Patients 'should look after teeth if they want care'
Christmas is a great time to enjoy sweet treats: cake, pudding and mince pies are all part of the festive fayre. But they can also take their toll on your teeth. In this week's "Scrubbing Up", Newcastle University dentistry expert Professor Jimmy Steele, says that patients who consume sugary diets and do not look after their teeth, should not get expensive dental treatments on the NHS.
One of the things that marks dentistry out as "different" in the NHS is the patient charge; the state puts in over £2bn a year in England to support NHS dentistry - but most adults have to pay some charges.
Dentistry is highly skilled, complex, individualised and is never cheap in any system, so patients, one way or the other, are used to paying a direct cost.
But do the presence of charges, whether NHS or private, distort the way we think about the service we receive, and does the way that dentists are paid affect how services are provided?
With Christmas shopping done and January sales approaching, we are all pretty familiar with the concept of getting something tangible for what we spend.
But when it comes to health, and particularly to oral health, there are a few problems with this basic relationship between money, value and goods.
For a start, it does not make any real sense to want "more" fillings for less money; given the choice I think most of us would choose to have no fillings at all, if possible.
Teeth start healthy, it is neglect, poor hygiene, and the consequent disease and treatment that cost.
So, are we all prepared to pay to avoid treatment then? And should the dental team be paid to stop disease before it starts even if that means less treatment?
New dental contract
Last week the coalition government announced pilots for a new dental contract where the dentist will be paid for the number of patients they look after and the health outcomes they achieve rather than for the fillings, crowns or root treatments they provide.
A system like this should give clear incentives to the dental team to help the patient minimise the risk of disease up front, rather than wait for it to appear and then treat it.
Patients will still pay, so you may get less treatments, but better health for your money. This is surely right for a health service.
So in this preventive world, what if you and your dentist agree that something more complicated and more costly to deliver is required, as it will be for many millions of people at some stage?
This might be a root treatment to save a valued molar from extraction, or a bridge to fill a visible space.
Some people might advocate the removal of such time consuming and costly treatments from the NHS completely - and there is certainly a case for being clearer about NHS entitlements.
But many such treatments play an important role in good health and well being.
Rationing on health
If we are serious about health outcomes, in these situations a healthy mouth should come before costly and complex treatment.
Your root treatment or expensive bridge is more likely to fail if disease risk is not managed first.
It simply does not make sense for the state to support costly treatments without the patient taking appropriate steps to look after their own oral health, to ensure clean teeth and a degree of dietary control.
On the face of it, this sounds like another discussion about rationing on health.
Perhaps it is, but it is not quite the same as restricting liver transplants to those on the wagon or by-passes to nicotine quitters.
Alcohol and tobacco are chemically addictive whilst other lifestyle changes are no easier to manage.
By contrast, cleaning your teeth usually requires little more than a few short and sensible conversations with a professional, a toothbrush and some toothpaste.
If taxpayers are contributing to the NHS to provide costly and difficult treatment, asking the patient to provide a healthy mouth first seems a reasonable deal, doesn't it?