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Reforming NHS dentistry

BMJ 2008; 336 doi: (Published 29 May 2008) Cite this as: BMJ 2008;336:1202
  1. Ruth Freeman, professor of dental public health research
  1. 1Dental Health Services Research Unit, University of Dundee, Dundee DD2 4BF
  1. r.e.freeman{at}

    Equitable distribution of affordable dental services is still possible

    The accompanying analysis article by Thomas and colleagues provides routine data on hospital admissions and case reports to support their assertion that “admissions for surgical drainage of dental abscess are a result of changes in the provision of primary dental care in the United Kingdom.”1 Are Thomas and colleagues correct in their assumption? What have been the effects of the “new contract”—launched in England and Wales in 2006—on NHS dentistry?

    The new contract was perceived as a portal to a new era of NHS dentistry. No longer would the general dental practitioner be chained to the “treadmill” of a “fee per item” NHS service but would focus on the prevention of dental caries, periodontal disease, and oral malignancies, thereby allowing for a more stress-free working environment for dentists and patients. Dental educators, dental hygienists, and dental therapists were of central importance in the new contract as providers of expertise in oral health. The essence of the contract was to promote oral health and subsequently increase access to primary dental health care, with dental treatment being conceptualised as a safety …

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