentistry. Taking into account numerous factors including age, sex, income, education and location, among others, recent research published in the Journal of Dental Research pointed to similar outcomes. The authors of the report commented: “It’s probably not a big surprise that poorer people have worse dental health than the richest, but the surprise is just how big the differences can be and how it affects people.”
Citing the case of a 40 year old HGV driver, who cleaned and prepared a cavity before plugging it with an incredibly dangerous toxic steel called Quik Steel, Jack Toumba, professor of paediatric dentistry at Leeds University, says that those from poorer backgrounds who cannot find an NHS dentist are forced into performing procedures themselves as they simply cannot afford private treatment. He said: “We’re finding patients who’ve rung practices across the north asking to register as an NHS patient only to be told the NHS lists are full and they can only register as a private patient… He’d treated the tooth twice by himself in the three years before he came to see us.”
Something to be worried about? Most certainly
As an eager, but often misguided, DIY practitioner of tasks around the home and garden, I know first-hand the effect of a poorly done job. It can look aesthetically terrible, involve a lot of fruitless hard work, be painful to re-do and would probably best be done by a professional who knows what they’re doing. This light hearted approach to garden furniture assembly aside, DIY dentistry presents a very serious risk to those who practise it. We wouldn’t try to perform surgeries on other parts of our body at home and our teeth should be no different. When done wrong, it can make matters worse and make the pain increase at an alarming rate. There is something seriously wrong if people are turning to this as a viable option. The GDC prosecutes anyone it discovers to be illegally offering teeth whitening. Prosecuting people who perform these risky procedures, thought, simply because they cannot afford to get it done by a professional wouldn’t be the answer.
The tale of Alex, which was reported by the news outlets, who bought an over the counter dental first aid kit from a pound shop who began fixing his own teeth after being made unemployed by the recession, is particularly unsettling. “I couldn’t justify going and getting my teeth out when we can’t afford nappies,” he said. The real story here, then, is not just the anecdotal evidence of people turning to self-performing dental procedures. It is the fact that this is even a possibility under the current unequal nature of our society which is most worrying. According to NHS figures, most areas of England have at least 45-50 dentists per 100,000 people. If more people are visiting the dentist than ever before, why are there some still slipping through the net? Why do there remain dental health inequalities depending on your income and where you live? We may not have concrete figures on how many people are unable to access dental services, and decide to do the work themselves, but that does not mean that these people should be ignored.
In all likelihood, although, with the absence of actual statistics concerning the number of people unable to afford dental treatment or unable to access an NHS dentist, it is likely that very little will be done. These DIY dentistry kits may indeed become more popular and more prevalent. This must be avoided at all costs. Action must be taken by the next Government to put in place measures to allow the most vulnerable access to NHS dentistry as and when they need it. Furthermore, the new proposed emphasis on prevention in the reformed NHS dentistry contract has the potential to reduce the number of people presenting with costly repair work. All the official figures would suggest this is not a problem. Those who have the power would do best to not simply ignore the so-called anecdotal evidence. They would do best to listen and take the appropriate steps so that more and more people do not choose to imitate them and engage in DIY dentistry. The NHS is a key battleground in the upcoming election. Oral health inequality is now such a serious issue that it deserves to form a core part of the arguments surrounding the future of the NHS.