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Last Updated: Monday, 15 October 2007, 15:17 GMT 16:17 UK
Many 'cannot get NHS dental care'
dental work
Dentists have been critical of new NHS dental arrangements
Many NHS dental patients in England are being forced to pay for private care, go without treatment or even pull out their own teeth, a survey suggests.

The survey of 5,200 patients for an NHS feedback body found 20% had refused treatment because of high cost and 6% had treated themselves at some point.

Most of those going private said they could not get NHS treatment locally.

The Health Committee, a group of MPs, has announced an inquiry into the new dental contract, introduced last year.

Of 750 dentists polled, 84% said their new contract had failed to improve access to NHS services for patients.

The picture it paints, of patients unable to access care, dentists struggling with the target-driven system and anxieties about the new charging system, is an all-too-familiar one
Susie Sanderson
British Dental Association

About a quarter of patients who took part in the survey by the Commission for Patient and Public Involvement in Health said they used a private dentist.

The majority said they paid for dental care privately because their dentist had stopped treating NHS patients or they could not find an NHS dentist in their area.

Some 15% had gone private because they thought they would receive better care than on the NHS.

Half of patients, whether NHS or private, were confused about dental charges, with some saying they had taken out loans to cover the cost of treatment.

I took out one loose tooth with pliers just last month
Andrew, Exeter

And 6% said they had treated themselves because they were unable to get professional treatment.

These included one patient from Lancashire who said they had removed 14 of their own teeth with pliers and others who said they had used glue to fix broken crowns.

A new contract for dentists was introduced in April 2006 and was meant to tempt more dentists to work in the NHS by moving away from the "drill and fill" culture under which they had to maximise the number of procedures they carried out.

Of the dentists questioned as part of the survey, almost half are not accepting any more NHS patients.

And 58% believe quality of care has deteriorated since the introduction of the contract.

Sharon Grant, chairwoman of the Commission for Patient and Public Involvement in Health, said many patients were being let down "very badly".

Under the new system, if a dentist leaves the NHS, the local PCT will re-invest the funding to bring in new dentists
Department of Health

"It appears many are being forced to go private because they don't want to lose their current trusted and respected dentist or because they just can't find a local NHS dentist," she said.

"Where NHS dental services are available, people are happy with the quality of treatment provided but many find the NHS fee system confusing and expensive, with some patients taking out loans to pay for treatment or more worryingly taking matters into their own hands."

Charge 'anxieties'

Susie Sanderson, executive board chairwoman at the British Dental Association, said: "The picture it paints, of patients unable to access care, dentists struggling with the target-driven system and anxieties about the new charging system, is an all-too-familiar one.

"The new contract has done nothing to improve access for patients and failed to allow dentists to deliver the kind of modern, preventive treatment they want to give."

But a Department of Health spokesperson said 21,000 dentists were providing NHS services and the survey reflected a very narrow view of NHS dentistry.

"Under the new system, if a dentist leaves the NHS, the local PCT will re-invest the funding to bring in new dentists," she said.

"Patient charges are now easier to understand - with just three bands of treatment instead of 400 differently priced items.

"There is also a reduction in the highest charges from 389 to 194."

Health Minister Ben Bradshaw said it would take the government "some time" to deal with the shortage of dentists - but he said the idea of a golden age of NHS dentistry was a myth.

He said: "Only 60% of us ever accessed an NHS dentist. The figure now is 56%.

He also argued that there was no need for anyone to resort to pulling their own teeth out.

"Last year we introduced for the first time a duty on local health services, on the primary care trusts, to provide urgent dental treatment to those who need it.

"If people need urgent treatment they should go either to their GP or the primary care trust and demand what is their right."

But the British Medical Association said GPs were not in the position to fill the gap left by inadequate dental services.

"Family doctors are not qualified as dentists and cannot pick up the pieces if there are not enough NHS dentists to go round," said Dr Laurence Buckman, chairman of the BMA's GPs Committee.

Dental charges in England, 2007

Treatment NHS England* Private**
Band 1    
Examination 15.90 25-45
Small x-rays 15.90 8-10
Band 2    
Fillings 43.60 Small amalgam 28-50, large 50-95
Root canal 43.60 150- 600
Extractions 43.60 40-100, one tooth
Band 3    
Full dentures 194.00 350-850
Crowns 194.00 240-450 (non-precious metal)
Bridges 194.00 250-500 (pontic and retainer)
*All NHS treatments are structured into three different bands, and costs are inclusive, so Band 2 charges would include any fees related to Band 1 procedures **Private charges are cost estimates produced by the British Dental Health Foundation

When was the last time you saw an NHS dentist?
Within the last six months
Within the last year
Longer than a year ago
12390 Votes Cast
Results are indicative and may not reflect public opinion

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