Should technology be used more in both dental diagnosis and treatment on the NHS?

Due to the links between oral and systemic health, poor oral hygiene or the development of an illness in the oral cavity could signify a more significant issue with the patient and, provided it goes unnoticed, could be potentially fatal. Thus, the use of new technology in the field of Dentistry ought to be encouraged in order to prevent further implications. However, it has been hindered for over a decade, with fundamental issues including the NHS contracts as well as the lack of funding for dental practices. Not only this but there must be a greater emphasis on dental education and the importance of dental health in order to establish a foundation for which technology can be used in such a way that it would vastly improve the quality of dental health in the UK. As a result, it must be asked whether technology be used more in both dental diagnosis and treatment on the NHS.

On the one hand, technological advancements will vastly improve the quality of dental care on the NHS. One of the most prominent issues with the field of dentistry is the fact that patients will often feel apprehensive when going to the dentist, with sound of the drill, the claustrophobic chair, the use of injections and the bright light all adding to this feeling. Thus, one way to motivate patients to attend is by addressing this issue directly. The main method for doing so is by changing the way in which illnesses and treatment are viewed by dentists. Historically, the biomedical model was used, which ‘has a strong focus on the physical processes that affect health’ (Garrod, 2019) and encompassed the idea that pain was a sign of a deeper issue and so needed treatment. However, more recently, this has been adapted to today’s issues, through the transition into the Biobehavioural/Biopsychosocial model. This incorporates the previous model as well as the psychology of pain and treatment – by considering the way in which patients mentally feel with the treatment, they will feel more incentivised to return, which would improve the quality of dental care and dental health amongst the public greatly. To illustrate this, laser surgery that has been used privately has very little effect on the patient psychologically due to the lack of sound and pain. In addition, the implementation of CAD/CAM in some private practices enables the dentist to provide the patient with a visualisation of the treatment prior to its fabrication, whilst also allowing the patient to customise their treatment. By providing patient-centred care, not only does this address the GDC’s core principle of putting patients’ interests first (General Dental Council, n.d.) but it enables the dentist to provide for the patients’ needs and desires. By using technology such as intra-oral scanners, it enables dentists to focus on the finer details of the oral cavity. For instance, with regards to the gingival tissue or the gum, there is a link between the development of gingivitis, which is not severe, and the onset of as neurodegenerative diseases like Alzheimer’s. Thus, giving dentists on the NHS, who will see the vast majority of the public, a platform to analyse their patient with greater precision, one can formulate a more accurate diagnosis by using such technology to elucidate their presumptions and thus refer people who are at a greater risk of developing systemic health issues, like dementia or cancer, to check using more thorough methods. As a result, this shows that due to the links between oral and systemic health, dental treatments and even dental check-ups can act as the first line of defence against illness and thus, improvements are needed in the field, not just for those who can afford private dental care but everyone.

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Conversely, there are some negatives to increasing the use of technology. Firstly, it has been claimed that technology can form a barrier between the dentist and the patient (Kaye, 2017). By focusing on technological advancements, the core principles of dentistry which lie in empathy and communication as highlighted by the General Dental Council are being abandoned. This could result in patients feeling unsatisfied or, due to the prevalence of dental phobia amongst all ages and all social strata, even apprehensive to attend a dental appointment. For instance, ‘50.7% of adults saw an NHS dentist in the 24 months to 30 June 2018. [This is] 98,445 fewer than the 24 month period to June 2017’ (NHS, 2018). This could either be attributed to a better quality of dental health or the aforementioned increasing prevalence in dental phobia. Thus, it may also be logical to emphasise the importance of dental health and dental education as well as attempting to implement technology. This could be a more effective method of improving the health of the oral cavity, as not only would it potentially motivate the general public to practice and maintain better dental hygiene but also it would stop the frequency of unnecessary treatments due to poor dental care due to the patients such as veneers being used as patients attempt to attain a ‘Hollywood’ or the ideal smile. In the short term, whilst it may seem counter-intuitive, in the long term, it will prevent the development of additional illnesses and so the need for more treatment such as orthodontic treatment arising from the development of calculus. Furthermore, it must be stated that there are more pressing issues such as the financial issues which the NHS currently suffers from as opposed to the affordability of new technology. For instance, according to reports by the British Dental Association, since 2010, the real net expenditure per capita on dental care by the government had fallen by almost £12, from £41.83 to £29.69 (British Dental Association (BDA), 2019). Simultaneously, during the same time period, charge levels have risen by over 30% while it is also believed that the current NHS dental budget is ‘sufficient to cover care for around half the English population’.  Consequently, attempting to implement new technology on the NHS may not be the most effective method in improving dental diagnosis and treatment, but it may be more viable and effective privately.

Overall, this question fundamentally concerns whether restorative dentistry, which is in support of new technology, or preventative dentistry, which is against it, is a better attitude to uphold for the future of the field. Personally, I believe that there are more pressing matters which need to be tackled first prior to technology being implemented such as the impact of ‘dental phobia’ on patients. Dentists, on the whole, encourage preventative dentistry, as it enables the patient to retain the natural structures in the mouth, which are significantly more effective at their role compared to the materials such as adhesives used in restorative dentistry. Consequently, I think that focusing on helping patients with improving their own dental health through methods such as showing more effective was of brushing their teeth as well as notifying them of potential causes for poor oral hygiene such as a poor diet can minimise the need for patients to go to dental practices as regularly and it would allow the NHS to invest these funds more appropriately. I also hope to see technology being implemented but so it is used to allow the dentist to interact with the patient in the best way possible. For instance, when dealing with young patients, using animations can help to both explain and demonstrate the best methods to deal with their teeth. However, achieving the overall feat of improving dental education is not simple and requires both time and money to see the full effects of it. Not only this but it may also require others who are not dentists to research how to teach people in the most effective manner possible. This could also be time-consuming and there is no guarantee of this being successfully implemented. On the contrary, if this concept can be used, it may have greater implications namely in other healthcare fields, where these methods can be adopted too. As a result, I hope that this could be achieved and, if it is not possible, then aspects of this task can be used to adapt the GDC’s guidelines, improving dentalcare overall regardless.

Photo Credits due to: https://www.rolanddg.co.uk/applications/dental-cad-cam

Rohan Mangalpara