Dentists are to be paid NHS salaries rather than being forced to rely on piecework rates in experiments aimed at reforming the state dental system in England.
The present practice of effectively paying dentists simply for "filling teeth" has lasted for more than 50 years and can earn full time NHS dentists an estimated £55,000 a year.
But it has helped to confuse patients because some treatments, including white fillings and some types of crown, are not available on the NHS and they have to pay privately.
Some adults find huge difficulties in getting NHS treatment because dentists see private care as giving them more time with their patients and allowing them to use a far greater variety of treatments.
The system under which dentists are paid under national contracts will also end if trials involving dentists and new primary care trusts at "demonstration sites" are a success. New local agreements could bring annual salaries, payments per session of work, or a broader system of charges depending on the complexity of overall treatment rather than piecework.
The traditional five minute check-up undergone by patients to see whether any fillings need doing will also be replaced by a longer oral health assessment. This would be aimed at prevention as well as cure, with advice on lifestyle, giving up smoking and changing diet, as well as screening for oral cancer and more detailed discussions about treatment options.
Patients are usually invited back for six-monthly checks but the NHS's clinical watchdog, the national institute for clinical excellence, is reviewing whether that is a suitable interval.
The government is also con sidering giving dentists access to state funds for buildings and equipment through private-public partnerships.
At present, such improvements have to be financed through the NHS charges and other fees collected by dental practices. There will also be broader roles for dental hygienists and nurses.
Dentists told a committee reviewing the system that the direct link between patients' visits and collection of charges should be ended because it had the potential to undermine trust.
Patients who are not exempt from charges have to meet the first 80% of NHS treatment up to £360 and most of the 18,000 family dentists in England still depend on income via NHS charges, with around 60% earning more than 75% of their income this way.
Many of them are increasing the private side of their work, but only about 200 of the nation's 11,000 practices are thought to offer no NHS service at all.
The British Dental Association welcomed the plans as having "the potential to safeguard the future NHS dentistry" if they were properly funded. Changes would not happen overnight and there was unlikely to be one answer for all parts of the country.
John Renshaw, chairman of its executive board, said: "Dentistry remains one of the NHS's best used services. But it is under threat because dentists are frustrated by working within a clapped out and underfunded service."
David Lammy, the junior health minister, said: "Many dentists are unhappy with the fee per item system, so demonstration sites will explore more flexible ways of paying them. The mix of private and NHS work can be confusing for patients who need clear information on what treatments are available on the NHS and what they cost."
