The inability of millions of patients to access an NHS dentist is one of the longest-running injustices in the history of the health service. The misery and the harm it causes is profound and well documented. The scandal is not new.
Going private is often the only alternative. If it means getting a checkup, a scale and polish, a filling, an extraction or if necessary a root canal, many will pay. Anything to keep your teeth in good nick.
But now a new horror is emerging. Just like NHS dental care, private dental care risks becoming more inaccessible too. Fees for private treatments are rocketing, an analysis shows. Average costs of non-surgical treatments are up by as much as 32% in two years.
Patients can be billed £325 for a white filling, £435 to have a tooth out and in some cases £775 for root canal work. It means millions more people could face a double blow in 2025: inability to access NHS dental care and inability to afford to go private.
Of course, many of those denied NHS dental care have not been able to afford to go private for some time. One in five people, and two in five of those on lower incomes, already avoid going to the dentist in England because it costs too much, according to a recent survey by Healthwatch.
Some go years without care, or live in agony with untreated pain. Some even attempt DIY dentistry. The dramatic rise in the cost of going private could put more Britons in the same peril.
Fundamental changes to NHS dentistry are needed urgently to improve access and avoid people having to choose between living with poor oral health or going into debt to pay for private care.
Surveys show a majority of adults want the ability to register permanently with a local NHS dentist in the same way that they can with a GP surgery. This right was removed in 2006.
Most experts also believe that the current contract between the government and dentists in England is failing and should be ripped up.
The British Dental Association (BDA), which represents dentists, says some of its members have raised private fees to compensate for the loss they are making on NHS patients. The money dentists receive from the government for NHS care is not enough to make ends meet and does not cover their costs, it suggests.
Inflationary pressures, including rising energy and equipment costs, may also help to explain the rise in private fees, the BDA says. It wants a new contract that rewards dentists who help prevent dental problems in the first place.
A recruitment crisis also means there are fewer NHS dentists to see patients despite a growing population. There were 483 fewer dentists doing NHS work in England last year compared with 2019-20.
The previous government’s plan to broaden access to NHS dental care failed spectacularly. The National Audit Office said two key elements had not been achieved.
None of the promised new fleet of mobile dental vans appeared, and £20,000 “golden hellos” to entice hundreds of dentists to work in areas of acute shortage produced just one extra practitioner.
The Labour government says it has inherited a dental sector suffering from years of neglect and insists turning it around is a priority.
Ministers have vowed to create 700,000 extra urgent dentist appointments and reform the dental contract to make NHS work more appealing to dentists. But they have yet to set out how or when they will deliver change.
“This government is committed to rebuilding dentistry, but it will take time,” Stephen Kinnock, the dentistry minister, said in November. The clock is ticking.
