With charges scaling from £18.80 to £1,800 and beyond for single visits, it is hardly surprising that NHS and private practice dentistry inspires polar opposite opinions. It appears a stark choice between the conveyer belt of a busy NHS dental practice and the cosseting warmth of a well-appointed private service – factory fillings versus cosmetic smiles.
The everyday reality is more complex with many practices offering both, and tailoring treatments to a number of health and social factors.
Private dentistry is on the rise after a static period, fuelled by the recovering economy and the desire for a perfect smile, while NHS services exist within a limited public healthcare budget.
The UK spends £5.8 billion a year on dental treatments with £3.6 billion generated by NHS services and 60 per cent of the nation visiting the dentist once a year, according to health analysts LangBuisson’s 2014 dental survey.
But demand varies individually, geographically, by age and social grouping. Younger generations, who have benefitted from improved techniques and performances, have different problems to their elders who are known in the trade as the ‘”heavy metal brigade” because of their profile of multiple fillings.
People who go private generally feel their mouth is worth that much to them that they are prepared to make an investment in its care
Only 2,500 of the UK’s 29,500 dentists are private with no restrictions on their charges, while NHS work is charged at three set bands. The British Dental Health Foundation advises comparing a few before selecting a private practice.
Time and affordability are the big factors influencing the choice of NHS or private, says Mervyn Druian, a pioneer of teeth whitening who runs the London Centre for Cosmetic Dentistry, in Hampstead. He believes the current government contract with NHS dentists makes it difficult for them to squeeze enough time for patients.
“People who go private generally feel their mouth is worth that much to them that they are prepared to make an investment in its care,” he says.
Dr Druian, who has 40 years’ professional experience and has been behind many high-profile smiles, left the NHS in 1990 because he felt the financial return was not keeping pace with the profession’s soaring costs and technological advances.
“You could invest £30,000 for a scanning machine to take digital impressions of patients’ teeth, but if you are only getting a nominal amount for a crown on the NHS, then you have to work so fast or opt not to do it on the NHS because it is not cost effective,” he says.
“Price is obviously on patients’ minds, but private is not that expensive and not everything has to be done at the same time. My patients are not all wealthy. I get them from all over the place and many plan for any work they may have. If they need a crown, then they will put something away for it.
“A patient is told what they need and given a print out of everything. We talk them through it and there are no surprises. It can still cost you £200 a time if you keep having to go back to an NHS dentist.
“One of the great aspects of private treatment is the time. We are on first name terms and regard patients as friends. We hug when we greet each other and celebrate family events.”
Although seeing a clear benefit for the private pathway, Dr Druian is concerned that preventative care and dental health education needs to be strengthened in the UK.
“People still don’t pay enough attention to oral health and they should see a hygienist three to four times a year, and the dentist only once. I’d like to see more funding put into real preventative measures. Hygienists and basic dentistry should be well funded, but none of the major political parties had dentistry in their manifestos.”
The Department of Health is trialling a new system of funding NHS dentists in an attempt to reduce the pressures from a system that pays them by every piece of treatment.
“The current contract is measured by activity so there is a suggestion that it leads to dentists having to turn things round quickly,” says Dr Nick Stolls, who works at a busy NHS practice in a market town in south Norfolk. “But that doesn’t mean the work is going to be done badly. However, sometimes a patient will leave a practice feeling they haven’t had sufficient explanation about their treatment plans. There is nothing, of course, stopping them going back for clarification.”
NHS treatments are divided into three cost bands, starting at £18.80 for examinations, X-rays and polishing, through a second tier of £51.30 for fillings, extractions and root canal work, advancing to £222.50 for more complex procedures such as crowns, dentures and bridges.
Dr Stolls believes NHS dentistry has contributed to a huge upswing in the nation’s oral health over the last decade. “It is getting better and that is partly because the profession has done a very good job of prevention and improving general dental health,” he says. “The majority work tirelessly and are extremely skilled technicians performing under difficult conditions.”
A restructured service has dissipated the long queues that used to form at NHS dentists’ doors, but there is still concern over access in some areas and treatment for housebound elderly patients, says Dr Stolls.
“If you go private, you may expect to see your dentist when you want and we feel that element is disappearing from the NHS a bit because of the contract,” he adds. “But you are entitled to a full range of treatments on the NHS and it is a relatively inexpensive way of getting your teeth fixed compared to private.”