If there's one thing worse than the pain of root canal surgery, it's having to pay for the privilege. According to a simplyhealth survey, our fear of going to the dentist isn't just about physical pain, dental cost plays a big part too.
It found that 52% of us are worried that we won't be able to afford dental care in the future, while 28% of us are putting off appointments because we're worried about dental cost.
This isn't helped by the fact that many of us feel ripped off by dentists. Although NHS dentists are no longer able to charge for each procedure they carry out – a system that incentivised less scrupulous practitioners to provide unnecessary treatment – there is still evidence that patients aren't always treated as fairly as they should be.
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A 2012 investigation by the office of fair trading (oft) revealed that 500,000 patients a year are being misled about their rights to NHS services and encouraged to go for costlier private treatment.
It also found dentists aren't always upfront about charges, with 39% of NHS patients saying they hadn't seen any fee information in the surgery. Among private patients, 56% didn't see fees displayed at the reception desk and less than 20% of patients who paid for treatment received a written treatment plan.
Whether it's money, fear or lethargy that's making you give the dentist a wide berth, failure to get your teeth examined could seriously affect your health.
Ruth Chesmore, Bupa's director of dental services, says: "Oral health can be a good indicator of overall health, and one of the many things our dentists will look out for is early signs of oral cancer," cases of which have risen by 25% in the past 10 years according to Cancer Research UK. "Gum disease has also been linked to heart disease," she adds. Even more straightforward dental problems can become more costly and difficult to fix if left to fester.
So if you haven't had a check-up in a while, it's important to book an appointment as soon as possible – just make sure you do your research to ensure you get value for money and don't end up paying over the odds.
According to Simplyhealth, an NHS dentist was the preferred choice for 56% of us in 2012. All treatment that your dentist deems necessary to keep your mouth, teeth and gums healthy and pain-free will be available on the NHS. Just how much you pay will depend on which of the three bands your treatment – or treatments – falls into and you should only pay that charge once, even if you need to see your dentist several times over the same course of treatment.
NHS Price bands
- NHS Band 1 costs £18 and includes a check-up (including X-rays), advice on how to prevent future problems, a scale and polish if necessary, as well as the application of fluoride varnish or fissure sealants.
- NHS Band 2, at £49, includes the above plus fillings, root canal work and tooth removal.
- NHS Band 3 is the most expensive band at £214 and includes everything covered by bands 1 and 2 plus crowns, dentures and bridges.
Importantly, urgent treatment – including trauma to the mouth and serious toothache – is covered by band 1, so don't let the cost put you off making an appointment with a dentist in an emergency.
This banding system should make the cost of seeing an NHS dentist pretty transparent – you'll only ever pay £18, £49 or £214 for one course of treatment. However, as the OFT investigation suggested, problems arise because many dentists provide both NHS and private services.
This is where it is important to know your consumer rights. Dentists are not allowed to say you can't have a particular treatment on the NHS and then claim you can pay for the work privately. The only exceptions are cosmetic treatments such as teeth whitening and veneers.
However, Dr Mark Hughes, senior partner at the Harley Street Dental Group, points out that in some cases there may be good reason to go private because there is a greater range of treatment options – for example when filling a decaying tooth. "A lot of dentistry that is considered ‘aesthetic' is more conservative for the tooth in the long term." He adds: "Make sure you ask your dentist about the pros and cons of your options first."
Going private doesn't automatically mean you are going to pay over the odds. The important point is that you know your rights, your options and the cost upfront so you can make an informed choice. Either way, make sure you get a written treatment plan detailing exactly how much you will have to pay before work starts.
A sizeable 44% of us prefer the private route. Chesmore says the main draw is greater choice of appointment times and length of a visit. "You could get two to three times more time with the dentist," she says.
This flexibility and time does of course come with added cost. How much you pay will vary depending on the practice and where you are in the country but, as a guide, a 45-minute new patient consultation with Bupa ranges from £50 in Leeds to £59 in London. At the upper end of the market, a two-hour initial consultation with London's Harley Street Dental Group costs £150, although that cost is deducted from further treatment.
If large dental bills are a concern, there are a number of policies in the insurance market that can help you manage these costs. Cash plans, for example, pay you a cash benefit whenever you need to stump up for a range of medical treatments such as visiting the dentist, getting your eyes checked or visiting a physiotherapist or podiatrist.
Bupa cash plans start at £6.50 a month and will pay £50 towards dental costs, rising to £150 for £19.50 a month. That's expensive if you only use the plan for dentistry, but cash plans also pay out on a number of other treatments.
Alternatively, you can go for a dental insurance policy, available from medical insurers including Bupa, Simplyhealth and WPA. You can choose a plan that just covers NHS treatment or one that covers private work, too.
These typically cover the costs of check-ups and maintenance but the downside is they may only cover a proportion of your costs. For example, Simplyhealth level one cover costs £7.95 a month and includes 100% cover for check-ups up to £30, 75% cover on scale and polishes up to £30, and after a three-month qualifying period pays 50% towards treatments up to £200. It also includes benefits for dental emergencies.
Maximum cover is provided by its level 4 plan at £23.95 a month which pays £120 each for check-ups and scale and polishes and up to £800 for treatment, but again only 50% of the cost.
The final option is a dental payment plan, available direct from companies including Denplan or via your dentist. Here, after a full examination, you pay a monthly fee based on your dental needs over the coming year. This might include general maintenance or treatment if necessary. It's important not to feel forced into buying these plans in the dental chair – the OFT report found that 20% of patients who joined plans as a means of paying for private care felt pressured to do so.
Dr Hughes says insurance plans can be great for your oral health. "They're a good idea because it encourages people to come into the surgery more often," he says. But, whether or not they offer good value for money will depend on the state of your oral health. Paying £100 a year or more could make sense if you need major work or want to go private but if you only need a check-up, paying as you go with an NHS dentist will give you less financial pain.
What to do when things go wrong
If you believe you've been overcharged, misinformed or received substandard treatment you may be able to get redress. How you make a complaint will depend on whether your treatment was NHS or private.
NHS patients should complain direct to their dentist. If the reply is not satisfactory, then the next step is to contact NHS England or your local care commissioning group. They will provide local resolution. If you're not happy with the outcome, you can escalate your complaint to the Parliamentary and Health Service Ombudsman.
The NHS website (nhs.uk) can provide you with all the relevant contact details (for England, Wales, Scotland and Northern Ireland) and there is a link about the complaints process on its home page.
Private patients need to make complaints to the Dental Complaints Service which is a free and impartial service funded by the General Dental Council. It may be able to get you a refund, remedial treatment or an explanation or apology from your dentist, depending on the nature of the complaint. Its helpline is 08456 120 540 and is open Monday to Friday between 9am and 5pm.