Who will look after the restorative patients?

By Dr Dhru Shah
Friday November 20th 2020

There is always going to be a group of patients who need restorative care.  The adult dental health survey that used to be done every 10 years was very good at identifying how big this need was. However this has since been stopped unfortunately.

Nevertheless, the need for restorative care will not disappear. Restorative includes endodontic, periodontal and prosthodontic care. There is still a large part of the population who will have primary disease in the form of caries, gingivitis, periodontitis and endodontic lesions requiring this care and this is now compounded by the "modern" disease of tooth surface loss. Dietary changes and lifestyle changes with stress have possibly exacerbated this.

Historically such restorative care was adequately funded by the NHS but over the last decade, it has been very difficult to provide this. The UDA system that does not differentiate between a single tooth, needing a single restoration and multiple teeth needing endodontic and prosthodontic treatment has made provision of such care in challenging economic conditions very difficult. Nevertheless many practitioners continue to do their best serving patients under severe time pressure. However it is fairly obvious that the complexity of the system, the limited and often (insufficient) renumation and the high beauracratic overload is draining people. 

However many practitioners do wish to provide private care for their patients. Setting up a wholly independent private practice that can offer restorative care is not easy - the regulatory overload created by successive governments, the high running costs and the high financial investment involved make it a challenge. 

So some practices are offering mixed care - offer NHS check ups and then find ways to offer private care where the NHS would not suffice to deliver the long term quality needed. (although under the contract all care except cosmetic must be provided - irrespective of cost ...or something to that effect). 

Offering this treatment is not easy in mixed practices. The rules around mixing are not clear and not easy to interpret. 

One "escape" from those feeling disenchanted, stressed or poorly rewarded by this system and in order to deliver the kind of quality work they wish to, is to embark on the cosmetic journey particularly focused on the provision of short term aligner orthodontics, bonding with composite and bleaching (the kind of treatment that appears to be seen and has found a very able home on instagram accounts).
Another "escape" is to provide treatments that the NHS can not cover such as dental implants.

Ofcourse the other option is to refer patient - either to secondary or tertiary care. Secondary care are mainly private specialists or dentists with special interest and tertiary care are the hospitals. However there is only so much workload that we can also take up as there are very few of us specialists and very limited space in hospitals.

COVID-19 is likely to have created a further increase in such cases (I am only speculating and time will tell)

But my question is - in the above circumstances and limitations created by so many regulatory and renumeration bodies, who is going to deliver this complex restorative care?

Will the dental practitioners take the brave steps and set up private practices despite all the risks?
Will the NHS increase its budgets significantly to cover the costs of complex care?
Will the tertiary and secondary sector get more providers?

There is definitely going to be a gap whichever way it goes but here in lies the gap in the future. After all, how many invisalign open days can every practitioner hold and how many invisalign marketing campaigns can any media handle?

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