British teeth have long been the subject of jokes, from Austin Powers’ gnashers to the “big book of British smiles” used to scare Lisa Simpson into wearing her braces. But are British teeth actually getting worse? As Covid shines a light on the growing gaps in oral health inequalities, I asked Paul Woodhouse, Stockton-on-Tees dentist and British Dental Association board member.
Hi, Paul, how was work?
Coco, it’s carnage. Nonstop.
I heard there was a backlog of 37 million NHS appointments due to practice closures during Covid – although I still don’t fully understand the difference between NHS and private appointments. Is it based on income?
No, anyone can have NHS treatment. It’s free if you’re on benefits, and everyone else pays banded dental charges. The good part for patients is that if they need one filling, it’s band 2, £65.20. If they need 20 fillings, it’s still band 2, £65.20. Though that means sometimes patients will save up work, staying in pain until they’ve got other problems, or refusing work they need in the more expensive band 3.
That reminds me of a friend in the US who had a car accident but couldn’t afford to go to hospital. When it comes to teeth, we’re almost as bad.
One hundred per cent. I’ve had people try to pull their own teeth out, file them, put glue in them. And this was long before Covid. Children, too: the most common reason children end up in A&E is for a dental procedure. Yet we have no national strategy for the prevention of tooth decay.
Will the usual 5% rise in dental charges help?
That only reduces the amount the government has to give dentists. The government doesn’t fund enough dentistry for the population, and half the money comes from patient charges anyway. It’s so wrong – I’ve had grannies use their winter heating payments for dentures.
I’m still confused: when I needed to find a new dentist, I rang loads of surgeries and they all kept saying they weren’t taking NHS patients.
That’s because of the target system. Dental practices are allocated funding from NHS England and assigned a target of activity to achieve it. In my practice, it’s about 30,000 units of activity. A checkup is one unit, a filling is three, a crown is 12. However, if a patient comes in and needs 10 fillings, three root canals and four extractions, you still get three units of activity.
So with private patients, the practice knows what they’ll receive, which is why they get prioritised. Got it! That is one of the most counterproductive systems I have heard of.
In 2008, the health select committee said the system wasn’t fit for purpose. And yet no government has changed it. It’s why dentists are quitting the NHS. The media loves to talk about dentists driving flashy cars, and people love sharing horror stories: the number of people talking about a dentist kneeling on their chest! I couldn’t get my leg that high.
It sounds like an advanced yogic move – “upward facing dentist”.
I’m an old-school lefty. I think the NHS should be free at the point of access, including teeth and eyes. It’s frustrating when you can’t spend time with patients, or try a treatment where a tooth might be saved because the NHS system pushes you to take it out. We want to give people the best care. There is nothing so rewarding as helping someone out of pain.
