Four in 10 people in the UK admit to skipping routine visits to the dentist because they can't afford to pay the bills, according to recent research.
Meanwhile, a Channel 4 Dispatches undercover investigation into NHS dentistry screened last month claimed to uncover evidence of a system "that often prevents the patient from getting the right treatment at the right price".
Reforms brought in five years ago were supposed to benefit patients and dentists by turning a fee-per-item system into a simple flat-rate one involving three bands of treatment but they backfired because many dentists have felt unable to justify devoting the necessary time to NHS treatment.
Tim Adlem, director of specialist financial consultancy Jelf, says: "The 2006 changes caused thousands of NHS dentists to switch to private work and, although there has been some recent improvement in the numbers available, the public is now clearly worse off than before the reforms."
Health insurer Simplyhealth's 2011 annual dental survey confirms that the quality of NHS care is deteriorating, despite a slight increase in accessibility. It found that 54% of the UK population had experienced a change in dental services in the past four years, with a reduction in the quality of treatment and lower levels of NHS cover cited as the main reasons. It also found that almost 40% say they can't afford regular trips to the dentist.
Most adults who are able to access NHS treatment still face significant costs. Band 3 treatment for crowns, dentures or bridges costs £204, and even a routine examination under Band 1 costs £17. Private treatment costs are much greater still. A crown can cost around £500, and a mere filling can easily cost more than £100.
Private insurance can therefore be worth considering, but the outlay makes it far from an open and shut case. The first step is to inquire whether you have access to cover via the workplace. Some employers provide company-paid dental insurance, and the better schemes refund the lion's share of NHS and private treatment costs. This will be taxed as a benefit in kind, but you are virtually guaranteed to use the cover, even if only for routine check-ups, so it should seem a price worth paying. Alternatively, your employer may offer you the chance to pay for voluntary cover, either via a flexible benefits programme or a standalone scheme.
Mike Izzard, managing director of Premier Choice Group, a private health and protection insurance broker, says: "Voluntary cover is not taxed as a benefit in kind and, because insurers enjoy a spread of risk through the size of scheme membership, it offers much better value than individual insurance cover. The treatment limits are much more generous and the premiums are typically 25% to 50% lower."
If no group cover is available, consider individual insurance plans offered by the likes of Simplyhealth, WPA, Universal Provident and Dencover. Costs range from £7 to £9 a month for plans covering NHS treatment only, to more than £20 a month for the most comprehensive formats that cover NHS and private.
Mark Taylor, 48, who lives in Camberley, Surrey, feels he has received good value from the family cover he has had with Simplyhealth since 2008, even though it only covers 50% of the more significant treatment costs. For a premium of £31.95 a month, it covers him, his wife Angie and their three sons: James (17), Michael (15), and Thomas (14). Although the three boys receive treatment free on the NHS because they are under 18, the plan still gives them the option to go private if, for example, they require more aesthetically pleasing braces or need to use the accident and emergency cover. When Michael chipped his tooth playing football two years ago, the plan enabled him to be seen immediately by his own dentist for extensive private treatment.
Taylor, who runs his own business, says: "Because I am self-employed I like to have the peace of mind of knowing I'm not going to get unexpected bills and my dental plan certainly provides this. Angie and I have regularly claimed for check-ups, hygienist sessions and fillings, plus occasional, more expensive items of treatment. Michael's chipped tooth cost over £300. I would say we have more than recouped our premiums, and there is never a quibble when we have to claim."
The other main private provision option is to cap the costs of regular preventative treatment by taking out a "capitation" or maintenance plan via your dentist – if they offer one. But these do not cover all dentistry costs and can be expensive. For example, Denplan's Care plan typically costs between £12 and £36 a month – and it can be significantly more if you have poor oral health – yet it doesn't cover laboratory fees, which can account for up to half of what you pay for crowns and bridges.
Those who find such costs hard to justify may also consider cash plans offered by, for example, Westfield Health, Health Shield, Simplyhealth, BHSF or Medicash. These blend minimal dental cover with cover for a range of other medical expenses such as optical costs, complementary therapies and consultation fees. But someone paying an overall cash plan premium of £12 to £15 a month may only secure dental cover of around £100 a year.
