Health officials have been warned that planned cuts to Northern Ireland's dental system will devastate a service already on the brink.
The British Dental Association (BDA) has written to Peter May, Permanent Secretary of the Department of Health to request a cost of service review and warned of the implications of further cuts to the dental system.
In an open letter from representatives of every field of practice in Northern Ireland, the organisation said that without investment, the service faces collapse.
Read more: Two NI dental practices among 85 set to close amid UK shortage of dentists
Its members who provide dental services within hospitals, general practice and community settings have shared their grave concerns in respect of the budgetary outlook for 2023/24, and the implications any further cuts could have on the dental system, patient care and the profession overall.
In the absence of a functioning government at Stormont, the BDA is calling on MLAs to step up and protect the future of NHS dentistry across Northern Ireland.
Stormont's Department of Health is currently facing a funding shortfall of £470 million
In the absence of a devolved Executive, Northern Ireland Secretary Chris Heaton-Harris recently set a budget for Northern Ireland. The Department of Health received £7.3 billion for 2023/24, a similar funding level to the previous year.
Dental leaders say Northern Ireland faces ‘a three-tier system’, where those who can't get registered for NHS care but can't afford to pay privately are left without routine access, short of accessing emergency services.
They said: "If the axe falls on dentistry - indeed if there is a failure to provide needed investment - this service faces collapse. The price will be paid by patients across Northern Ireland. Dental services in Northern Ireland are hanging by a thread.
"A demoralised workforce is still struggling to recover services from the hammer-blow of the pandemic. General Dental practitioners operating under a contract, which was already unfit for purpose, now face the very same inflationary pressures which are impacting on the Department’s budget."
Their letter also cites bleak evidence from the frontline, with the crisis on the high street being felt acutely across community and secondary care.
They say red flag referrals for suspected oral cancers from high street dentists to secondary care set at two weeks are currently running at 8.5 weeks in some areas.
Activity levels have only recovered to approximately 80% of pre-Covid levels, they say, adding that a workforce crisis is fuelling this access crisis, combined with unviable fees to dentists for providing NHS care.
They also warn that 60% of dentists intend to increase their amount of private work while 41% of practice owners plan to decrease their health service work, adding that this picture is set to worsen.
The BDA says there is currently a 5-6 year wait for routine assessment for oral and maxillo-facial services and 219-312 weeks hospital orthodontic waiting times for patients with facial deformities. Northern Ireland is also currently reliant on a surgeon from Wales to come over every two months to treat children with cleft lip and palate.
Cuts could mean waiting times increasing further, and some treatments being no longer available in Northern Ireland, according to dental leaders.
They add that the possibility of no pay uplift would have a devastating impact on the recruitment and retention and the financial sustainability of practices.
Alliance health spokesperson Paula Bradshaw said a failure to address issues impacting health service dentistry will only add to pressures on the health service in the future.
The MLA has called for a renewed Oral Health Strategy and a Dental Workforces Plan from the Department of Health.
“It is clear dental professionals and services are under unprecedented pressures, which are widening inequalities and having a huge impact on oral health, including cancer referrals,” Ms Bradshaw said.
“The current system is unsustainable and fees payable are not keeping up with the cost of treatment, causing this shift toward private care. A recalibration is desperately needed, and I support the BDA’s request for a cost of service review.
“We also need to look at contracts to make NHS dentistry viable for practitioners and address the growing pay gap, otherwise, we will continue to see a reduction in NHS care, a lack of access and dentists leaving to seek better conditions elsewhere.”
She added: “Without immediate action from the Department, we risk dental health and hygiene becoming an inaccessible luxury to our most vulnerable. We need to understand that failure to address problems now will only add to the pressures on our health service in the future.”
In response, a spokesperson for the Department of Health said: "Whilst the Department recognises the challenges that dental practices are experiencing due to cost of living increases, the financial pressures facing health and the wider public sector are considerable and without precedent.
"These pressures will inevitably be felt right across all parts of the health and social care system."
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