Dental patients feel the pain of pricing inconsistencies

Before 1990, going to the dentist was something you did without really thinking about it. You just made an appointment with the old family tooth snatcher, opened your mouth and said “ah”.

But then the government brought in a system whereby patients had to register with an NHS dentist, even if it was their existing one, and the rot set in. Even in the early days, many people struggled to register with their existing dentist and moved to a private practice. Since then the number of people registered has dropped steadily.

The figures rallied in 2006, but then the government introduced a new charging structure. It was supposed to make the charges simpler to understand. It brought in three tiers: £15.90 for basic treatment, £43.60 for something more complex, such as fillings, and £194 for something complicated, like crowns and bridges.

The result, according to the Department of Health, was that over 650,000 people lost their NHS dentist. Dentists claimed that a tiered structure meant they could only charge £43.60 for fillings, even if they were doing 10 of them, and couldn’t function profitably within the NHS. Some estimated they would need to see 40 patients a day to make their work pay. Yet more patients moved to private practice.

Today most people aren’t registered with an NHS dentist – almost 60%, according to the Dentistry Watch survey from the Commission for Patient and Public Involvement in Health – while some 25% of people have gone private. Worryingly, most have simply defaulted to using their old dentist, but switched to his or her private practice.

They have not shopped around and don’t realise they could be paying up to three times more for treatment than those going to private competitors.

Inconsistencies in dental treatment charges hit the headlines in 2003. The Office of Fair Trading responded by demanding that itemised charges should be presented to patients before treatment is carried out and that a detailed bill should be produced.

It set up the Dental Complaints Service in May 2006. Figures show that in its first year the organisation helped resolve more than 1,500 complaints and recover £138,000 from dental practices for patients who had complained.

However, the Dental Complaints Service still can’t do anything about varying charges. Peter Woods, a consultant from the West Midlands, went hunting for a dentist in December.

He says: “Every practice had a different charging structure, and none of them were easy to understand. A check-up might include a scale and polish, or it might not. It might, or might not, include x-rays. How are you supposed to make comparisons?"

Peter found the cost of a basic private filling varied from £25 to £90 at the practices he checked, while more expensive treatments, could vary by hundreds, or even thousands, of pounds.

Another problem is that no practice will be cheaper across the board. One that is cheap for a check-up may be extortionate for a filling, for example, and is it really possible to know what you’re going to need each time you go to the dentist and hunt down the cheapest option?

One of the most worrying things Peter found was that some practices had trained their receptionists in the art of the hard sell. “One receptionist made me feel very uncomfortable leaving without an appointment,” he says, “and it was only after I left that I found they had a £65 fee for a first consultation.”

It’s worth shopping around for an NHS dentist. In many areas this is almost impossible, but if you search the internet at, you will see a list of dentists in your area indicating those accepting NHS patients. Also look out for new practices opening. They will often accept a small number of NHS patients.

An inexpensive product called a dental cashplan can help with the cost of private care. However, the plan has an upper limit. You can claim back just £20 of what you spend a year on maintenance work, such as check ups, and £200 of treatment costs (subject to limits for certain treatments). But it only really pays to have a plan in years when you have treatment, and it’s not really possible to predict when treatment will be needed.

So until an NHS dentist comes to your area, it’s a case of getting hold of the list of charges of local private practices and that’s never going to be easy to predict.

On the other hand, the Dentistry Watch survey found respondents who had found a new solution: the DIY approach. Two had resorted to pulling their teeth out with pliers, while a third had mended a crown with superglue and a fourth had filled a tooth with DIY filler.

It brings a whole new meaning to the concept of opening your mouth and saying “argh”.