As has been well documented in recent years, the NHS is in crisis. It has been reported that 90% of dental practices cannot offer NHS appointments to new adult patients, with 80% not accepting new child patients either.[i] The government has published their plan to recover and reform NHS dentistry[ii] outlining a number of areas for improvements, and suggestions as to how this might be done. However, many in the dental profession feel that this falls short, with the BDA stating that the government “risks condemning a generation to decay and widening oral health inequality”.[iii]
This highlights the value of preventative care for patients, particularly when it comes to tooth wear which, when allowed to worsen, can require extensive restorative treatment. However, many question whether widespread prevention is achievable within current NHS dentistry, and whether technology may be able to assist clinicians in the long-term.
Tooth wear: a growing problem
At its inception, NHS dentistry was fundamentally designed to manage caries, rather than prevent it. As such, disease prevention is not rewarded in the current UDA system, despite the introduction of the new minimum UDA value.ii,[iv] However, as the incidence of caries reduces, tooth wear is increasing and is projected to be a significant problem facing patients and clinicians in the years to come.[v] Levels of caries and gingivitis appear to be decreasing, while tooth wear is increasing in the UK – with 75% of those assessed having some form of tooth wear.v Currently, the NHS is not equipped to deal with this – especially considering that the UK has an ageing population and can expect patients who have kept their natural teeth to require greater assistance managing tooth wear in order to prevent damage and the need for extensive restorative treatment plans.v
While tooth wear is considered age-related,[vi] its severity and patterns can be attributed to a number of factors – including lifestyle, diet, and oral hygiene. It is highly prevalent globally, affecting between 20-45% of permanent teeth,[vii] with the highest levels in Europe found in the UK.[viii] The NHS is not set up for effective preventive care or the management of complex tooth surface loss, so what can be done to assist the patients affected going forward?
How is tooth wear managed?
Checking for signs of tooth wear is crucial to assess which patients might be at risk for dental trauma or disease in the future. Whilst certain levels of tooth wear are expected in all patients as a natural part of ageing,[ix]significant tooth surface loss indicates an area of concern.[x] The long-term monitoring of tooth wear is key for preventing pathological wear, and returning the rate to that of physiological wear.x To do this, monitoring patients and diagnosing them early is key for preventing further tooth surface loss. Depending on the severity, some patients may require the application of fluoride varnish to remineralise the tooth, whereas others may require restorative intervention,x or endodontic treatment where pulpal involvement occurs.[xi]
Currently, monitoring the progression of tooth wear requires taking regular clinical photographs, and the periodic production of study casts. Whilst these offer clinicians a point of reference to measure tooth wear over time, they lack accuracy are time consuming and are difficult to compare. Digital solutions may present a solution here, but current models are costly, and may not be a realistic option for NHS dental practices.x
Effective use of technology
Across the entire dental profession, digital solutions are improving clinicians’ workflows. Day-to-day tasks are becoming more efficient and, with the continued implementation of AI-assisted technology, clinicians and their patients can enjoy more comfortable and interactive experiences.
In many cases, digital solutions could be very helpful for monitoring tooth wear over time. Looking to the future, digital dentistry will help to more effectively prevent catastrophic root fracture and the need for expensive treatments. This could provide an alternative system for monitoring tooth wear not currently available in the existing NHS framework. Digital solutions can be useful in the treatment of tooth wear too, by means of 3D planning and design of restorations to ensure that they are the appropriate dimensions to support recovery. Further to this, digital solutions may be used to prevent damage to the restorations once in place, by fabricating mouth guards.
Digital technologies are already making the processes needed to complete these workflows far more efficient, which is promising for the future of dentistry, and particularly preventive dentistry. They will enable clinicians to monitor their patients with intense accuracy, providing the ability to offer the right interventions at the right time.
Alyn Morgan
Alyn Morgan graduated from Leeds Dental School in 1995 and worked in general dental practice from 12 years.He undertook an MSc in Endodontics at the Eastman Dental Institute which was awarded with Distinction in 2009. He has worked as a specialist in Endodontics practice for 12 years at U Dentistry in likely and has been a Senior Clinical Teaching Fellow in Endodontics at both the Eastman and Leeds Dental Institutes.He is currently Head Of Endodontic Teaching At Leeds where he teaches undergraduates, postgraduates and hands-on courses for GDPs.He has been a Council member of the British Endodontic Society since 2021 and was elected President of the Society for 2023/2024
[i] The conversation. ‘I couldn’t stand the pain’. Accessed Apr 24. https://theconversation.com/i-couldnt-stand-the-pain-the-turkish-holiday-resort-thats-become-an-emergency-dental-centre-for-britons-who-cant-get-treated-at-home-224762
[ii] Gov.uk. Our plan to recover and reform NHS dentistry. Accessed Apr 24. https://www.gov.uk/government/publications/our-plan-to-recover-and-reform-nhs-dentistry
[iii] BDA. NHS ‘Recovery Plan’ unworthy of the title, say dentists. Accessed Apr 24. https://www.bda.org/media-centre/nhs-recovery-plan-unworthy-of-the-title-say-dentists/
[iv] BDA. The Dental Recovery Plan: What does it mean for you? Accessed Apr 24. https://www.bda.org/news-and-opinion/blog/the-dental-recovery-plan-what-does-it-mean-for-you/
[v] London tooth wear centre. Tooth wear. Accessed Apr 24. https://www.toothwear.co.uk/wp-content/uploads/2012/12/LTWC-Patient-Information-Leaflet2.pdf
[vi] Bartlett D, Dugmore C. Pathological or physiological erosion – is there a relationship to age?. Clin Oral Investig. 2008; 12:S27-S31 https://doi.org/10.1007/s00784-007-0177-1
[vii] Schlueter N, Luka B. Erosive tooth wear – a review on global prevalence and on its prevalence in risk groups. Br Dent J. 2018; 224:364-370 https://doi.org/10.1038/sj.bdj.2018.167
[viii] Bartlett DW, Lussi A, West NX Prevalence of tooth wear on buccal and lingual surfaces and possible risk factors in young European adults. J Dent. 2013; 41:1007-1013 https://doi.org/10.1016/j.jdent.2013.08.018
[ix] Lambrechts P, Braeme M, Vuylsteke-Wauters M, Vanherle G . Quantitative in vivo wear of human enamel. J Dent Res 1989; 68: 1752–1754.
[x] Mehta, S., Banerji, S., Millar, B. et al. Current concepts on the management of tooth wear: part 1. Assessment, treatment planning and strategies for the prevention and the passive management of tooth wear. Br Dent J 212, 17–27 (2012). https://doi.org/10.1038/sj.bdj.2011.1099
[xi] Leeds Teaching Hospitals. Tooth Wear. Accessed Apr 24. https://flipbooks.leedsth.nhs.uk/LN002840.pdf
