I AM in almost complete agreement with Brian Derbyshire when he expresses his shock and sadness regarding the poor quality of dental care available to the vulnerable elderly in care homes.

He is probably incorrect when he says access is only possible in an emergency. I am certain the directors of homes throughout the borough would suggest that even emergency visits are almost impossible to arrange.

Mr Derbyshire reiterates my assertion that there are enough dentists in Bolton to attend to every child, and presumes this would be the case for vulnerable adults also. I support that view.

How has this state of affairs been allowed to happen, and what can be done to improve things?

At the inception of the NHS there was a need to treat an epic amount of disease, causing the system to rely on treatment of disease as its central currency. This outdated attitude persists to this day, resulting in target orientated and poorly focused contracts loaded with perverse incentives imposed by politicians on the dental profession without any meaningful consultation. We now have legions of people entering care homes with complex dental work and no longer able to achieve for themselves the high standard of personal care necessary for its maintenance. Our outmoded contractual arrangements mean dentists are simply not equipped to deal with this escalating problem effectively.

I return to earlier debate regarding fluoridation. I do not accept the argument that imposition of measures such as attention to diet, oral hygiene and the professional application of fluoride varnishes can have a significant effect on the oral health of our children due to our difficulty in accessing these patients; the reverse is true in care homes. It is certainly possible to improve these things in what is a captive and easily accessed and manipulated population.

The Local Dental Committee has been attempting to have a meaningful dialogue with the Health and Wellbeing Board on this issue since 2013 without even the courtesy of acknowledgement; it took a national Healthwatch England report citing Bolton as a beacon of poor care to shame the HWB into issuing a half hearted soundbite from Cllr Cliff Morris.

Effective action here would reduce the need to consider other measures such as water fluoridation; come on all you anti-fluoridationists! Here's an issue you can really back with your customary vigour — vulnerable people need all the help you can give them.

Peter Moss

Chair Bolton Local Dental Committee