THE percentage of NHS dental patients in Scotland regularly attending for check-ups and treatment has fallen to a record low amid claims that the Scottish Government's policy of lifetime registration "is meaningless".

In NHS Shetland, barely half (55.6 per cent) of adults registered with an NHS dentist have gone in the past two years, with children from the poorest areas less likely than those from wealthier postcodes to have had a recent check up.

The British Dental Association called for action to encourage more low-income patients to attend as the figures also show that the gulf in attendance rates between both adults and children in the wealthiest and poorest areas is now wider than ever.

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It warned that this is resulting in higher costs for some health boards in the long-term as more expensive, curative treatments are required.

The figures from ISD Scotland show that attendance has fallen steadily over the past decade since lifetime registration was introduced in April 2010, replacing the previous system whereby people who did not attend were erased from their practice's register.

Prior to April 2006, if a patient failed to attend an NHS dental practice for 15 months they were de-registered.

This was extended to 36 months in April 2006 and 48 months in April 2009, before ‘lifetime registration’ was introduced in April 2010 - meaning that, once registered with an NHS dentist, people would remain on the list even if they never attended for check-ups.

The policy has succeeded in its aim of driving up the number of people in Scotland registered with a dentist to a record 5.2 million patients by the end of September 2019 - more than double the number registered in 2007.

However, the withdrawal of any penalty for failing to visit the dentist has coincided with a steady fall in attendance rates.

By September 2019, a record low of 68.8% of people in Scotland who were registered with an NHS dentist had been for a check up or treatment in the previous two years, down from 98% in 2006.

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The figures only cover NHS-registered patients, so the decline cannot be explained by people using the private dental sector instead.

They also exclude any emergency dental treatments, such as paediatric teeth extractions, which would occur in hospital.

There is also a significant difference in attendance rates between poorer and more affluent areas.

For adults living in the most deprived postcodes, attendance was markedly lower at 60.8% of adults compared to 71.5% for those in the most affluent neighbourhoods.

Among children, the figures ranged from 79% attendance in the poorest areas to 88.8% in the most affluent.

BDA Scotland has campaigned on persistent and costly oral health inequalities between the most and least deprived areas.

It notes that NHS Greater Glasgow and Clyde, which contains four of the five most deprived areas in Scotland according to the Scottish Index of Multiple Deprivation (SIMD), spends £59 per head of adult population on dental treatment - £9 more than the Scottish average - reflecting the higher costs of curative treatment.

It also has the lowest dental attendance rates for children in Scotland, at 82.2%.

Robert Donald, chair of the BDA's Scottish Council, said: "Being on the register is meaningless if patients aren't making it to their dentist.

"Behind the spin is a large and growing gulf in attendance between rich and poor.

"Scotland’s most deprived communities face major oral health challenges, yet there is little energy to bridge this divide.

"When patients bottle up problems we all pay the price."

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The BDA had opposed the introduction of lifetime registration in 2010, arguing that it sent the "wrong signals" to patients about the value of regularly visiting a dentist for check-ups and could see more cases of oral cancers going undetected.

However, the Scottish Government has defended lifetime registration, stressing that the drop in attendance rates is overridden by the overall increase in registrations. 

As a result, the actual number of people visiting the dentist at least once every two years increased from 2.5 million in September 2006 to 3.6 million by March 2017.

ISD Scotland notes that this growth has "stabilised" in the past two years, while the number of children going for check ups "has been declining" since September 2016.

A spokesman for the Scottish Government said: "We can say with certainty that the number of people who have seen their dentist in the last two years has increased substantially since 2006.

"In our view, lifetime registration has increased both registration and participation numbers."

There is also evidence of improved dental health in children and juveniles. Since 2000/01, the number of fillings given to under-18s in Scotland has fallen by more than 60%, with tooth extractions down 35%.

In 2019, 80% of Primary 7 pupils had no obvious decay in their permanent teeth, up from 53% in 2005.

This varied from 88% to 69.5% between children from the wealthiest and poorest households, but the gap has narrowed. 

Public Health Minister Joe FitzPatrick said record registration figures were "encouraging". 

He added: “Substantial investment by the Scottish Government along with actions taken by NHS boards means that nearly twice as many people were registered for NHS dental services at September 2019 than was the case in September 2007.

“Improving people’s dental health can contribute greatly to wellbeing but they need to be able to access NHS dental services - having your teeth actually checked is key. 

"So while the majority of the population visited a dentist in the last two years, I’d urge everyone to ensure they take regular advantage of their right to a free dental check.”