Dentistry in a time of energy descent
By Ben Brangwyn 20th March 2013
An earlier blog post by Ben Brangwyn, from the dim distant past of 2007
There is a deafening silence from the world of dentistry on the subject of Peak Oil. As we move into the era that marks the end of cheap and abundant fossil fuels, all healthcare systems will need to adapt to the ensuing constraints, dentistry included.
In this short paper, two UK dentists respond to a set of questions regarding dentistry and Peak Oil that were recently posted on the ODAC website. Both dentists have chosen to remain anonymous for the moment. They are identified, rather unimaginatively, as Dentist #1 and Dentist #2.
Introduction from Dentist #1
As a quick intro, here are some notes about the state of dentistry right now. Most of the focus in the UK is on NHS dentistry [as opposed to private], because until recently, this is where the majority of dentists worked. This is now changing however.
Prior to last year, if a dentist had room on his books and a patient called them, that patient would generally be seen (although it was not uncommon to have to wait). However, one has to remember that at that time 50% of the population didn’t have a dentist. The newspapers picked up on this fact and turned it into a big story. All of a sudden, people who weren’t really bothered suddenly got scared because there was a perceived shortage of dentists. This resulted in a flood of people vying for limited places, which resulted in shortages, letters to MPs and more media attention.
In 2000 the government released a document called “Options for Change” which promised to change the way dentistry was done. Under the old system “General Dental Services” (GDS), patients paid a fixed price for each item of treatment, the price being set by central government. In real terms these prices had been below the rate of inflation, meaning that some dentists had to work harder and do more to get paid the same.
Dentists complained and started to go private, so the government set up different trial schemes across the country to try out a new approach. This was known as “Personal Dental Services” (PDS). The dentists loved PDS, as did the patients and the Primary Care Trusts (PCTs), but the government didn’t because, released from financial pressure, dentists started spending more time with patients, doing more prevention, and taking it easier. But this meant that fewer procedures were done for the same money. Gordon Brown (then UK Chancellor of the Exchequer) hated this.
Everything learnt in PDS was scrapped and targets were introduced. At the same time, funding was devolved from central government to local PCTs.
Dentists are now paid to meet targets. Any money patients pay to dentists goes to the PCTs, who haven’t been given enough money by government, and are thus mostly even more in debt. If dentists don’t meet targets they are financially penalised. This is resulting in and ever increasing wave of dentists leaving the NHS.
That’s how dentistry stands at the moment in the UK.
Questions and answers
Q1. Name the top 5 energy intensive procedures in modern dentistry.
- Dentist #1: Probably implants, anything involving dental laboratories, and anything requiring a drill. We are moving to single use, disposable everything due to unscientific scares about nvCJD etc. The actual waste produced by dental practices is increasing year on year as regulation upon regulation gets foisted on us.
- Dentist #2: Agreed
Q2. Name the top 5 materials in frequent use that have the longest supply chains
- Dentist #1: Cannot answer that, but most dental materials suppliers do offer next day delivery as standard. There was a recent problem with a shortage of local anaesthetic, which is produced in a limited number of plants, all outside the UK. This was due to one company closing down one manufacturing plant and being unable to open its replacement due to USA bureaucrats.
- Dentist #2: This illustrates the fragility of seemingly secure supplies.
Q3. What are the most expensive procedures in dentistry and how might their prices be affected post peak oil?
- Dentist #1: Basically implants or anything involving the use of a dental laboratory (dentures, crowns and bridges). With the new contract the government brought out last year, dentists are moving away from the NHS into private practice, reducing the amount of complex NHS work they do in the transition period. This has resulted in many of the low cost / high volume dental laboratories either closing or facing financial difficulties.
We have overseas laboratories trying to break into the cut price market, but they won’t last when peak oil causes shipping costs to rise significantly. UK dentistry is moving more towards a high cost / high quality ethos, resulting in FEWER complex items being made overall. Those without the necessary funds for a private dentist will be forced out of the market and will need to rely on what will eventually become an extraction service (staffed by overseas dentists and graduating or recently graduated dentists). Prices will invariably increase with the increase in overall running costs, as well as increases in the prices of gold, silver, palladium etc.
- Dentist #2: Agreed
Q4. What are the main crucial procedures could we not do without, regardless of the effects of peak oil?
- Dentist #1: Extractions, fillings and dentures. Everything else can go out the window. However, dentures are very materials based.
- Dentist #2: Agreed, though dentures are still very materials based and therefore subject to potential problems in physical supplies and supply chains.
Q5. Given the potential disruptions to travel posed by peak oil, how suitable is the current locations of dentist surgeries relative to the people who use them?
- Dentist #1: Dental surgeries are different from medical practices in that the vast majority have been set up where the dentist wanted them to be set up. There are many in town centres over shops etc, but it is not uncommon to find them in rural settings, but generally only in connection with high population centres.
- Dentist #2: Agreed
Q6. What is the likelihood of the UK adopting Mobile Dentistry clinics, as per Mobile Dental: Pacific Northwest, USA ?
- Dentist #1: There already are a few of these, but with oil at $100, who’s going to pay for the fuel – see comments on PCTs in question 7.
Q7. What is the population/dentist ratio in the UK, and is that trending up or down?
- Dentist #1: Don’t know the figures, but several studies in the 70/80s suggested that fluoride would mean fewer dentists would be needed, resulting in the closure of several dental schools. This has, today resulted in a shortage of UK dentists, where only half the population now have a dentist that they visit regularly. Money has been pumped into overseas recruitment, and increasing training places, but there is a big problem. The old NHS model resulted in high volumes of work, with dentists each looking after thousands of patients.
The new contract meant that dentists were given targets to meet based on previous activity. Not only is this driving dentists towards the private sector (which means less work being done on fewer people), the recently qualified dentist will emerge into an environment where targets are more important than developing clinical skill. All PCTs will be bothered about is targets being met, and an absence of complaints against the dentist.
The type of dentistry being done will change as dentists feel more and more pressurised (failure to meet targets results in financial penalties for dentists). Many of the overseas dentists are already going back home, fed up with the working conditions. So whilst the number of dentists will increase, the actual level of work done, and the number of patients treated will probably decrease.
- Dentist #2: Agreed
Q8. In the blog post “New Era Investor – Peak Oil Jobs No.1 – The Dentist” it states (towards the end) “Now as I see a trending down in calorific intake mirroring Hubbert’s distribution curve, my advice to anyone assessing their careers is simple. Don’t go into dentistry.” This implies that the requirement for dentists will go down. What predictions, if any, do you have in this regard?
- Dentist #1: Well, as I see it, we are in a society near the edges of collapse. I don’t actually think the governmental structures will be able to function in the long run, so spending five years on a dental course may not be in the individual’s best interest, unless a slow steady decline can be envisaged. It all depends on how bad things get.
There may well be a decrease in the availability of refined carbohydrates reducing rates of tooth decay, but conversely, food shortages will of course effect peoples immune systems and will likely increase the risk and rate of gum disease. Also as society trends downwards, people will look for ways to escape from an ever increasing sense of despair through distractions like alcohol and tobacco (a government that wants to cling to power will make sure these are available in my opinion).
- Dentist #2: I suspect that the requirement for dentists will increase, since it’s likely that health in general will deteriorate, teeth and gums included.
Q9. Roscoe Bartlett (Republican Congressman in the US), when asked how peak oil would affect health care in the US, responded with, “Americans have a Ferrari health care system. Post peak oil we will not be able to afford it.” (Peak Oil and the Healthcare Crisis in America ). To what extent might this dramatic assessment be applied to UK dentistry?
- Dentist #1: Again, it’s a question of how bad things get. The NHS aspect of dentistry is pretty much doomed. There is a reason the government is hacking off great chunks of the NHS, it costs them £90 billion, which they cannot really afford now that North Sea oil has peaked. The NHS is trapped in a system of increasing expectation by the populace, resulting in ever more complex drugs and treatments, with ever increasing costs, and increasing litigation when things go wrong. This also requires increased specialisation resulting in 5 people doing the job that one person used to do, resulting in more levels of Management and thus more levels of interference, with decreasing efficiency. It’s a vicious circle.
- Dentist #2: Agreed
Q10. How much of dentistry work is handled by hospitals and therefore subject to the additional pressures that mainstream medicine and hospitals may experience?
- Dentist #1: Really only braces and surgical extractions, and these departments are usually very efficient because a large proportion of it is done outside of the operating theatre on an outpatient basis.
- Dentist #2: Also mouth cancer work and specialist reconstructions are handled by hospitals.
Q11. What aspects of dentistry would be very resilient in a post peak UK?
- Dentist #1: Extractions and simple fillings. Basically emergency “I’m in pain, and I don’t want to be” sort of scenario. All the cosmetic, high end stuff will be limited to practices in locations that can cater to the very rich, places like Wilmslow, London etc.
- Dentist #2: Agreed
Q12. What steps might dentists take right now to wean themselves off their dependence on fossil fuels?
- Dentist #1: Not sure
- Dentist #2: Complex!
Editor note: It’s not unusual to see this kind of response from any person when faced with the uncertainties of Peak Oil and Climate Change. Ideally, the British Dental Association would be taking a lead here and convening dentists and energy/materials experts to take a proactive stance. This may still happen… “Transition Dentistry” anyone??
Q13. What changes might you suggest for preventative dental care as performed by the public at home?
- Dentist #1: Don’t eat refined sugars, at all, period. Do not drink ANY drink that contains sugar. No excuses, do not pass go, do not collect £200. This will not only help your teeth, it will get you off the western diet and a dependency on unnecessary calories. Brush twice a day religiously for at least two minutes. Floss ever day. Don’t smoke, don’t open bottles with your frickin’ teeth and be damned strict with your kids on what they eat. A bad tooth in an environment where there are no dentists can kill you. This is what people seem to forget. Every tooth is an organ of your body and should be respected as such.
- Dentist #2: No comment
Q14. As diets change to take account of much more localised food production, what will be the effect on teeth, and dentistry, generally?
- Dentist #1: No comment
- Dentist #2: The site of food production is unimportant. It’s the kind of food eaten and the basic dental care that is paramount.
Q15. Given the potential for economic disruption in a post peak UK, how exposed are dentist practices to, for example, severe interest rate increases?
- Dentist #1: That all depends on whether they have bank loans or not.
- Dentist #2: Agreed, and therefore in reality, I imagine, very exposed.
Q16. What is the overarching structure for UK dentistry, and what leadership role might they take in preparing the UK for lower energy dentistry?
- Dentist #1: The voice of UK dentists is split between the BDA (British Dental Association) and the DPA (Dental Practitioners Association). Both are absolutely useless and have the leadership qualities of a small moist rock. Dentists are not a united front, and generally can be walked all over by government, which has happened several times over the last 15 years. I can see no hope in dentists even becoming informed about Peak oil, rather than getting ready for it. I do what I can through my website, but I have a limited audience. Peak oil is something that people can easily go into denial about, especially with reporting of the likes of Greg Palast et al who say it is a manufactured rather than a real problem.
- Dentist #2: Agreed.
The British Dental Association’s view of 2020
Coincidentally, in 2007 the British Dental Association published their visioning report “Dental Futures – forward to 2020″. There’s plenty of business-speak such as, “improving marginal return” and “find ways to maximise their return to remain viable”, and there are some fascinating hallucinations about nanotechnology, such as, “… includes the design and use of small sensors… may provide exciting opportunities in the mouth where it may be possible for teeth to sense changes such as load, temperature… fed back to the dentist to help prevent damage to the teeth”.
However, if you’re looking for an enlightened understanding of energy constraints, you’ll be disappointed. There’s simply no mention of potential disruptions to supplies of materials or energy. The following words do not feature at all in that document: energy, oil, sustainable, electricity, gas, carbon, Peak Oil (as if…!)
Dentistry in the UK and around the world has a long way to go before it can even start a discussion about dental care in a post peak oil world. In the same way that Transition Initiatives have emerged at ground level to examine how communities can rise to the challenge of Peak Oil and Climate Change, I suspect that it’ll be an informal network of enlightened dentists around the world that will start the conversations that lead to an understanding of how such resource constraints will affect this area.
In the end, it may be the shocks to the economy rather than energy constraints that most affect the provision of dental care. If people can’t afford to pay dentists and dentists’ businesses collapse and banks claim their assets for unpaid debts, then the care simply may not be available. A bizarre thought occurs to me – what would the Nationwide Building Society actually do with 5,000 repossessed dentist chairs? Debt “counselling” with electric drills, perhaps…
On that thought, the more doomsterish among you may want to get the book, “Where there is no Dentist” , companion to “Where there is no Doctor”. These books cover self managed healthcare, typically in communities within the non-industrialised world where access to professionally trained dentists and doctors is very restricted.
On a brighter note, by the time the economy is really feeling the strains of ever diminishing oil supplies, your community may already have fully committed to a Transition Initiative and have implemented a local complementary currency so that scarcity of sterling won’t mean scarcity of money. And by relocalising other aspects of life, you may have rebuilt for yourselves a vibrant local economy replete with dentists, a colourful and cohesive community and most importantly, an abundant and varied local food supply. And if you’ve followed our dentists instructions, you may even have a healthy set of gnashers to enjoy it all.