Providing free dental treatment to oral cancer patients should not be an issue of cost-effectiveness, Michael Watson says.

Last week the Oral Health Foundation called for free dental care for mouth cancer patients ‘to combat the discriminatory costs of ongoing healthcare that survivors are often burdened with’.

It said that following cancer treatment, patients are faced with long-term oral health issues, that often result in complex and expensive dental work.

Dr Chet Trivedy, trustee of the Oral Health Foundation and consultant at Kingston Hospital said: ‘Frequent dental treatment is often a necessity for mouth cancer victims.

‘With NHS dental charges ranging from £21.60 to £256.60 in England, the recurring costs over the course of a year can be staggering.’

Limiting demand

Now charges both for prescriptions and dentistry have been around a long time, barely 15 months into the life of the NHS, in October 1949, Prime Minister Clement Attlee told Parliament that the Government proposed to make a charge for each prescription under the NHS.

The purpose of that is, he said: ‘To reduce excessive and, in some cases, unnecessary; resort to doctors and chemists.’

Two years later, the new Minister of Health, Hilary Marquand, who had succeeded Bevan said that, in order to increase the availability of dental services, he was introducing charges ‘to limit the demand for dentures’.

What was true in 1951 is still true in 2018, patients’ charges are levied to reduce demand on the NHS, put bluntly to discourage people from attending the dentist.

There can be no justification for levying charges on those who have suffered from mouth cancer and thereby discouraging them from seeking the care they need.

Now, if you are undergoing treatment for cancer, ‘including the effects of cancer, or the effects of current or previous cancer treatment’, you are entitled to a ‘medical exemption certificate’, which means that you don’t have to pay for your prescriptions.

But it doesn’t extend to dental treatment, why not?

Free dental treatment

It would be relatively simple administratively to extend free dentistry to anyone with a medical exemption certificate.

Such a move would, incidentally, also include diabetics and it would be no bad thing to treat their dental treatment as an integral part of their care package.

But should the Government not go one stage further for those not yet diagnosed with oral cancer?

The last issue of the BDJ was a mouth cancer themed issue, required reading for all in practice.

Guest editor, Mike Lewis, stressed the importance of early diagnosis, saying that The Oral Health Foundation’s Mouth Cancer Action Month, which is drawing to its close, ‘aims to raise awareness of mouth cancer and save lives by promoting the values of prevention and early detection’.

Cost-effectiveness

If I or my wife have symptoms that might indicate a cancerous lesion, then we go to the doctor and have any tests free of charge, so why do we have to pay an NHS charge for a dentist to look at, for example, a mouth ulcer that does not heal within three weeks?

As the chief executive of the Oral Health Foundation, Nigel Carter, says: ‘Cost remains a significant barrier for why people continue to avoid regular dental visits.

‘These are crucial for frequent mouth cancer examination and for diagnosing cancer as early as possible.’

Given that the purpose of NHS charges is to reduce demand and discourage people from attending a dentist it is, as the Oral Health Foundation says, ‘a morality and ethical issue’ not one of cost-effectiveness.


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