As if going to the dentist wasn't painful enough, the rising cost of treatment can really set your teeth on edge. Dentists willing to accept new patients onto their NHS lists are now as rare as hen's teeth and some 11 million people get no dental care whatsoever. On those rare occasions when dentists do throw open their lists, the queues generally stretch round the block.
Around 300 of the UK's 20,000 dentists convert to private practice every year, disillusioned with low fees and the "drill and fill" mentality of the NHS. In 1990, just one in 10 people had private treatment; now four times that many do. Much of the problem is down to long-term underfunding. While total NHS spending increased by 75% over the last 15 years, spending on dentistry rose just 9%. The government recently increased the number of dental students by a quarter to 1,000, but these will take five years to train.
NH stress
Even if you are lucky enough to find a dentist willing to see you on the NHS, you may still have to pay for treatment. Children, pregnant women and new mothers get seen for free, but everyone else, including pensioners, must pay unless they are on a low income as defined by complex criteria. This leaves around seven out of 10 people paying 80% of the cost from their own pocket, up to a maximum of £378.
Under the current system, dentists charge a fee for every filling and extraction, with no incentive to carry out preventive care. There are more than 400 different charges, with prices starting from £5.64 for a basic check-up and further charges for x-rays, fillings, extractions, crowns and dentures. A new NHS dental fees and payment system is planned for next April, under which the cost of treatment will be tiered. Under the proposals, treatment fits into one of three bands:
· Band 1 costs £15 and covers general check-up and preventive work, such as scaling and polishing
· Band 2 costs £41 and includes simple treatments, such as fillings and extractions
· Band 3 costs £183 and covers more complex work, such as crowns and dentures
Frances Blunden, principal policy adviser at Which?, says the new system of charges will be much clearer, and she welcomes the halving of the maximum charge. "But we are concerned that the proposed Band 3 charge will be too high for many vulnerable members of society, especially older people." And Lester Ellman, spokesman for the dentists' trade union the British Dental Association (BDA), says the proposed changes will do nothing to tackle the "excessive workload" of NHS dentists or make it easier for people to get affordable treatment.
If you are trying to track down an NHS dentist, there are two websites that may be worth a visit. NHS Direct provides details of five dentists in your area, although there is no guarantee they will take you on under the NHS. The BDA will also help you find a dentist through its website. But although it claims to have 6,000 dentists registered, many won't lay a surgical glove on NHS patients. A search on a Suffolk postcode, for example, found the nearest NHS dentist to be in Luton. Other suggestions were London, Brighton, Coventry and Derbyshire.
If local lists are closed, ask NHS Direct if there is a dental access centre in your area. These offer treatment to people who aren't registered with an NHS dentist, although they can't register patients themselves.
Private finance
The alternative is to opt for private dental treatment, the drawback being that when the dentist asks you to open wide, he or she might be talking about your wallet. Question your dentist carefully about charges before signing up, because they vary greatly. The General Dental Practice Association (GDPA), which represents private dentists, has drawn up a scale of fees as guidance, but this isn't available to patients and dentists aren't obliged to stick to it. Private practices can set their own rates, so shop around. What you pay depends on the dentist, the treatment you are having and where you live. Patients in London and the south-east inevitably pay more.
Some dentists will give you a free initial assessment, others might charge £50 or more, plus another £50 for a trip to the hygienist. Veneers, crowns, bridges and white fillings can cost anything between £100 and £350. Root canal treatment could set you back £500 and a new set of dentures around £1,500. Private dentists may also offer cosmetic services such as teeth whitening from around £200.
Derek Watson, chief executive of the GDPA, says private dental treatment may cost more, but you get a better service in return, with more flexible appointment times, better facilities, a wider choice of treatment and materials and more time with the dentist. However, the Office of Fair Trading (OFT) is concerned that patients lack the information on prices and treatment necessary to make choices about which services best meet their needs. It urges patients to seek a written quote for work in advance and ask for an itemised invoice. These, and other tips, are outlined in an OFT guide to private dentistry.
Got a plan?
If you do use a private dentist, he or she will probably offer you a dental plan, sometimes known as a dental capitation plan. These allow you to budget for treatment by paying a fixed monthly premium. The dentist will charge to clear up any existing problems, then set your monthly payment according to the state of your teeth.
Denplan is the most popular scheme, with more than 1.5 million patients. Its Care plan covers all routine and preventive care, plus fillings, extractions, crowns, dentures and bridges, for around £15 a month. For around £10 a month, you can buy routine and preventive dental care, but pay extra for crowns, fillings, extractions and so on. You can compare more than 40 plans plans at Insure Supermarket. It says bigger-name brands can be pricey, and urges people to shop around.
Cash plans are an alternative and offer a tax-free, lump-sum benefit towards dental treatment and other everyday healthcare costs, including buying glasses and contact lenses, and paying for physiotherapy, osteopathy, acupuncture, maternity care and hospital stays. You can typically claim 50% or 100% of your costs within set annual limits, which depend on the level of your monthly premium. Healthsure, HSA, Medicash and Westfield Health Scheme all offer cash plans with varying benefits.
Whether you have paid for your treatment or not, you have a right to expect a good job. If you are unhappy with the quality of treatment from an NHS or private dentist you should first complain to the practice, which should have an in-house complaints procedure. If you are still unhappy and your treatment was carried out on the NHS, you can seek redress under the NHS complaints procedure. Currently private patients have limited options, and may be forced to go to court for compensation. This is set to change next year, though, with the launch of a new dental complaints service, funded by the General Dental Council.
