Falling numbers of NHS dentists are forcing many patients to go without treatment or even try pulling out their own teeth, a study found today.
Almost a fifth (19%) of those questioned in the biggest patient survey of its kind revealed that they had missed out on dental work they needed because of the cost.
The research, involving more than 5,000 patients in England, also found that as many as 6% had even resorted to treating themselves because they could not find a dentist.
Patients interviewed spoke of taking out their own teeth or fixing broken crowns with glue.
One person questioned in Lancashire spoke of carrying out 14 separate extractions with pliers.
Meanwhile, one of those conducting the research at a shopping centre in Liverpool met three separate people in one morning who had pulled out teeth themselves.
Almost three fifths (58%) of dentists themselves said new contracts brought in last year had made the quality of care worse and as many as 84% thought the changes had failed to make it easier for patients to get an appointment.
The stark findings came in research carried out by the members of England's Patient and Public Involvement (PPI) Forums - special feedback bodies covering every NHS trust in the country.
A total of 78% of patients from private practices polled said they were there either because their dentist had stopped taking NHS patients or that they could not find an NHS clinic, with only 15% saying it was for better treatment.
Of those who said they were not registered with a dentist at all, 29% said they had left their previous one when they went private.
Two out of five (42%) of all patients revealed they had no idea how to get emergency dental treatment out of office hours, and more than half (54%) did not understand how charges worked.
Some of the starkest findings in the study were the views of dentists themselves.
Almost half (45%) said their surgery was no longer taking NHS patients with 42% spending less than 75% of their time on them.
Four out of 10 (41%) felt they had an "excessive" workload with 29% saying their clinic had problems recruiting or retaining dentists.
Sharon Grant, chair of the Commission for Patient and Public Involvement in Health, which set up the forums, said: "These findings indicate that the NHS dental system is letting many patients down very badly.
"It appears many are being forced to go private because they don't want to lose their current trusted and respected dentist or because they just can't find a local NHS dentist.
"Where NHS dental services are available, people are happy with the quality of treatment provided but many find the NHS fee system confusing and expensive, with some patients taking out loans to pay for treatment or more worryingly taking matters into their own hands.
"This is an uncomfortable read for all of us, and poses serious questions to politicians from patients.
"There are real policy issues here that have been fudged for too long.
"Is NHS dentistry just for those who can't afford anything else - or can it revert to a universal, affordable, service to which people have entitlement as citizens and taxpayers?
"At the moment there is a massive gap between what's on the NHS dentistry tin and what's in it."
* A total of 5,212 patients were interviewed as part of the Dentistry Watch survey carried out by the PPI Forums as well as 750 dentists.Reuse content