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Children's dentist slams 'supervised neglect'

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Children's tooth decay is being either ignored or badly treated as a result of a system of ‘poor care' and ‘supervised neglect'.

That's according to Monty Duggal, the head of paediatric dentistry at the NHS's Leeds Dental Institute.

Writing in the Faculty Dental Journal, Duggal criticises dentists and parents who believe problematic first teeth can be left to drop out naturally.

He condemns non-intervention as ‘wrong and unjustifiable'.

He writes: ‘We must ensure that those children who still get caries do not suffer further from the provision of poor care and its consequences.

‘Specialists in hospitals treat children on a daily basis with severe oro-facial infections caused by poor restorations, placed with a disregard for good restorative principles or a non-interventionist "keep under observation" approach.

‘Hospital paediatric dental services across the UK are replete with children referred by general dental practitioners for pain due to untreated or inadequately treated caries in the primary dentition.'

That workload shows that the current neglect of children's teeth ‘has serious cost implications' for the NHS, he adds.

Monty Duggal sees 10-15 children a week, aged between three and eight, with severe toothache from several decayed teeth.

Most are from the most deprived estates in Leeds.

He blames the NHS's way of funding dentists for producing ‘supervised neglect' of children's teeth, suggesting the system ‘fails to recognise the increased treatment needs of such children' and ‘includes economic disincentives to the provision of such intervention'.

• Professor Duggal is a consultant and head of paediatric dentistry at Leeds dental institute. He has published more than 65 research papers in international scientific journals.

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where's the surprise here? " keep under observation"=standard practice for the uda system for both children and adults-observe till pain then extract. 3 pts lovely.Mind you if he's looking at children from a deprived estate what was he expecting?Tooth decay and social standing are in direct correllation.

Posted by gordie 12/5/11 at 08:44

Once again it's an example of the inescapable result of a grossly unfair sytem in which highly qualified members of a caring profession are expected to provide a comprehensive five star service on their own time and at their own expense and are then reviled if they do not do so. It is very easy for a salaried academic to score cheap points by sniping at those unfortunates who find themselves working in a system in which they are systematically exploited and emotionally blackmailed by a fund holding body that knows the profession is weak, spineless and hence totally at their mercy. If aforementioned were forced to work under similar conditions would they provide a better service? We will, of course, never know but I think the answer is obvious. In our Private Practice we occasionally see emergencies, many of them children, from NHS practices run by colleagues who are on holiday and whom we help out by seeing their emergency cases. Most of these patients' dentitions are in an appalling state despite regular "care" under the NHS system, and toothace from untreated grossly carious teeth is ever present. Judging by the sheer volume of similar observations in the Dental Press and on these forums this is a widespread phenomenon. The public, of course, say how disgusting it is that they cannot get a free service from these "greedy" Dentists, but they would undoubtedly complain and scream "unfair" (and probably instigate a general strike) if similarly treated in their working lives. Basically, if you are misguided enough to provide Dentistry on the NHS you can't possibly win. Provide a first class service and you will be penalised financially as a result of falling down on your UDA factory quota. Cut corners in an attempt to keep the roof over your head and you will be labelled "callous", "mercenary", "greedy" etc. You can't win. You are doing nobody any favours by treating patients on the NHS. Your standards will be compromised as will be the high income that we all deserve for a lifetime of sacrifice. Patients will receive bad treatment that will cause them worse problems than they would have had if left untreated (in many cases) and will not be slow to drag the poor dentist who provided this treatment through the mud with the help of their friends the GDC. Dentists should all work for no less than the same hourly rate as senior barristers (£500 to £1,000 per hour) or refuse to provide treatment on the NHS. Only then will things improve for both the profession and the public. Until that time we will all continue to be exploited and do nothing but complain about it, providing the same old recurring topics of conversation in these forums and in the press. If you do what you've always done you'll always get what you always got.

Posted by biker2260 12/5/11 at 16:17

Well said Biker.The system is broken and has been for some time. However, the chances of the majority of the public or the public sector NHS authorities paying dentists £500/hour are slim to none. Barristers have a much better monopoly on the practising of law than dentists have on the practice of dentistry. I'd settle for £200/hr providing quality care for the NHS. The last tooth I extracted on the NHS for a child took me forty minutes of cajoling and stressed me out big time. The fee didn't even cover the wages of my dental staff for the time spent, let alone anything for all of the other practice expenses to which we can now add the requirements of the CQC. I read a book at the start of my practice career when my social conscience burned very brightly. It was called 'Dr Jacobi's Flight Manual for Success' or something similar. I didn't understand it at the time (late seventies). Much of it seemed unfair, especially the quaint Amercan ideas about the need for a profit, and to plan against overwork and burn out. As the years under the NHS yolk ground on, I finally began to see what the author was trying to say. One great comment, amongst many, was a quip to a patient who complained about the high cost of a filling. 'Hey lady, the filling was for free. You're paying for the exclusive hire of this dental surgery for an hour, and my professional expertise'. I remember overhearing some dentists at a conference over coffee. One claimed he only needed ten minutes for an NHS apicectomy. The other said he was far too slow. They were serious.On another occasion, at the end of a course on splints, I overheard one chap say 'Let's get cracking. Everyone gets a splint from Monday' That was the old NHS fee per item of service in it's worst mode.'I have a hammer, and you're the nail. If I don't treat I don't get paid'. In trying to cure that problem, the pendelum has swung to supervised neglect, especially in children. Perhaps ethics should assume a greater role in the undergraduate syllabus, but if the young ethical graduate wishes to provide high quality NHS care, they'd better find a salaried NHS post after qualifying or they will go bankrupt.

Posted by edwardmk 12/5/11 at 20:37

How do you deal with ignorant parents (who should not even be allowed to have children in the first place)? It's not really the child's fault for having caries.

Posted by dentist 14/5/11 at 10:29

You give them more "benefits" to have a couple of more children !!

Posted by Expat 14/5/11 at 20:19

actually when I went private many years ago the problem disappeared-as did the children-people will happily spend afortune on their children eg education etc but not teeth-can't say I was sorry -one less stress-twice the work for half the money.The ones I do see are mostly dentally fit-its always the nhs ones who aren't but these days that applies to the adults as well.And don't believe they are the adult patients of the future -they're not

Posted by gordie 15/5/11 at 15:31

the logical way forward is to introduce a free market model in health care like in the usa (though it is fraught with problems, but at least what you get is what you pay for) and the so-called 3rd world countries, some of which eg India have far more advanced systems of health care and dentistry, optical services, pharma, etc. the only way forward for this country is to do away with the socialist system, reduce taxes, enable people to save and increase their disposable income, whilst simultaneously minutising public spending. sometimes taking ine step back is the only way to move two steps forward. taxpayers are treated like slaves. it's no surprise that everywhere the government has interfered by providing social services they have backfired very shamefully and yet belligerently continue this enterprise. let people evolve naturally and develop their inherent survival instincts. the intense competition will actually drive down the cost of provision of health care services - the government can just provide a community-based vestigial system for those in dire straits. by the way in some 3rd world countries, the public-funded hospitals, etc are cheaper than private ones, but there are long waiting lists just like in the nhs, and their national health insurance systems are not mandatory to join. if you do opt in, but choose fully private health care, that national health insurance scheme will pay a percentage of your health care costs. even people who are unable to pay a deposit for hospital treatment are seen in public/private hospitals but they are given credit at a nominal fee which they must pay back and they always do. it's hard to believe that we continuously keep pouring funds into a totally unproductive segment of society instead of empowering them and giving them education. there is nothing wrong if one has to sleep rough - one's sole source of income should not be the taxpayer's purse and expect that as one's birthright. that is outright abuse and until and unless this stops we are allowing a thankless society to breed.
i think i have digressed but this is all part of a vicious cycle and 'expat' has quite sensibly emigrated.

Posted by dentist 15/5/11 at 17:37

disagree with the last part-no need to emigrate-you can still do very well in this country

Posted by gordie 15/5/11 at 18:29

Nectar points.....again.

--This post was last edited on 16/5/11 at 10:04--

Posted by docholliday 15/5/11 at 21:56