Teething troubles

IT began with some chewing gum, a pleasantly creaky feeling in a lower left molar - and a filling popping out. I was going on holiday at the weekend. No problem. I went to the emergency surgery at my local NHS dentist, was given a temporary filling, and left well satisfied. Four weeks seemed a long wait for the temporary filling to be replaced with a permanent one - but there was no emergency so I wasn't worried.

The four-week appointment turned out to be for assessment only. Another appointment was scheduled for three weeks later. But again, no pain so I didn't complain.

The filling itself was painless enough. After the numbness wore off that evening, the tooth ached a little. But it was just taking a while to settle down, I thought.

Next morning, a Saturday, it was worse. My jaw felt warm, and I began to develop an ache in my cheekbone and the side of my face. My wife - who trained as a 'barefoot doctor' in China - put me on antibiotics. But the following day, Sunday, it was worse still: a grinding, throbbing ache, together with a headache and an infection from my throat to my cheek.

I wrapped myself up to keep warm and waited grimly for the next day so I could get it seen to.

Emergency surgery on Monday began at 1.45pm. I turned up ten minutes early having been warned there could be a queue. It was cold, and raining. A man was standing outside the locked surgery door. I fell in behind. By the time the doors opened ten minutes later there were five people - most, presumably, with toothache - standing in the rain. I thought we might be allowed in the waiting room, one man protested mildly.

Inside, I waited for an hour, then was called through. It wasn't my regular dentist, but what did I care?

He probed gently. "Is that tender?"

"Yes!"

There were two possibilities, he said: either it was taking a while to settle down, or else the nerve was dying. In that case I'd either need to have the tooth out or a root canal filling. Either way he couldn't do anything now. I'd have to make an appointment.

I seethed: it had been difficult working that morning because of the pain. I didn't know how much longer I could wait. I stood glowering while the receptionist ran through her appointments book with her pen. It stopped on a Thursday. Not too bad, I thought. Three days.

"November 7 is the earliest I can do," she said. It was a Thursday, all right: but two and a half weeks off.

"You've got to be kidding!"

She wasn't. No earlier appointments, she said. My pleas and demands, my requests to see a different dentist, met with an averted face and a gesture at the appointments book. All she could do was take my number in case of a cancellation.

I left, simmering with rage. Back at the office I rang one of the practice's senior dental surgeons - not my own dentist - and said I was writing an article. I'd never had any complaints before, I said - but was it really acceptable that someone with a raging toothache should have to wait two and a half weeks to see a dentist?

He was contrite, even apologetic. The problem was, simply finding time, he said. And if the appointments book was full...

If I was in real pain, he added, I wouldn't have to wait until November 7. The best thing would be to wait a couple of days to see if the antibiotics worked. "If they are not taking effect then, you come back to one of the emergency sessions. Then we would have a look and see what else could be done."

He sounded sincere, concerned, and overworked. The surgery has since rung to say there has been a cancellation and I can now be seen on November 1. It's an improvement - and, after completing my course of antibiotics, the tooth is anyway much better.

I don't feel angry any more - at least, not with my own dentists. They are doing their best. But should you really be expected to wait two and a half weeks in pain to see a dentist on the NHS? I don't think so.

NHS 'turned its back' on dentistry...

IF YOU were expecting the same standard of dental treatment on the NHS you would get by going private, think again.

John Renshaw, the Scarborough dentist who is now national chairman of the British Dental Association (BDA), says the NHS has "turned its back on his profession".

"Dentistry is not a cheap service - and the Government won't pay for it," he says.

"You might get a basic course of treatment on the NHS. But you certainly won't be getting a comprehensive one."

The evidence is there. The money an NHS dentist receives for a check-up has increased by £1 in the last ten years, to £6.65 - and 80 per cent of that is paid by the patient. The fee for a filling can range from as little as £6.50 up to about £18, depending on what needs doing. It is no longer enough, Mr Renshaw says, and inevitably NHS dentists are having to cut corners.

He's not alone in saying that. "People should expect the same standard of care on the NHS," says one well-known York dentist, who has not taken any new NHS patients for several years.

"But they don't get it. If a dentist needs to spend one hour on a treatment and gets paid £10, it is unlikely he will spend one hour on the treatment.

"He will spend time commensurate with £10.

"If you look at an NHS dentist and say am I getting the best treatment, he will not look you in the eye. Because you are not.

"He is making short cuts, using cheap materials, not doing things in the way he was trained."

Now dentists, fed up of providing sub-standard treatment, are leaving the NHS in droves. Six years ago, says Mr Renshaw, just ten per cent of dental interventions were private. Now it is 40 per cent and growing. He himself will no longer take new NHS patients.

It has led to well-documented problems finding an NHS dentist, since many other dentists will also no longer register new NHS patients. In York the situation is not too bad - a practice in Haxby expanded recently, for example, and should be able to take on 1,200 new NHS patients in the next year - but in places such as Malton and Scarborough, Mr Renshaw says, you won't find a dentist willing to take you on the NHS.

Inevitably, that means longer waiting times for treatment at dentists that still do NHS work. But what about the quality of treatment?

The Department of Health insists it has "not received any evidence of patients receiving sub-standard treatment on the NHS". Hambleton and Richmond Primary Care Trust - the leading trust on dentistry for North Yorkshire - adds it "would not expect the quality of care on the NHS to be any different from that available privately".

The man the trust puts up for interview, however - Richard Emms, secretary of the North Yorkshire Dental Committee - admits you won't get the same standard of care on the NHS as privately. The treatment will be of a "clinically acceptable standard". But there is not the same range of options and materials, you will wait longer and many NHS dentists are so rushed they will not have time to explain options to their patients properly.

The BDA is pressing for changes to the way NHS dentists are paid. The Department of Health insists it is working with the BDA to reform the system.

In the meantime, if you are struggling to find an NHS dentist, or are fed up with second class treatment, what can you do?

There is an alternative: go private. It need not necessarily cost the earth, says John Renshaw, especially if you take out an insurance plan to cover the cost. And anyway, adds the York dentist who spoke on condition of anonymity, if we are honest with ourselves, most of us can afford to pay.

It is a question of attitude. Many of those who grumble about dental charges, he points out, spend a fortune on cigarettes, alcohol or foreign holidays.

For those who believe passionately in the NHS, it seems desperately sad to abandon it. But if it means you won't have to wait two and a half weeks for a toothache to be dealt with, it may be worth thinking about. Toothache isn't much fun.

Here's the drill...

- To find an NHS dentist, call NHS Direct on 0845 426427.

- If you have a concern about the quality of your NHS dental care, call the Selby and York Primary Care Trust's Patient Advice and Liaison Service on 0800 587 0856.

- If you do decide to go private, a dental health plan may help ease the cost. Denplan (0800 328 3223) offers cover in five 'bands', depending on the state of your dental health. The exact cost will be decided by your own dentist, but average rates in the York area last year were £8.74 a month for those in Band A (good dental health) to £26.05 a month for those in band E (poor dental health). Nationally, the average monthly payment was £14.45.

- Western Provident Association (WPA) also offer a plan. The standard rate of £10.99 will pay for routine dental treatment of up to £250 a year, though you pay one quarter of the cost of dental work. The plan also covers you for two courses of emergency treatment costing up to £500 a time in any one year. Call WPA on 0800 783 3783.

- Some dental practices offer their own payment schemes. Ask your dentist to find out more.

Updated: 09:37 Monday, October 28, 2002