Page last updated at 14:35 GMT, Wednesday, 19 August 2009 15:35 UK

NHS dentist patient numbers fall

Patient being treated by dentist
The number of dentists offering NHS treatments has risen

The proportion of the population who were treated by an NHS dentist in the last two years has fallen since the service was overhauled, data shows.

But both the number of NHS dentists and treatments provided in England did rise in 2008/2009 from the previous year.

However data from the NHS Information Centre shows complex treatments, like crowns, have fallen dramatically.

A new dental contract, introduced in 2006, has been heavily criticised and is now to be revamped itself.

Some 53.8% of the population saw an NHS dentist in the two years ending March 2009, down 1.9 percent from the two years ending March 2006, although this has started to creep up marginally in the last year.

The new dental contract was introduced in a bid to end what was dubbed the "drill and fill" culture, in which dentists were paid by the number of treatments they carried out.

However there has been severe criticism of the new contract, which was structured to allow dentists to spend more time on preventative work with individual patients, by paying them a flat salary.

An average dentist's take-home pay is in the region of £90,000, NHS data shows, and many earn in excess of £200,000.

Because they receive this wage regardless of whether they carry out simple or complex treatment, critics argue that the financial incentive to carry out difficult work such as crowns or root canals has been removed.

NHS Information Centre figures show that the number of crowns fell by nearly 50% between 2004 and 2009, while the number of root canals fell 40% over the same period, from nearly a million.

The number of dentures meanwhile increased by nearly 14%.

Quality care

Overall, the number of treatments has increased in the last year, up nearly 6% from 2007/2008. There are significant regional variations, with treatments in the North East Strategic Health Authority substantially higher than the South Central.

There were 528 more dentists providing NHS treatment in this past year than the year before, a 2.5% increase.

But in June, ministers agreed to an overhaul of the system although the row over whether the problem lies with the contract or the propensity of dentists to "play the system" continues.

In the autumn a new scheme will be piloted. It is thought likely to put more emphasis on the need for quality treatments.

"This is crucial," says Dr Anthony Halperin of the Patients Association. "The fall we have seen in complex procedures is very significant and very concerning.

"Numbers are not enough - what is vital is the quality of care. This is what needs to be urgently addressed."

Conservative shadow health minister Mike Penning said: "The very fact that the Government was forced to set up such a detailed review of their contract only shows how flawed it was in the first place.

"We now learn that the type of treatments patients are receiving is changing - with increases in dentures and a fall in the amount of bridges provided. It is vital that Labour ensures dentists are properly supported to give patients the most appropriate care."

But Chief Dental Officer Barry Cockcroft said the decline in complex treatments was "evidence that the new system is freeing up time that dentists can use to deliver more preventative care.

"Dentists are legally and ethically obliged to deliver all treatment under the NHS that is clinically required and effective. We are sure most dentists would be deeply shocked by the suggestion that patients may be deliberately under-treated to maximise profit.

"This would be a breach of contract as well as patient trust."

The British Dental Association (BDA) the increase the data had started to note in the number of patients receiving NHS care was "good news for those who are benefitting from it".

"This increase must continue so that it recovers to pre-reform levels and starts to afford care to all those who wish to access it," said John Milne, chair of the BDA's general dental practice committee.

"These reports also highlight a change in the treatment patterns of care provided by NHS dentists, with decreases in the amount of many more complicated treatments compared to 2003-2004.

"This change is in line with the aim of the reforms to reduce the amount of complex treatments being provided."

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