I felt like I had been hit by a bus when my dentist casually told me that a tooth needed root canal treatment and a new crown – at a heart-stopping cost of nearly £1,200. And I am an NHS patient.
With another 23 pearly choppers to look after, how much should you spend on one tooth when charges are this high? The prospect of dental bills running into tens of thousands of pounds has started to fill me with terror. An older friend has just been quoted £25,000 for various treatments including implants, a modern alternative to dentures.
Blame it on my mother’s generation, which suffered wartime sugar rationing and wanted to give their children what they themselves had missed, or on overzealous dentistry in my childhood. But it seems I am a member of the heavy metal generation – a new term of oral rather than aural abuse.
Our mouths are full of metal and porcelain, most of which will have to be redone as we age, at very considerable cost. But how is it to be paid for? Or will good dental care, like so many other things, become the prerogative of the seriously wealthy?
I am not alone in my concerns. Which?, the consumer lobby group, recently launched a “Clean Up Dental Costs” campaign after its research revealed great vari. This is triggering worry and uncertainty for patients, who find it difficult to shop around, and has caused one in five to be overcharged.
Dentists are obliged to display a price list and make sure that patients are clear about the costs of any treatment they may need, as well as the options under both the NHS and private practice.
Which? found that at least half failed to do so. One in three patients was already putting off treatment as a result, according to its research.
Others question why our dentists charge more than those anywhere else in Europe.
Keith Pollard, chief executive of Intuition, the health-care publisher, said: “We have the most expensive dentists in Europe. Ask the dental profession why that is and you won’t get an answer.”
So what do you do? I paid up, of course, after a half-hearted attempt to shop around. No one else will quote you without another assessment examination, which can cost up to £80. A couple of those and you have wiped out any potential saving. Patients are effectively trapped.
In fairness to the dentists involved, the treatment I received was of the highest standard. So good was the root canal practitioner that he was able to complete the job and leave intact my existing, privately fitted crown, which he subsequently admitted was an excellently installed piece of high-quality workmanship. This brought the overall bill down to within a whisker of £800.
Even so, the experience left me feeling bruised, mistrustful of the profession and fearful for the future. I also now understand why thousands of British dental patients are flocking abroad for treatment each year.
Dentists deny that costs are rising, but say new treatments that allow people to keep teeth they would previously have lost come with a price tag. On top of this, patients are litigious and insurance is expensive.
Peter Hodgkinson of the British Dental Association said: “Demographics are changing. We have an ageing population, many of whom already have a mouthful of metal, which will need more work as they get older. But the NHS pot available for looking after them is very limited. Materials are costly and dentists face different lab costs.”
We look at your options for cutting costs.
NHS TREATMENT
A good NHS practice is worth its weight in gold, as I can testify, courtesy of my last dentist. Here charges are standardised and affordable. A “band one” charge of £18.50 covers examination, diagnosis (including X-rays), scale and polish and preventive advice.
For more complex work, such as fillings, root canal work or tooth removal, band two charges apply, which are a maximum of £50.50. Finally, band three is for the most complex work such as crowns and bridges, for which patients cannot be charged more than £219.
But finding an NHS dentist is not easy, as I discovered recently after moving house. Several offered to put me on their waiting list and treat me privately until an NHS place became available. But none could say how many months, or years, this might take.
If dentists are not rationing patient numbers, they may be rationing the treatments available to them. The sizeable practice that agreed to sign me up as an NHS patient was unable to help me when a swelling appeared on my gum. They suspected that root canal work was needed but none of the partners was capable of carrying out that treatment. They sent me to a private specialist.
This is also part of a trend, according to Mr Pollard, who said: “Some procedures require technology that is too expensive for the general practitioner to invest in, so they refer patients to a specialist. Root canals now require kit that costs tens of thousands of pounds, so some dentists invest in the technology and training and do nothing else.”
Dentists complain that a new contract, introduced in 2006 in England, restricts the amount they can earn from the NHS. Mr Hodgkinson said: “When the allocation for the year has been spent, the money has gone.”
The contract is under review and a new system is being piloted in a few areas.
Furthermore, some treatments, such as implants, or more attractive fillings and crowns, are not available under the NHS.
PRIVATE DENTISTS
Good private dentists can also be worth their weight in gold. I was registered for 15 years with one who did no NHS work. He carried out the other root canal treatment I have had and I don’t remember dying of shock at the cost.
Yes, my bills were a bit higher than under the NHS, but he was very good – confirmed since by other dentists. And he was able to offer solutions more pleasing to the eye, such as white fillings.
But you have to pay for it. The price of a private filling can be up to £200, compared with the £50.50 NHS ceiling. Similarly, a private crown could cost up to £1,100.
However, Which? found a high degree of satisfaction with exclusively private dentists, with only 7pc of those questioned complaining of poor value.
The highest level of dissatisfaction was levelled against those who “mix and match” private and NHS treatment. Here one in five expressed disappointment.
COMPARISON WEBSITES
Although it is difficult to shop around, some embryonic tools are emerging on the internet, such as toothpick.com, Compare My Smile, WhatClinic and Teethwise.
Eoin Holohan of Teethwise said: “We launched the service about a year ago after discovering that you could pay £5,000 for treatment with one dentist and £15,000 with another down the road. The range of charges is huge.”
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DENTAL INSURANCE
Some workers are covered for dental costs via an employee benefit arrangement, but it is also possible to buy medical insurance privately from organisations such as Bupa. These can provide either a contribution towards your NHS costs or more comprehensive cover.
Bupa’s premiums begin at £10 monthly for the NHS contract, rising to £28 monthly for a fully comprehensive policy covering private work.
Denplan is a payment scheme under which a dentist assesses what your costs are likely to be in the coming year and settles a monthly premium accordingly. It was unable to provide Telegraph Money with sample premiums.
OVERSEAS DENTISTS HERE AND ABROAD
You can cut your costs by anything between two-thirds and a half by using a clinic employing overseas dentists here or abroad.
For example, VitalEurope, which is currently treating around 500 patients a month in Britain, has a clinic in London, where patients attend an initial assessment. Depending on the work required and patients’ budgets, treatment can be carried out either in London or in Budapest.
Paula Szorfi from the company said: “Everyone who attends in London receives several treatment plans outlining various cost options depending on how much work is carried out in London and how much in Hungary.
“All our dentists in London are members of exactly the same professional bodies as English dentists, but Hungarian dentists don’t expect to be paid as much.”
An English patient who recently needed complex reconstruction with four implants and a number of new crowns was told to expect to pay £36,000 for this treatment in Britain. VitalEurope priced the work, carried out partly in London and partly in Budapest, at £12,000.
But you don’t need to go to Hungary. Dentists in Spain and even Germany can offer cheaper treatment than may be available in Britain for substantial work. They advertise on the internet, but you need to do your homework, and always check relevant qualifications and membership of professional bodies.
Indeed, Bupa, which has a new network of dental centres in Britain, has similar networks in Spain and elsewhere in Europe.
Ruth Chesmore, director of Bupa dental services, acknowledged that charging structures in these countries could be different from those at home, while maintaining Bupa’s high standards.
However, she said the quality of aftercare wasn’t as good, adding: “People want continuity of care with follow-ups and repeat appointments with the same dentist. You won’t get that if you go abroad.”
FREE OPTIONS
If you have a good dental school near you, they are often looking for guinea pigs to treat for free. As the work is normally well supervised, you could receive a bargain deal.
Otherwise, only children and pregnant women or those who have given birth in the previous 12 months receive treatment free under the NHS, as well as some people on certain benefits.
