Page last updated at 17:10 GMT, Monday, 18 May 2009 18:10 UK

Q&A: NHS dentistry

Dental equipment
A new dental contract was only introduced in 2006

The Tories are recommending a shake-up in NHS dentistry, saying not enough people have access to treatment.

The issue is hardly ever out of the news, but the government only made changes a couple of years ago. What has been happening?

What is the problem?

Ever since the start of the 1990s dentists have been increasing the amount of private work they do, meaning there are fewer and fewer NHS appointments to go round.

As early as Tony Blair's first term as prime minister, the government was looking into ways to reform the system.

A complete overhaul was carried out in 2006 when a new contract was introduced. The aim was to make the NHS more attractive to the profession, but instead 1,000 dentists walked away before it started.

These dentists have now been replaced and there are more than 21,000 dentists doing NHS work.

However, figures still show that 1m fewer patients were treated in the two years after the contract was introduced than the two years before.

How does the new system work?

Dentists are paid for agreeing to do a set amount of courses of treatment over a year.

The theory was that this would relieve some of the pressure from having a revolving door of patients constantly asking for treatment.

It means patients should be able to go anywhere to get treatment as the system of registration does not exist.

If a dentist has spare treatment courses available, then a patient can get treatment.

However, because the pool of dentists has not increased dramatically demand is still outstripping supply and patients are struggling to get access in some places.

What is the government doing?

Ministers accept there is a problem. A review was launched in December 2008 amid continuing reports that people could not find an NHS dentist.

The report is expected to be published later this year, although the government has always maintained that in the long-run it is confident the changes will pay off.

Ministers have pointed out that undergraduate training places have risen by 25% in recent years - and in time this will lead to a large increase in dentists working in the health service.

What do the opposition parties think?

The Tories want to see the system of registration restored so that dentists are paid for looking after a set number of patients rather than carrying out a set number of courses of treatment as they currently are.

However, built into the contract would be a series of incentives to ensure good quality care is provided to all in a similar way as happens under the GP contract.

The Tories have also suggested curbing the amount of private work dentists do.

It costs the taxpayer £175,000 to train a dentist, but as soon as they qualify they are free to turn their back on the NHS and do solely private practice.

Under the Tory plans, newly-qualified dentists would be compelled to do a certain amount of NHS work for five years.

The idea of a tie-in has been floated before, mainly by patient groups, and is something the Lid Dems are looking into.

However, the Lib Dems are less keen on a complete overhaul of the system, suggesting it could create "turmoil" in the health service.

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