UK dental crisis laid bare as patients stick teeth back in with superglue
In a nation of so much decay under the Tories, one area has probably suffered the most - our teeth.
And now the rotten state of public dentistry in Britain is so deep some fear it cannot be saved. Today it emerged some patients face a ten year wait to get appointments, while a YouGov poll found that one in ten adults have attempted some form of DIY dentistry, from pulling out their teeth with pliers or sticking them back with superglue.
Others are resorting to travelling abroad to places like Turkey to see a dentist due to lack of slots in the UK. The British Dental Association (BDA) estimates a staggering 11million people are caught up in NHS treatment delays.
They include thousands of children, who are automatically entitled to free dental care, but are left waiting in pain for up to 18 months for some dental procedures that require general anaesthetic. Figures obtained last year by the Liberal Democrats found that about 27,000 children were on waiting lists for specialist dental care, including children whose untreated tooth decay has become so severe they not require specific treatment for complex dental problems.
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Seeing a dentist on the NHS used to be quick and easy, but today it’s more painful than.. well, pulling teeth. So what has gone wrong? At the heart of the problem is something common throughout the NHS - a haemorrhaging of professionals who amid drastic funding cuts have decided that public sector work is no longer worth their while.
The NHS dental crisis is a “perfect storm”, according to Dr Nigel Carter, CEO of the Oral Health Foundation, exacerbated by underinvestment, a bad deal forced on NHS dentists in 2006, and Brexit.
He says: “Over the last 12, 13 years we’ve seen a gradual drift towards private dentistry. Dentists who decide to go private aren’t going off to make lots of money, many feel it’s the only way they can run a viable business, in many cases it’s just to be able to survive.”
He says rural areas are worst affected. “So if you’ve got one NHS dentist in a market town and they decide to private, you’re then left with having to travel miles to the next market town, which has an NHS dentist but who might already be full. Dental deserts are a huge problem in our country today.”
Going private is also often a lot more expensive. The NHS has three charge bands for patients: Band one is £25.80 for examinations and X-rays. Band two is £70.70 for fillings, root canal treatment and extractions. And band three, costing £306.80, involves more complex procedures, such as crowns, dentures and bridges.
According to figures from Which?, in the private sector a check up costs from £40 to £75, root canal between £250 to £320, and bridges as much as £1,050. Linda Walkington, 78, found herself in a dental desert when her NHS dentist in Bridlington went private in 2022, and when she tried to register with the only other NHS practice in her town she realised she could be waiting years for treatment.
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She says: “I had to go to another one in Scarborough, but I’ve been on the waiting list there for nearly a year. My son has the same problem, he has had to have three fillings in a year and because he had to go private it cost him over £1,000. He can’t afford it, but just had to put it on his credit card.
“Even the private dentists in Bridlington are now saying that their lists are full. The last NHS dentist here is telling people he might have to go private, not because he wants to but because he says the government isn’t paying him on time and he’s waiting so long for the money. What kind of state is our country in?”
It’s the same picture all over the country. A recent BDA survey found that 3,000 dentists had stopped providing NHS services since 2020, while half the dentists polled had cut back on NHS work and 43 per cent said they planned to go fully private in the near future.
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The UK now has the fewest dentists of every European country, with 5.3 per 10,000 of the population, compared 8.5 in Germany, 6.5 in France and 7.1 in Latvia. England is the worst affected of the home nations, with just 3.4 dentists per 10,000 people.
Labour MP Kate Hollern, who has expressed worries over access to dental care in her Blackburn constituency, places the blame squarely on the government who she says has cut funding for dental services in England by 8% in real terms since coming to power in 2010.
She says: “At a national level, there has been no real strategy. Over a decade of Conservative mismanagement has led us to a crisis point. In 2021 alone, 2,000 dentists quit the NHS, with many stating that they felt undervalued and under-resourced.
“To make matters worse, in November 2023, NHS England gave Integrated Care Boards (ICBs) permission to use dentistry underspends to balance their bottom lines. This is despite the Prime Minister’s pledge to protect the budget for NHS dentistry.”
She said she recently received an email from a constituent who “has had to perform ‘DIY-dentistry’ and self-medicate due to an abscess at the root of a chipped tooth - this is all while undergoing chemotherapy. The individual’s inability to access a dentist in the local area has led to them being very concerned and worried as they have been warned that any dental problems can potentially delay their cancer treatment.”
Many believe the problems began with the introduction of the new Dental Contract in 2006, which changed the way dentists were paid for NHS treatments. Until then, dentists had been paid per filling, extraction or crown, with no limits on how many they could perform to keep patients’ teeth and gums healthy. But since the new contract they have been paid per course of treatment - meaning that if a patient needs ten fillings, they only get paid the same fixed amount.
Each practise is also only allowed to perform a fixed number of procedures, or units of dental activity (UDAs) from each of the three treatment bands, and may have to hand money back if they don’t do the number set out in their contract. Dr Carter explains: “The Dental Contract wasn’t well received by the profession at all. They went from 1500 different types of treatment, each at a different price and paid of individually, to a very simplistic system which didn’t favour dentists, who didn’t like what was being imposed.”
One dentist, writing anonymously in NHS whistleblowing website The Lowdown, explains how the 2006 deal forced many dentists to give up their NHS work. “Imagine for a moment, that you are a freelance reporter and you have a contract to provide 1200 words per week for a fixed fee. Although the work is time-consuming and the amount you earn from this work isn’t phenomenal, it’s certainly useful and helps pay the overheads.
“Then one day, the client comes to you and says, ‘I’m making a change to your contract… From now on, I want you to produce as many words as I demand, when I demand them, for the same fixed fee. Unreasonable? Yes, but this is exactly the situation NHS dentists faced in 2006.”
He adds: “Prior to 2006, many of my colleagues were of the opinion that the Government was trying to ease the ‘greedy dentists’ out of the system by the back door. I’d say ‘mission accomplished’.“
Becoming a dentist involves at least five years study at dental school, followed by one or two years of supervised practice. Qualified dentists employed by the NHS earn a basic salary of between £48,000 and £102,000. Private dentists can make £130,000 and some times even more.
Labour has promised to reform the NHS dental contract and provide 700,000 more appointments a year in a £111million plan, funded by abolishing the non-don tax status. “NHS dentists want to do more NHS work, but the Government are standing in their way,” says MP Kate Hollern. “It is a moral outrage that the managed decline of NHS dentistry has left millions with no choice: either go private or go without.”
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