Routine dental visits are now as rare as going to church – David Behrens

I don’t know if you’re familiar with the WC Fields film in which he plays a California dentist who pulls a shotgun on his patients, but as I reclined in the chair the other day, my head clamped in the grip of a hygienist’s hands, it seemed as though the art of tooth extraction had advanced not one whit in the intervening 88 years.
A dentist at work using personal protection equipmentA dentist at work using personal protection equipment
A dentist at work using personal protection equipment

As an implement that looked as if it belonged in the hardware department at B&Q made its way towards my mouth, and as the dentist wrenched and heaved at the offending molar like someone in a tug o’ war, I found it hard to understand why anyone should have chosen to have to do this for a living. But who am I to question their vocation? Dentists probably feel the same way about journalists.

When the oral roadworks were complete, I was instructed to rinse with a salt water solution for the next few days, and it was at this point that I realised the extent to which the years have turned me middle-class. Should I pop into Sainsbury’s on the way home for a tub of sea salt, I wondered, or would the regular stuff do?

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Bradford South MP Judith CumminsBradford South MP Judith Cummins
Bradford South MP Judith Cummins

I was lucky to have been able to see a dentist in the first place. A report published while I was still nursing the bruises revealed that every month, thousands of people are pitching up at overstretched A&E units with toothache, rotten gums and other dental maladies that might have been prevented by routine treatment.

But regular trips to the dentist are becoming as rare in Britain as going to church. Partly it is because of the rocketing fees for NHS dentistry and partly because it’s so hard to get an appointment unless you go private. This, by the way, was the case long before coronavirus halted treatment.

It is now extremely rare to be able to find an NHS dentist with an open register. In my case, it was possible to get on the books of a good practice close to where I live, only after being on a waiting list for five years. That’s like turning up for treatment today and being told to take a seat; the dentist will see you in 2025.

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In other parts of the region, that’s painfully close to the truth. In the Commons on Wednesday, the Bradford South MP Judith Cummins reported that a constituent living with gum disease and toothache had been trying since June to get to get a single appointment. Yorkshire had struggled for so many years with the crisis in NHS dentistry that there was now a North-South divide in oral health, she suggested. A child in Yorkshire was five times more likely to be taken to hospital for a tooth extraction, and in Bradford, more than two-thirds of children have tooth decay, compared to just one in 14 in more prosperous areas.

Worse still, a second report this week revealed that because check-ups had become so infrequent, cases of mouth cancer were often going undetected until it was too late. Cases have nearly doubled since 1999 when Tony Blair famously promised that everyone would have access to an NHS dentist within two years. Across Yorkshire, some 1,800 people were taken to hospital with mouth cancer in 2018 and in Barnsley, the figure was up by 133 per cent on the previous year.

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What has happened since Mr Blair’s ill-considered pledge to the Labour conference – for which he apologised years later – is a wholesale change to the way dentists are paid for their time. A regime of hard-to-hit targets means they earn no more for administering a whole course of NHS treatment than for a single filling. If they fail to hit their targets, as many do, a mechanism known as “clawback” is brought into play. This works exactly the way it sounds: it’s basically the fiscal equivalent of the blunt instrument they used to yank my tooth out.

The system was condemned as unfit for purpose by a health select committee as long ago as 2008, since when hospitals, rather than dentists, have become the go-to destinations for extractions.

The cost of mine was £62, which seemed fair to me, but might not do for someone struggling to pay the grocery bills. So for many, the choice now is between chancing your luck with the queues at A&E or paying for private care at rates so high that you’d expect a three-piece suite to be put in where the tooth used to be.

That is very much the case in the US, where an average check-up costs about £220 and where the surgeries probably still have shotgun cabinets. But at least you can get an appointment.

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