Frightened of NHS dentists? At £40 a filling, you will be

Subsidised treatment is hard to find and prices are rising. Sam Dunn looks at ways to grin and bear the pain of going private

Your trip to the dentist is about to get more painful. A shake-up intended to reverse the decaying number of NHS dentists is likely to lead to a doubling of charges for basic treatment such as check-ups, to £12, and fillings, to £40.

Your trip to the dentist is about to get more painful. A shake-up intended to reverse the decaying number of NHS dentists is likely to lead to a doubling of charges for basic treatment such as check-ups, to £12, and fillings, to £40.

Over the next 12 months, a pricing overhaul will do away with 400 separate treatment charges and replace them with tiered fees. Dentists will be paid per patient instead of per treatment, putting a price cap on the costlier procedures.

However, uncertainty about what the changes will mean in the long term, and the fear that they will lead to lower income, could cause many of the remaining NHS dentists to go private. Still more people would then have to pay for treatment.

The changes are part of a desperate Government attempt to make dental treatment more widely available on the NHS. In 1994, 25 million people in Britain were registered with an NHS dentist; today, that figure has fallen to barely 18 million - less than half the adult population.

Searching for an NHS dentist in your area is often a futile exercise, with the shortage of practices leading to long waiting lists. Some 800 new dentists graduate each year - not enough, admits the British Dental Associ- ation. There are plans to establish another 170 places at dental schools from next October. In the meantime, dentists are being recruited from India and Poland.

Against this background, consumers are left gnashing their teeth. "People avoid going to the dentist because of the cost, and also the difficulty of getting on to an NHS list," says John Cox of the consumer body Which?.

"When the pain is then really bad [and requires more treatment than if they had seen a dentist sooner], they have to go private, where it's expensive."

New guidelines recently proposed an end to the six-month dental check-up in favour of a "needs-must" approach. But for those on low incomes with poor teeth and who can't find an NHS dentist, the cost of any kind of private treatment could be prohibitive. Even a simple check-up, descale and polish can come to as much as £50.

One way to cut down on dental bills is to take out a "capitation" repayment plan. For a fixed monthly sum, your teeth will be covered for any routine and emergency dental procedures - regardless of how much treatment you have. The cost will depend on the state of your teeth. When you sign up, a dentist gives your mouth an oral MOT; you will then be charged according to a price-banding system.

Denplan operates the UK's biggest such scheme, with more than 6,000 member dentists offering their services to around 1.3 million patients. It has five price bands, charging an average of £15 a month. This covers check-ups, X-rays and restorative work, including root canal treatment. Emergency cover is also included.

But Denplan's customers will benefit most if they require major restorative treatment: charges for a new bridge, for example, can start at around £600. However, in such cases, you'll still be expected to pay the laboratory fee, which can be as much as £80. Watch out, too, for exclusions; cosmetic dentistry, such as teeth whitening, isn't covered.

Schemes like Denplan help dentists to spot problems early on and take preventive action. If you move to a different area, you will have to undergo another oral health assessment with your new Denplan dentist. Your monthly charge may also increase if dental costs are higher than in your previous area - for example, in a large city.

An alternative to capitation schemes is dental insurance. You can use this to help pay for NHS treatment - if you're lucky and can find it - as well as private dental care, and premiums won't depend on the condition of your teeth. You pay the bill up front and claim the charges back on your policy.

There are limits, though, to the level of reimbursement you can expect to receive. Specialist insurer WPA Providental charges a flat rate of £11.84 a month for 18- to 49-year-olds and provides up to 75 per cent of the cost of routine treatment to a maximum of £250 a year.

You qualify for up to £1,000 a year for emergency treatment, and as much as £20,000 to cover serious dental injury, for example a blow to the face.

Remember that you'll still have to pay for a quarter of the cost of any treatment, up to a maximum of £500 per claim. You'll also have to wait for three months after taking out a policy before you can claim on it. (In the case of accidents, this is reduced to two weeks.)

Cash plans from providers such as healthcare mutual HSA can also help cover treatment costs; these start from as little as £1.35 a week.

If you can't find an NHS dentist and have to go private - even if you are taking out insurance to help pay for this - always ask to see price lists and compare charges between practices before signing up.

BRUSHED OFF

You can ask to be registered at any NHS dental practice - but expect long waiting lists.

Alternatively, you can search for an NHS dentist on the internet. Try www.nhs.uk or www.dpb.nhs.uk/patient/patient.shtml.

Even if you do get treated on the NHS, you'll still pay 80 per cent of the cost of any procedure, though treatment is free for the under-16s, full-time students under 19, mums-to-be and mothers with children under one year.