Why the tooth hurts for the NHS

The NHS may be approaching its 60th anniversary but there are few celebratory smiles among its dental patients as frustration grows over rising costs and longer waiting times, with many choosing to turn their backs on the service altogether.

According to insurer HSA’s annual dental survey of 2008, one in five UK adults put off visiting the dentist due to concern about the cost and the Citizens’ Advice Bureau estimates that seven million people have been unable to get an appointment with an NHS dentist in the past two years alone.

It’s even getting tougher for children to get the treatment they need. Though NHS dental care should be free until the age of 18, figures released from the NHS Information Centre for Health and Social Care last month revealed that the number of children visiting an NHS dentist in 2007 slumped by 100,000. This means that one in three children now get no NHS dental care at all.

What has caused the fall in standards?
In April 2006, the Government reformed the dental care system with the aim of giving more patients the chance to register for NHS treatment. However, the changes, which saw the introduction of new dental contracts, seem to have had the opposite effect.

Many dentists have complained that they are not paid properly for the amount of work they receive and due to the demand from patients others claim they cannot provide an adequate service. The result is that around 2,000 dentists – 10% of the total – now offer private treatment only.

Before the new dental contracts were introduced, the average cost of a basic NHS check-up was £5.54, the price of a filling was £10 and a gold crown cost about £95.

However, the changes implemented in 2006 mean there are now a series of bands with a maximum charge of £194. Treatments in band one, including routine examinations and X-rays cost £15.90, band two exercises including fillings and extractions cost £43.60, while band three work including crowns and veneers can cost up to £194. With dentists now earning more for easier procedures there has been some speculation that the amount of complex work has dropped as a result.

So what can you do to get the treatment you need?
While NHS costs have risen, private treatment has become less expensive as the sector becomes more competitive with growing competition. It is estimated that the cost of a crown for example, is £200 – that’s only £6 more than the NHS flat rate and down from the £258 it cost around two years ago. According to a consumer survey, the average price of UK private dental care treatment has fallen from £391 to £327 since 2005.

As a result more people are turning to private care but with costs still high they are relying on insurers and other financial institutions for help.

There are several options to choose from. First there are cash plans, the cheapest option with cover starting at around £2 a week. These provide money back on NHS or private dental care treatment. However, annual payouts can be limited – usually in the region of £100 a year.

Capitation plans rely on assessments from a dentist to determine a monthly sum for insurance cover. The downside to these schemes is that if you do require dental treatment when your assessment takes place you will usually have to get it before you join the scheme.

For many therefore, the best option is dental insurance. With dental insurance there’s no need for a pre-evaluation of your dental condition and with a good policy you should get immediate cover for check-ups and emergencies at any UK dentist.

The price of dental insurance will be dependent on the type and level of cover you choose. The cheapest options will usually only cover basic NHS treatment such as check-ups, crowns, fillings and accidental injuries. You should check the small print of a dental insurance policy too as many will have an upper limit that you cannot exceed. If you’re willing to pay more, then you could be covered for treatment as a private patient and the upper limits should be set a lot higher.

However, as with medical insurance, pre-existing conditions will not be covered, regardless of the level of cover. You should always read the small print of insurance policies and make sure you know exactly what you are and aren’t covered for.

What are the leading deals for dental insurance?
As with any insurance product, there’s no one policy that is right for everyone – which is why you’re best to compare insurance deals based on your circumstances using a dental insurance comparison website.

Dencover has an exclusive deal through Moneysupermarket offering customers single cover at £12.99 a month, meaning an overall premium of £155.88 a year. What is striking about the Dencover deal is that it actively encourages patients to take care of their teeth and get regular check-ups. You can claim up to £102 of the costs of visiting a dentist and hygienist twice a year for check-ups – meaning that you are effectively only paying £53.88 a year, that’s only £1.04 a week, to cover yourself for all other oral health treatments, accidents and emergencies.

There are other good deals out there too. For example, HSA will cover all resident children below the age of 18 for just an additional £1 a month on top of your premium. Tesco dental insurance is also offering up to £2,000 worth of cover a year for private medical treatment with a free Oral B electric toothbrush if you apply before May 9 2008.

The key to dental insurance is that it increases your choices while helping you manage costs, meaning those trips to the dentist no longer have to cause your wallet so much pain. And remember, as with all insurance you need to compare the level of cover as well as the price. You may decide it is worth paying a little more each month to have extra peace of mind.

Have your say: Are you struggling to find an NHS dentist in your area? Have you considered dental cover, or do you have insurance and feel you can offer advice to those thinking about taking it out? Visit our community forum and share your experiences with other members.

Disclaimer: Please note that any rates or deals mentioned in this article were available at the time of writing.

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