SECURING EXCELLENCE IN COMMISSIONING PAEDIATRIC DENTISTRY Dr Clare Ledingham Chair, BSPD Specialists’ Branch, Specialist Paediatric Dentist/Senior Dental Officer, Liverpool Community Health Westminster Health Forum, 2 July 2014
Children’s caries experience • 28% of 5-year-olds have caries experience ( Davies et al., 2013 ) ( Davies et al., 2013 ) • Average dmft (England) 0.94 • Average dmft in those with caries 3.38 • Highest caries rates are in areas of greatest social deprivation
Dental care experience of children • The restorative index (f/dmft x100%) is around 10%, but has a wide range across the country (3-43%) but has a wide range across the country (3-43%) • The restorative index has continued to fall since the 1980s when it was 24% ( Nugent, 1997; Pitts et al., 2005 ) • Children treated by paediatric dentists have a significantly higher restorative index than those seen in practice ( Tickle et al., 2007; Schorer-Jensma, 2010 )
Some good news: preventive care experience of children • There has been an increase (55%) in the number of topical fluoride varnish applications for children over the last 12- fluoride varnish applications for children over the last 12- months, representing 8% of all child treatments ( NHS Statistics ) Delivering Better Oral Health An evidence-based toolkit for prevention 2009 Updated June 2014
Extractions under General Anaesthetic • 5 th most common cause for admission to hospital for GA for GA • 3.1% of 5-year-olds across England ( Davies et al., 2013 ) • Range 1.9% (SE) – 4.6% (Yorkshire/Humber) • 49,555 GA for dental extractions in 0-14 yr olds ( PH England data, 2013 )
BSPD Response “In the 21 st century, it’s entirely unacceptable that children in the UK are having to undergo a general anaesthetic, in the UK are having to undergo a general anaesthetic, losing their teeth at a young age due to a disease which is entirely preventable. “BSPD wants to work with health officials to make it easier for parents and concerned healthcare professionals to help children with dental decay get early access to a paediatric dentist.
A Document to Guide the Commissioning of Children’s Dental Services A document produced by the British Society of Paediatric Dentistry 2012
BSPD, the DH and the paediatric dentistry care pathway (March, 2012) • BSPD invited to join DH working group • BSPD invited to join DH working group ‘ with the aim of improving the effectiveness and outcomes for the dental treatment of children. The work aligns with the development of the care pathways in dental services and taking forward the wider quality agenda’ • Following on from work on other advanced care pathways
Agreed Care Pathway (January, 2013) Level 1 – Procedure/conditions to be performed or managed in General Dental Practice Level 2 Level 2 – Procedures/conditions to be performed or managed by a dentist with additional competencies in GDS/CDS Level 3a – Procedures/conditions to be performed or managed by a registered specialist Level 3b – Care delivered by a consultant in paediatric dentistry .
Commissioning Paediatric Dentistry – where are we now? • Expert Commissioning Task Group to inform and • Expert Commissioning Task Group to inform and work with the DH • Considerable academic experience/evidence re engagement of patients/parents in decision- making re services
What are BSPD’s main concerns? • Lack of a Level 2 workforce • Lack of specialists in paediatric • Lack of specialists in paediatric dentistry • On-going poor quality care for many children, especially those with high disease levels often coupled with extreme dental anxiety
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