{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T12:16:38Z","timestamp":1770984998023,"version":"3.50.1"},"reference-count":18,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: England is a high-income country with a predominantly publicly funded health system organised around the National Health Service (NHS). Yet children\u2019s oral health outcomes continue to reflect a persistent access and prevention gap, with late presentation and hospital-based extractions remaining common. Objective: To present a policy-facing, evidence-informed critique of how structural constraints in NHS dentistry shape paediatric clinical pathways\u2014often converting \u201cadvances\u201d (biological caries management, silver diamine fluoride, and planned extraction pathways for compromised permanent molars) into compensations for service failure rather than patient-centred progress. Methods: Narrative commentary drawing on UK official statistics and major policy reports, alongside key clinical trials and evidence syntheses relevant to contemporary paediatric dentistry. Results: The dominant failure mode is not a lack of clinical tools but impaired delivery: restricted access to routine NHS dentistry, contract and workforce pressures, and unequal prevention coverage. These pressures correlate with crisis-led care (including extractions under general anaesthesia) and can distort how minimally invasive\/biological interventions are used\u2014functioning as endpoints rather than bridges to definitive care. In parallel, guidance for compromised first permanent molars (including those affected by MIH) risks being operationalised as an \u201cefficiency pathway\u201d when restorative capacity is constrained. Conclusions: In NHS England, paediatric dental \u201cadvances\u201d cannot be judged solely by trial efficacy; they must be evaluated within a delivery system that currently selects for late-stage, irreversible outcomes. A credible \u201cadvances\u201d agenda requires contract reform, workforce retention, prevention at scale, and explicit safeguards against the normalisation of extraction-only trajectories.<\/jats:p>","DOI":"10.3390\/children13020263","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T10:52:21Z","timestamp":1770979941000},"page":"263","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["When \u201cAdvances\u201d Become Substitutes for Access: A Systems Critique of Children\u2019s Dentistry in NHS England and the Normalisation of Extraction, Containment, and Planned Tooth Loss"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0071-9141","authenticated-orcid":false,"given":"Ziad D.","family":"Baghdadi","sequence":"first","affiliation":[{"name":"TopSmiles Pediatric Dentistry and Orthodontics, Winnipeg, MB R2M3A4, Canada"},{"name":"Butterfly Dental Group, Winnipeg, MB R3Y1P5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"ref_1","unstructured":"Office for National Statistics (2026, February 06). Healthcare Expenditure, UK Health Accounts: 2023 and 2024, Available online: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/healthandsocialcare\/healthcaresystem\/bulletins\/ukhealthaccounts\/2023and2024."},{"key":"ref_2","unstructured":"Department of Health and Social Care (2026, February 06). Millions More NHS Appointments Delivered Thanks to Independent Sector, Available online: https:\/\/www.gov.uk\/government\/news\/faster-care-for-thousands-thanks-to-nhs-use-of-independent-sector."},{"key":"ref_3","unstructured":"British Dental Association (2026, February 06). Dentists: 97% of New Patients Unable to Access NHS care. Available online: https:\/\/www.nature.com\/articles\/s41404-024-2929-x."},{"key":"ref_4","unstructured":"Office for National Statistics (2026, February 06). Experiences of NHS Healthcare Services in England Dataset (Health Insight Survey), Wave 2 Edition, Available online: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/healthandsocialcare\/healthcaresystem\/bulletins\/experiencesofnhshealthcareservicesinengland\/september2025."},{"key":"ref_5","unstructured":"NHS Business Services Authority (2026, February 06). Dental Statistics\u2014England 2023\/24. Available online: https:\/\/www.nhsbsa.nhs.uk\/statistical-collections\/dental-england\/dental-statistics-england-202324."},{"key":"ref_6","unstructured":"National Audit Office (2026, February 06). Investigation into the NHS Dental Recovery Plan (HC 308). Available online: https:\/\/www.nao.org.uk\/wp-content\/uploads\/2024\/11\/Investigation-into-the-NHS-dental-recovery-plan-HC-308-1.pdf."},{"key":"ref_7","unstructured":"Office for Health Improvement and Disparities (OHID) (2026, February 06). Hospital Tooth Extractions in 0 to 19 Year Olds 2024: Short Statistical Commentary, Available online: https:\/\/www.gov.uk\/government\/statistics\/hospital-tooth-extractions-in-0-to-19-year-olds-2023\/hospital-tooth-extractions-in-0-to-19-year-olds-short-statistical-commentary-2023."},{"key":"ref_8","unstructured":"National Dental Epidemiology Programme for England (OHID) (2026, February 06). Oral Health Survey of 5-Year-Old Children 2024\u2014Summary of Results, Available online: https:\/\/www.gov.uk\/government\/statistics\/oral-health-survey-of-5-year-old-schoolchildren-2024\/national-dental-epidemiology-programme-ndep-for-england-oral-health-survey-of-5-year-old-schoolchildren-2024."},{"key":"ref_9","unstructured":"Department of Health and Social Care, and Office for Health Improvement and Disparities (2026, February 06). Delivering Better Oral Health: An Evidence-Based Toolkit for Prevention\u2014Summary Guidance Tables for Dental Teams, Available online: https:\/\/www.gov.uk\/government\/publications\/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention."},{"key":"ref_10","unstructured":"Parliamentary Office of Science and Technology (POST) (2026, February 06). Water Fluoridation and Dental Health: 2024 Update (POSTbrief 63). Available online: https:\/\/post.parliament.uk\/research-briefings\/post-pb-0063\/."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta24010","article-title":"Best-practice prevention alone or with conventional or biological caries management for 3- to 7-year-olds: The FiCTION three-arm RCT","volume":"24","author":"Maguire","year":"2020","journal-title":"Health Technol. Assess."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Innes, N.P.T., Evans, D.J.P., and Stirrups, D.R. (2007). The Hall Technique: A randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: Acceptability of the technique and outcomes at 23 months. BMC Oral Health, 7.","DOI":"10.1186\/1472-6831-7-18"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1177\/0022034511422064","article-title":"Sealing caries in primary molars: Randomized controlled trial, 5-year results","volume":"90","author":"Innes","year":"2011","journal-title":"J. Dent. Res."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Seifo, N., Cassie, H., Radford, J.R., and Innes, N.P.T. (2019). Silver diamine fluoride for managing carious lesions: An umbrella review. BMC Oral Health, 19.","DOI":"10.1186\/s12903-019-0830-5"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1159\/000478668","article-title":"Silver Diamine Fluoride Has Efficacy in Controlling Caries Progression in Primary Teeth: A Systematic Review and Meta-Analysis","volume":"51","author":"Chibinski","year":"2017","journal-title":"Caries Res."},{"key":"ref_16","unstructured":"McDonagh, M., Whiting, P., Bradley, M., Cooper, J., Sutton, A., Chestnutt, I., Misso, K., Wilson, P., Treasure, E., and Kleijnen, J. (2000). A Systematic Review of Public Water Fluoridation, NHS Centre for Reviews and Dissemination, University of York. Available online: https:\/\/www.york.ac.uk\/media\/crd\/crdreport18.pdf."},{"key":"ref_17","first-page":"CD010856","article-title":"Water fluoridation for the prevention of dental caries","volume":"10","author":"Walsh","year":"2024","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_18","unstructured":"Royal College of Surgeons of England, Faculty of Dental Surgery (2026, February 06). A Guideline for the Extraction of First Permanent Molars in Children. Available online: https:\/\/www.rcseng.ac.uk\/-\/media\/fds\/guidance-for-the-extraction-of-first-permanent-molars-in-children.pdf."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/2\/263\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T11:30:29Z","timestamp":1770982229000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/2\/263"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,13]]},"references-count":18,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["children13020263"],"URL":"https:\/\/doi.org\/10.3390\/children13020263","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,13]]}}}