Anyone looking for an NHS dentist will know it can be a hard slog to find one among all the private practitioners. Various studies estimate the shortage of NHS dentists in the UK to be between 1,000 and 4,000 - and the situation could be about to get worse.
The government is launching a major reform of the dental industry on 1 April. The Department of Health is taking dentists off what is often described as the 'drill and fill' pay system - where they are paid separate fees for each individual item of treatment - and will instead pay them a guaranteed NHS monthly income for an agreed number of courses of treatment over the year. However, while the government says the new contracts will encourage dentists to stay in the NHS, the British Dental Association disagrees. It says that when the proposals were first put forward by the government, its research showed that 60 per cent of high street dentists will reduce their NHS commitment or quit the health service altogether when the new contracts come in.
The first noticeable difference for patients will be a new pricing structure. From April, fees will operate on a three-tier banding structure: tier one will cover an examination and a scale and polish and cost £15.50; tier two will include fillings, root canal work and extractions and cost £42.40; tier three will cover more complex procedures such as crowns, dentures and bridges, for which the price will be set at £189.
The structure has been widely welcomed in that it will simplify things for dentists and patients. But while some patients will find they will pay less - NHS treatments are currently capped at £384 - others will pay more for basic treatments such as a scale and polish, which can currently start as low as £6.
Unless you have a history of troublesome teeth, most people don't bother to budget for dental costs. This means they can be a real pain in the wallet - not to mention the mouth - when they do crop up. However, there are various ways to cover the cost of treatment which are worth considering if you are worried about escalating costs.
The scheme you are most likely to come across is Denplan, which is known as a 'capitation scheme'. It is a payment plan provided by your dentist and is offered by around a third of practising dentists across the UK. It differs from dental insurance in that is not designed to cover you for the possibility of something happening to your teeth, but is instead a way of budgeting for routine treatment and on-going preventive dental care.
Denplan charges a monthly premium, set according to the state of your mouth (as assessed by your dentist) and your past oral history. Any work deemed necessary in the initial assessment must be carried out at your expense before Denplan will sign you up. Denplan then designates you to one of five categories of oral health: 'A' meaning you have top- notch teeth and 'E' being the other end of the spectrum.
Denplan has a number of different products, some more comprehensive than others, and which one your dentist chooses will determine your premium. The most common product is Denplan Care, which covers any crowns, bridges, fillings, X-rays and oral hygiene. The only extra charges are laboratory costs. Premiums can be under £10 a month and up to £30 for some category 'E' adults. However, Denplan says the majority of people pay around £15 a month. Supplementary insurance, to cover such things as dental emergencies and serious dental problems such as oral cancer, is included as part of your premium.
The other main way to cover dental costs is through a traditional insurance policy from providers such as Universal Provident, WPA and Boots. These also charge premiums on a monthly basis, but base their cost on age rather than than oral health. Policies typically cover four main areas; general dental treatment, dental emergencies, dental injuries - for example, where teeth have been damaged by an external blow to the face - and serious dental problems such as oral cancer.
'If you're worried about the cost of dental treatment get your dentist to do a Denplan assessment, which will give you a price per month,' says Richard Mason, director of online broker insuresupermarket.com. 'You can compare this cost and the cover provided against conventional standalone dental policies.'
One advantage of dental insurance policies is that you can claim for both NHS and private treatment. But while premiums might be cheaper than Denplan, the benefits are only available up to a set sum per year (see table). You also need to check for exclusions and insurance companies' definitions of things such as 'routine treatments'. For example, the cheapest policy for a single person comes from Universal Provident at just £5.95 a month - this covers routine treatments up to £1,000 a year in total but will pay out just £20 each for new fillings at a maximum of two a year, up to £175 per tooth for a new crown up to two a year and up to £125 a tooth for new dentures, again up to two a year. It does not cover routine dental examinations or pre-existing conditions.
The other alternative to paying for dental and other medical treatment is to opt for a cash plan that pays on demand to cover a range of treatments. These can work out cheaper than dental insurance policies per month but are limited in how much they pay. HealthSure's cash plans, for example, generally cover the cost of check-ups, fillings (white and standard), crowns (standard and porcelain), and other more complex treatments up to a maximum limit of £240 a year on the most comprehensive plan. To get this cover, you would pay £29.95 a month, whereas if you pay £9.95 a month you only get £90 of dental cover a year. However, you also get cover for things such as opticians' costs, acupuncture, health screening, hospital benefits and maternity and paternity payments - making them a better bet if you are looking for help with general medical costs.
Smiles all round
Business information manager Patrick Morgan, who lives in Chester, is very happy with his new smile. The 37-year-old has had his teeth whitened - a process that cost a total of £200, but was covered by his HealthSure cash plan policy.
'I wanted to give myself more confidence, especially when smiling,' he says. 'The initial results were very white - bordering on Day-Glo in fact. But they've calmed down since then and I'm very impressed.'
The whole process took a week, including one session at the dentist and seven nights wearing bleach-filled teeth shields. Patrick, who is on the most comprehensive HealthSure plan, which costs £29.95 a month, pays £15 himself while his company pays the other £14.95.
The plan covers him for treatment worth up to £240 a year. 'There are no restrictions on the policy and you are not asked what treatment you've had done. You just pay the dentist, then claim the money back using a simple form,' he says - giving a broad smile.
