Tag: British Dental Association

Sugarier than Coke: Dentists press for government action on baby food

The British Dental Association has urged Government to step up and confront the baby food industry, after the most wide-ranging analysis of the UK baby food pouch market every undertaken has found no improvement in the sugar content. 

The professional body has noted that market leader Ella’s Kitchen, Piccolo and Aldi appear to have pre-empted the launch of this damning research on BBC’s Panorama tonight by confirming cosmetic changes to their labelling, to bring them in line with NHS guidance on not marketing products to infants under 6 months. While technically a ‘win,’ dentists’ leaders stress these changes do nothing to reduce grotesque levels of sugar or reign in ‘halo labelling’ claims. 

The BDA contacted Annabel Karmel, the worst offender from its last review in 2022, and was informed they have withdrawn from the UK market. 

Market analysis of 209 products aimed at children aged under 12 months – the largest such exercise ever attempted, and nearly double the BDA’s pioneering 2022 study – found: 

  • Top brands are actively undermining government guidance on weaning from around 6 months. At the time this research was undertaken market leader Ella’s Kitchen and Piccolo were pushing products to 4-month olds contrary to Government guidelines, simply stating that “every baby is different”.
  • It’s straightforward to offer lower sugar levels. While ‘natural’ levels of sugar are described by manufacturers as inevitable with fruit-based pouches, some brands offer products based on similar ingredients that contain a fraction of the sugar levels of the worst offenders. Aldi Mamia Organic’s Apple & banana porridge contains just 5.5g per 100g, a third of the levels of similar recipes at the very top of the table. Given there is no evidence of widespread systemic change, it underlines the need for government intervention.
  • Over a quarter contained more sugar by volume than Coca Cola, with parents of infants as young as four months marketed pouches that contain the equivalent of up to 184% of the sugar levels of the soft drink, dizzying heights not seen in the 2022 research. Those pouches are without exception fruit-based mixes.
  • ‘Boutique’ brands still appear to have higher levels of sugar than traditional baby food brands or own-brand alternatives. Market leader Ella’s Kitchen is now the worst offender, its Banana puree taking the sugar crown with 19.5g per 100g from Annabel Karmel’s now discontinued Apple, Blueberry and Banana, at 17.3g.
  • Nearly a quarter of products examined contained up to two thirds of an adult’s recommended maximum daily of free sugars. Neither the World Health Organization (WHO) nor the UK’s Scientific Advisory Committee on Nutrition (SACN) cite a guideline limit for babies, simply stressing that as little should be consumed as possible.
  • The sector remains wedded to disingenuous language highlighting the presence of only “naturally occurring sugars” or the absence of “added sugars”, with others making opaque claims of products being “nutritionist approved”. All high-sugar products adopt ‘halo labelling’ principles, focusing on status as ‘organic’, ‘high in fibre’ or ‘containing 1 of your 5 a day’, misleading parents into thinking they are making healthy choices for their children. Kiddylicious offer a “bedtime blend” suggesting a product with 13g sugar per portion is appropriate before sleep.
  • Nearly 3/4  of the products examined exceeded the 5g of sugar per 100ml threshold set for the sugar levy applied to drinks. Dentists stress expansion of fiscal measures would likely have favourable outcomes in terms of encouraging reformulation.
  • Eating straight from the pouch. Since the withdrawal of Annabel Karmel from the UK market, the BDA has not been able to identify any manufacturers still recommending babies feed straight from the pouch. However, only two brands – Sainsbury’s and Lidl – rule out this out this approach, which adds to the risk of dental disease.  Asda specifically state that ‘eating straight from the pouch can contribute to tooth decay.’ 

The BDA are launching a petition to the Department of Health to double down in the fight on sugar, with mandatory regulation, and to build on tried and tested policies from both home and abroad.

BDA Chair Eddie Crouch said: “Parents of infants are still being marketed products sugarier than Coke. 

“It shouldn’t take dentists naming and shaming the worst offenders to bring about needed change. Voluntary action has failed. We need government to step up and force industry to do the right thing.”

Full data is available to download here…

THE WORST OFFENDERS:

Ella’s Kitchen – Banana Puree https://www.ellaskitchen.co.uk/shop/bananas-baby-puree

With the highest sugar by volume, Ella’s Kitchen takes the sugar crown from past holders Annabel Karmel, who have now discontinued their line of pouches.

Ella’s Kitchen appear to have raced changes to packaging to pre-empt Panorama airing, removing messages that targeted the 4-month year old market, undermining official guidance by citing government advice on weaning from 6 months, but noting that “every baby is different!”

They look set to maintain all the ‘halo labelling’ cliches on ‘no added sugar’, being ‘organic’. The one redeeming feature is pouches offer guidance not to consume the puree straight from the pouch.

For Aisha: Pear & pomegranate https://www.foraisha.com/product/pear-pomegranate-pouch-100g/

A brand that prides itself on exotic flavours – the only pouch on the market featuring pomegranate – takes silver for sugar levels, at 16.4g/100g targeting infants aged 4 months+

Aldi Mamia Organic: Bananas & Apples https://www.aldi.co.uk/product/mamia-apple-bananas-pouch-000000000346206001

The highest amount of sugar in any pouch identified – with a portion size so large for its target 4- month plus market it represents nearly 2/3 of an adult’s RDA of sugar, and the same amount of sugar as half a can of coke.

Piccolo: Pure mango https://www.mylittlepiccolo.com/products/babies/pouches/pure-mango/?srsltid=AfmBOoq0ChT7IjUfbtLJnmyHtdHDhQDwJ2ReiNAKYMdiLaN2PsU8-NNr

Pure mango does exactly what is says on the tin, delivering 15g/100g of sugar to the 4-month+ market, also claiming that ‘every baby is different.

Progress on NHS dentistry risks being undone by NI hike

The British Dental Association has warned that reforms to NHS dentistry cannot be the end of the road for the struggling service, and that recent hikes in National Insurance may undo this progress. 


According to survey evidence from 195 NHS dentists in Scotland: 

  • 69% of respondents agree that Payment Reform, which launched in November 2023, represents an improvement over the system that proceeded it. However, dentists say it has not met the Scottish Government’s stated objectives. Only 1 in 5 (21%) agree that the reformed system reduces bureaucracy, little over 1 in 4 (26%) say it increases clinical freedom. Only 7% believe it enhances access for NHS patients, and only 3% says it supports a reduction in oral health inequality.     
      
  • With practices facing higher costs as a result of the most recent UK Budget, 45% estimated their practices will struggle to remain financially sustainable. Over half (53%) warned it will accelerate the move to the private sector. 65% stressed these costs must be covered by either the UK or Scottish Government.
  • Only 10% could describe the NHS as an attractive place to build and maintain a career.  91% felt their job was stressful, with 71% saying they felt burnt out by it.
  • 86% identified higher needs patients requiring more clinical time as a challenge affecting their practice. 83% cited not being able to accommodate all the patients who contact them. Recruitment and retention of dentists was flagged by 72%, for dental nurses by 78%.
     

These headlines were presented to the Conference of Scottish Local Dental Committees in Stirling yesterday the single largest gathering of NHS dentists in Scotland.  

Gillian Lennox, Chair of the BDA’s Scottish Dental Practice Committee, said: “Dentists on the frontline say payment reform is clearly an improvement on what preceded it.

“But in terms of sustainability, bureaucracy, prevention, access and inequality there is still so much more to do.

“The simple fact is that 9 out of 10 of my colleagues wouldn’t describe the NHS as an attractive place for dentists to build and maintain a career. We can’t go on like this.

“It’s the practices with vacancies they can’t fill. The NHS colleagues on the brink reporting high levels of stress and burnout.

“As dentists we believe in prevention, and that principle needs to be applied to the pressures we’re under. Broken systems have a very human cost, for colleagues and the millions we treat.”

Neither the UK nor Scottish Government have arrived at any tangible mitigations to the threat presented by National Insurance and National Minimum Wage hikes.

Gillian Lennox added: “The National Insurance hike risks taking a wrecking ball to already struggling practices, undoing the progress we’ve secured with payment reform.

“We do have sympathy with Holyrood, this mess is not of their making.

“However, what remains clear is that one Government – North or South of the border – is going to have to fix it.”

“Dental care is healthcare”: message to ministers from man who nearly died of toothache

The British Dental Association has applauded a video message from Nick Whelan, the student who nearly died of sepsis for want of a dental appointment.

Nick was forced to undergo life-saving surgery after he was admitted to Ninewells Hospital with septicaemia in 2021. Nick, 22, said he had been struggling to get a dentist appointment after his toothache began at the tail-end of the first lockdown in September 2020. 

In a video message marking World Oral Health Day, Nick says: “I have a simple message for everyone out there across the UK and beyond.

“To every patient waiting in pain, to every politician and policymaker, and to every dentist worried about what might come through that door next.  

Dental health matters.  It is not an optional extra. It is a vital part of our lives.  

“Dental care is healthcare. 

“Nobody should have to go through what I did, but I know until dentistry is taken seriously they will.”

Across the UK the BDA has been pressing for urgent reform to give NHS dentistry a sustainable future. 

BDA Chair Eddie Crouch said: “Nick has offered a message that every Health Minister in every part of the UK needs to hear. 

“The tone is very much ‘Horrible Histories’. The real scandal is this is the reality facing patients in a wealthy 21st century nation.” 

Scotland’s dentists respond to damning FOI data

Responding to new FOI data from the Scottish Liberal Democrats, the British Dental Association Scotland has warned lifetime registration figures are effectively meaningless, and that there can be no complacency from government or opposition over the future of the service.

New figures show nearly 40% of Scots registered with a dentist have not seen one in two years. 39.5% of all those registered with a practice have not been to one in 24 months, and that includes 1.8 million adults and 177,318 children. 80,000 children have not seen a dentist in five years. More than a quarter of adults (28.8%) who are registered with a dentist have not seen one in five years.

Reform to the discredited high volume/low margin model of care NHS dentistry in Scotland works to took place in November 2023. However, official data shows access problems remain the norm and the oral health gap between rich and poor is widening.

Research last summer found that no practices were able to take on new adult NHS patients within three months in Argyll and Bute, Dumfries and Galloway, Inverclyde, Orkney, Perth and Kinross and Shetland.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “The Scottish Government likes to talk about registration when what really matters is participation. 

“Scotland faces widening oral health inequalities. There’s no room for complacency from anyone at Holyrood.”

Time will tell if Scottish Government can halt exodus from NHS

The British Dental Association Scotland has responded to new freedom of information data from the Scottish Liberal Democrats showing the number of dentists providing NHS services has fallen from pre-pandemic numbers across most health boards. 

The BDA stress this data only begins to show the risks facing the service, as the data does not capture the mix of NHS and private work dentists undertake.

The professional body says the data gives no picture of the whole time equivalent NHS workforce, and without that there is no scope for robust workforce planning.

The broken high volume/low margin model high street NHS dentists work to proved unsustainable during COVID, and while some amends to this system were rolled out in November, it remains to be seen if reforms are sufficient to give the service a sustainable future 

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “For years the broken system NHS dentistry works to has left dedicated colleagues looking to the exit.

“We’ve seen some reform, but time will tell if it’s enough to put a halt to this exodus.

“One point is abundantly clear. If this service is going to have a future there can be no complacency at Holyrood.”

NHS dentistry in Scotland: SNP can’t pretend it’s “Mission Accomplished”

The British Dental Association has said there can be no complacency from the Scottish Government on the crisis in NHS dentistry, following yesterday’s debate in the Scottish Parliament, in which MSPs raised the heart-breaking case of a single mother going without food to pay for care, with others travelling hundreds of miles for access or embarking on ‘DIY’ dentistry. 

The BDA’s own recent surveys found 83% of dentist respondents in Scotland had treated patients that had performed some form of DIY dentistry since lockdown.

Some reforms to the discredited small margin/high volume system NHS dentists work to were rolled out in November 2023. This system has been in crisis for a generation but proved undeliverable during the pandemic. Facing soaring costs, some practices were left delivering some NHS treatments at a financial loss.

The BDA had been seeking a decisive break from this system, and a move to a patient-centred, prevention-focused model of care. The Scottish Government refused to break with the overall framework.

The BDA stress that this must be the beginning, not the end of the road for reform, and that access, outcomes and inequalities need to be closely monitored.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “MSPs and patients across Scotland have sent a clear message: the Scottish Government cannot pretend it’s ‘Mission Accomplished’ on NHS dentistry.

“Recent reforms may ease problems, but Ministers can’t afford to take their eyes off the crisis in this service.”

Government failure on amalgam ban ‘could break NHS dentistry’

Services in all UK nations face hit, Northern Ireland an existential threat

The British Dental Association has warned the European Parliament’s vote to ban dental amalgam from 1 January 2025, will send shockwaves across the UK’s already struggling dental services.

Silver amalgam is the most common material for NHS permanent fillings across the UK. Fillings represent around a quarter of all courses of NHS treatment delivered in England, with amalgam used in around in around a third of procedures.

BDA estimate treatment times and costs of alternative materials are over 50% higher than those of amalgam. [1]

On 14 July, the European Commission adopted a proposal to revise the Mercury Regulation, to introduce a total phase-out of the use of dental amalgam and prohibit the manufacture and export of dental amalgam from the EU from 1 January 2025 – 5 years earlier than expected.

The vote will hit all four UK nations but will have a disproportionate impact on services in Northern Ireland, which has the highest proportion of filled teeth of any UK nation. [2] Under post Brexit arrangements, Northern Ireland will be expected to phase out dental amalgam on the same basis as EU member states. Divergence means the rest of the UK faces disruption and higher costs given the impact on supply chains, but not a formal ban.

In an open letter to all four UK Chief Dental Officers, the BDA stress there are currently no alternative restorative materials that compete with amalgam on speed of placement or longevity, meaning the ban will eat into clinical time and resource that are in short supply, likely creating further access barriers. 

There are no indications where the millions in additional funding required will come from nor the workforce to carry out the tens of thousands of extra clinical hours.

MEPs also backed amendments stating that Member States need to “ensure appropriate reimbursement is made available for mercury-free alternatives” to limit the socio-economic impact. The BDA say the same approach is need from all UK Governments. 

The Nuffield Trust warned in December that NHS dentistry was at the most precarious moment in its 75-year history. The BDA warn that without decisive action, this ban will only hasten the service’s demise.

While the BDA has long supported a phase-down in dental amalgam, it believes this rapid phase-out is neither feasible nor justifiable. Dental amalgam has been in use and extensively studied for 150 years as a restorative material. Its safety and durability are well established, and it remains the most appropriate material for a range of clinical situations. 

BDA Chair Eddie Crouch said: “When we are set to lose a key weapon in the treatment of tooth decay all four UK Governments appear asleep at the wheel. 

“When alternative materials can’t compete, this will add new costs and new uncertainties to practices already on the brink.

“Without decisive action this could be the straw that breaks the back of NHS dentistry.”

[1] BDA research on treatment times and costs, 2023. Figures are derived from a comprehensive research study into NHS dental treatment times. A unit price per treatment has been generated using official figures for dental expenses, courses of treatment and dentist earnings (available through NHS digital), supplemented by further BDA research. 

[2] Total number of Teeth Filled per 100,000 population by UK nations and Financial Year, From Family Practitioner Services General Dental Statistics for Northern Ireland 2022/23

In Northern Ireland’s Item of Service Claims 2022/23, amalgam was used as a material in 153,000 of the 353,000 claims for permanent fillings on adults and children, or 46% of the total.

While amalgam use is not centrally recorded in England, the BDA understands these represent around a third of fillings placed in England on the NHS.

Dentistry: COVID impact on scale unseen in any other part of NHS

The British Dental Association has warned MSPs the pandemic has had an unparalleled impact on NHS dentistry, that leaves the service facing an existential threat. 

As the professional body prepares to give evidence to the COVID-19 Recovery Committee inquiry into NHS dentistry today (22 June 2023), it has published new analysis showing the scale of the backlogs.

Initially closed to routine care, and then facing exacting Infection and prevention control guidelines that reduced patient throughput, lost capacity on the high street exceeds general medical practice and secondary care, resulting in backlogs that will take many years to clear:

  • Dentistry has lost over half (52%) of its capacity since lockdown, when comparing examinations delivered since March 2020 with typical levels pre-COVID.
  • For GPs, that figure is just over 30% (when looking at lost face-to-face appointments). It is just over 6% for hospital outpatients and in terms of volume, inpatient care appears to have already recovered lost ground.
  • By any measure captured in official data, whether it is examinations or Statement of Dental Remuneration (SDR) activity claims, Scotland has lost more than a year’s worth of NHS dentistry.
  • Ongoing access problems are fuelling backlogs, with patients presenting with higher levels of clinical need. In recent BDA surveys over two thirds (67%) of dentists cite higher needs patients requiring more clinical time as a key issue on return to ‘full’ capacity. The only comparable problems are those concerning recruitment and retention of dentists (61%).

Dentist leaders say it will be impossible to restore pre-pandemic activity without radical change. The low margin/high volume model the service works to was incompatible with working through the pandemic and cannot form the basis for a meaningful or sustainable recovery.

This leaves the service at a crossroads: with a contract that is unfit for purpose, underfunded, overstretched and facing the challenge of deep and widening oral health inequalities. BDA Scotland fear that an exodus of dentists from the     NHS is already in motion. This shift is going unseen in official data, that counts heads not the amount of NHS work dentists do. These workforce statistics give an NHS full-timer the same weight as a dentist doing one NHS check-up a year.

Recent BDA surveys indicate only 1 in 5 (21%) of practices have returned to pre-COVID-19 capacity. The professional body say hard limits on restoring capacity, and the existential threats to NHS dental services require a proportionate response from the Scottish Government.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “COVID hit dentistry like no other part of the NHS in Scotland.  

“We’re not asking for special treatment, just a proportionate response. One that recognises the scale of the backlogs and the existential threat to this service.

“NHS dentists are already walking away from a broken system. There can be no recovery without reform.”

Poor children to suffer, as Scotland’s oral health gap set to widen

The British Dental Association has responded to new figures from the Scottish Liberal Democrats warning the oral health gap between rich and poor children will widen, given ongoing access problems, and the growing exodus from a broken NHS system.

Official data from Public Health Scotland has already shown the fall in participation is hitting those in most deprived communities the most. In September 2008, the gap in child participation between the most and least deprived areas was three percentage points; this had increased to seven percentage points by 2010, eighteen percentage points (55.3% compared to 73.1%) in September 2021. The figure now stands at twenty percentage points (55.9% compared with 75.8%).

The BDA has warned that lower levels of participation will inevitably translate into a higher dental disease burden, with deep oral health inequalities expected to widen even further given the cumulative impact of limited access to services, the temporary suspension of public health programmes, and the impact of lockdown diets. Lower participation will reduce the chance of picking up early signs of decay at routine check-ups, and delays in treatment will mean higher costs to the NHS and worse outcomes for young patients. 

The professional body has stressed that reform to the broken low margin/high volume model the service works to are now essential, and that a new model has been pledged for rollout in the autumn. At present certain key treatments can be delivered at a financial loss, accelerating the exodus from the service. A recent BDA survey showed over half (59%) of high street NHS dentist reported having reduced the amount of NHS work they did since lockdown. Over four in five (83%) said they plan to reduce or further reduce their NHS commitment in the year ahead. 

The BDA says that the future of the service hinges on reform providing it with firm foundations, with a decent, sustainable model that can deliver for patients and dentists across Scotland. 

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “The oral health gap between rich and poor kids is set to widen.

“It’s a national scandal. Prevention is better than cure, but dentists are losing the chance to nip problems in the bud. The growing exodus from the NHS may make that permanent.

“Tooth decay is already the number one reason for hospital admissions among young children. It will take real reform to bring this service back from the brink.”

‘A meaningless metric’: Scotland’s dentists respond to Lib Dem figures on registration

The British Dental Association has responded to new figures from the Scottish Liberal Democrats, acknowledging that the Scottish Government’s consistent use of registration figures to illustrate the supposed ‘recovery’ in the service is effectively meaningless.

Patients in Scotland are registered for life, so the key focus must be on participation, which remains stubbornly below pre-COVID levels.

The professional body has stressed that reform to the broken low margin/high volume model the service works to are now essential, and that a new model has bee pledged for rollout in the autumn.

At present certain key treatments can be delivered at a financial loss, accelerating the exodus from the service. A recent BDA survey showed over half (59%) of high street NHS dentist reported having reduced the amount of NHS work they did since lockdown.

Over four in five (83%) said they plan to reduce or further reduce their NHS commitment in the year ahead.

The BDA says that the future of the service hinges on reform providing it with firm foundations, with a decent, sustainable model that can deliver for patients and dentists across Scotland.

Charlotte Waite, National Director of the British Dental Association Scotland said: “When patients are put on the books for life registration is a meaningless metric.

“What really matters is the patients getting through our doors, and on that note NHS dentistry has not returned to anything resembling ‘business as usual’.

“This service is at a tipping point. Without reform there can be no recovery.”