Dentistry on the NHS faces its biggest shake-up since the service was established in 1948 in just four weeks' time. But will you be displaying a shiny white smile as many NHS dentistry costs fall or screaming "ouch" as your dentist goes private?
The new rules - due on April 1 after two postponements - are a mix of good and bad for patients.
The good news is that the 25 million people in England and Wales (the new set-up does not apply in Scotland or Northern Ireland) already signed up with an NHS dentist could pay less.
But it could be even harder to find an NHS dentist. So you might have to join those who pay privately - and that could mean sky-high fees.
News to make you smile
Under the present system, it's tough for patients to work out how much their NHS bill will be. Dentists use a list of more than 400 prices for different treatments, most meaningless to patients. So there is no way of knowing the bill. Even seemingly simple fillings vary on the amount of material used.
The one certainty for those who have to pay NHS dental fees - children, pregnant women and those receiving means-tested benefits generally do not face charges - is that no NHS course of care can now cost more than £384.
But from April 1, the almost impossible-to-decipher price list will be flushed down the basin. In its place comes a new polished three-tier tariff.
Those who are now exempt from charges will still pay nothing. The rest will pay one of three charges depending on the amount of work needed.
· Band 1 £15.50 (£12.00 in Wales). This is the basic charge and includes an examination, diagnosis and preventive care. The charge will also take in any x-rays, scaling and polishing required as well as planning for further treatment.
This will also be the fee for urgent, out of hours, work.
· Band 2 £42.40 (£39 in Wales). This covers all the treatments in band 1 plus additional treatment such as fillings (one or more) root canal treatment and/or extractions.
· Band 3 £189 (£177 in Wales). The highest band takes in all the treatments in the first two bands plus more complex procedures such as crowns, dentures and bridges.
This highest band cost will be under half the present top £384 course fee.
A few costs will rise. An examination on its own now costs £5.84, while an exam, scale and polish but no x-rays adds up to £15.04. Both treatments will in future be covered by band 1 (£15.50).
And, provided you are in good dental health, the old six-month check-up routine will end, leading to further saving of money and time. Guidelines from Nice - the National Institute for Clinical Excellence - suggest an 18-month interval. So you won't have to pay for unneeded inspections to avoid being struck off your dentist's NHS list.
News to make you wince
The new arrangements centre on a total rewrite of dentists contracts with the NHS. And so far, a huge number of dental practioners have failed to sign up. Most have missed the first deadline for the new deal.
So even though NHS dental charges may be going down, it could be tough finding an NHS dentist.There are fears that we could end up 5,000 short. And some NHS dental patients may soon receive a letter that tells them to go private or find an alternative dentist.
High street dentists, who are self-employed, object to switching contracts to local "primary care trust" control from the Department of Health.
Some categorise the changes as "a command and control approach that would have done the USSR proud."
They also object to a pay deal based on work in the year starting October 2004, but more crucially, the British Dental Association fears "it's a target-driven system which pushes cure above prevention with a treadmill based on 'units of dental activity'."
The BDA adds: "These changes could be shambolic."
There is undoubtedly a degree of brinkmanship involved - the Department of Health estimates 95% will sign, with the non-signers largely among those with just a few NHS patients. But while the BDA agrees most will sign up at the eleventh hour, the dental profession is not happy. Derek Watson of the Dental Practioners Association says: "It's not about money. It's about conditions of work and a scheme which many think will do little to encourage dental well-being."
All this will add to the dental postcode lottery. Some areas such as north-west London are well supplied with NHS dentists. But Wales, the south-west and the north-east of England need more dentists. The government is expanding dental schools, including opening one in Devon.
Mr Watson believes the new rules will not mean the end of NHS dentistry but accelerate the move from it.
Private dentists currently charge around £60 for an examination, scale and polish and £40 for a typical filling.
"You can't compare costs directly. Private dentists can spend more time on a patient and use better materials," says Mr Watson.
