When that tell-tale throb in the gums signals a trip to the dentist, many people are not just in fear of the pain of the drill, they are also anticipating some financial discomfort.
A recent Citizens' Advice report showed that more than seven million people in England and Wales have been unable to get an NHS appointment in the past 20 months, leading two thirds of these individuals to opt for private treatment, while another third decided to simply suffer and do without treatment of any kind.
It is estimated that around one million people have lost their NHS dentist since new contracts for dentists were introduced in April last year. These agreements demanded changes in working practices that many dentists were unhappy about, causing about 2,100 to refuse to sign the new contracts and subsequently opt out of offering treatment on the NHS.
The 400 treatments available on the NHS each used to come with a different fee, but there are now three standard charges, though these charges are set at different levels and there are different frameworks for England, Wales, Scotland and Northern Ireland.
In England, band-one procedures cost £15.90 and include examinations, a scale and polish, and X-rays. At £43.60, band-two charges cover basic treatment such as fillings, root-canal work and extraction, while band three, at a price of £194, includes more complex procedures such as crowns, dentures or bridges.
There are a number of categories of people entitled to free NHS treatment, such as those under 18 (or aged 18 and in full-time education), and those in receipt of, or who have partners in receipt of, income support, income-based jobseeker's allowance, or pension credit. Mums-to-be or those who have given birth within the last 12 months should note that they, too, can get free treatment.
If you want to try to find an NHS dentist currently taking on patients, go to the NHS Choices website ( www.nhs.uk) and carry out an online postcode search for your nearest practitioner. The site will generate a list of dentists and a number to call if you are having problems finding an appropriate dentist.
If you have no choice but to pay for private treatment, you can expect bills of hundreds if not thousands for more complicated works.
For example, as a new patient, an examination including X-rays might cost around £50, one white filling up to around £110, and root-canal work on a molar around £350.
There are, however, a variety of schemes available to help in covering the cost of dental treatment, available from certain dental practices, health plan companies and insurers.
Maintenance plans are available from some dentists and these cover routine work as well as some emergency work. They cost around £12 a month.
Unlike some cost plans, being accepted on to a maintenance scheme usually does not entail an initial examination, but the attendant downside is that these plans do only cover the cost of the basics.
So-called "capitation" plans are also available directly from certain dentists. Once an assessment has been made of your oral health, the dentist will set an appropriate monthly premium that covers the cost of routine care and hygiene visits. The downside is that lab work, such as some of the procedures involved if you need a bridge or crown fixing, will not be covered.
If your teeth and gums are deemed to be in good shape, you should pay no more than £10 a month for these sort of plans, but for those with poor oral hygiene, premiums could be three times as much.
Another option worth investigating is whether your dentist might be able to arrange an interest-free loan, though this might only be up to the value of around £200, where available.
Alternatively, you could take out a dental plan – a payment scheme designed to help towards the cost of either NHS or private treatment for your teeth. HSA's dental plans, for example, offer a choice of three premium levels on schemes, with prices starting at £7 a month per adult and £1 for children. For a monthly £12 fee, you can claim up to £50 for maintenance work, such as a check-up or scaling; £500 for treatment such as fillings and so on, and up to £750 for emergencies.
A further advantage of dental plans is that they tend to build in an emphasis on preventative care by encouraging regular check-ups. Many providers, such as Denplan ( www.denplan.co.uk) also offer family group discounts of around 15 per cent. Do bear in mind that most dental plans are likely to carry a three-month qualifying period for treatment and there may also be limits on the value of claims as well as the number of times a year you can claim. Also, most policies will not cover cosmetic dentistry, treatment for injuries sustained in hazardous sports or any pre-existing chronic conditions.
Most general-health cash plans also include cover for dental treatment, allowing you to claim back some of your costs following treatment. There will be a maximum that you can claim back per year, but most health plans are flexible with what kind of dental treatment is included, so you may be able to receive a contribution towards certain cosmetic treatments. Beware, though, that if you opt for traditional "dental insurance", you will typically only be covered for treatment needed following an accident or emergency, and this is usually sold as an add-on to an existing insurance policy.
Typically, there is no need to go for an oral assessment, but you must have visited a dentist at least once within the past 18 months.
Remember, you can mix NHS and private treatment, assuming you can find an NHS dentist to treat you. You can have everything you may need to keep your mouth healthy under the NHS, but you may want to have a treatment which is not necessary to your dental health, such as cosmetic treatment, done privately. Many dentists run private and NHS practices side by side, so ask them about the best options for you. Also remember that dentists operate differently from doctors and therefore do not have specific catchment areas. Treatments can be cheaper in certain areas of the country, so you might save money by becoming a domestic dental tourist.
Always ask for a full-breakdown of costs and insist on an estimate before agreeing to work. If the estimate seems inflated, seek a second opinion. A further examination might set you back up to £50, but it might save you cash in the long run. The British Dental Health Foundation advises patients to ask among their family and friends to help source a good private dentist and one which matches your pocket. Look into the plans available to help with private treatment including dental plans and maintenance schemes.
Dental care abroad
Travelling abroad for dental treatment to countries in Europe such as Poland, the Czech Republic and Hungary or even further afield to Mexico and Thailand is another way of saving money while getting in a break from home.
For example, dental and medical tourism search engine www.revahealth.com says a veneer in the UK costs on average £500, whereas in Thailand it might only cost around £150. And while a dental implant in the UK will set you back £2,000 on average, the same treatment in Thailand costs around £900.
The savings are tempting and standards of treatment can be high, but patients should proceed with care when shopping around for treatment overseas.
Last year oral health charity the British Dental Health Foundation issued a warning against those travelling abroad for dental treatment following a spate of calls to its dental helpline from people who had encountered problems.The Foundation said it had been dealing with a number of calls from patients who returned home from dental holidays in severe pain and needed further treatment to correct poor quality dental work, some at an additional cost of several thousand pounds.
BDHF's chief executive Dr Nigel Carter says: "The question you need to ask yourself is what will you do when something goes wrong? Are you willing to fly back? What are your legal rights as a foreign patient? Are you prepared to go through the courts? Do you have the money required to correct the treatment in this country?"
Of course, standards between different countries and individual dentists are hugely variable. Danish website www.askmytooth.com helps users from across Europe to find cheaper dentists in other countries across the continent, including Spain and Turkey.
Website owner Asger Frydkjaer says before a dentist is featured on the Ouchmytooth site, they will have been vetted: "On a recent trip I visited 20 dentists and only accepted two for the website. We look at how the dentist treats patients, especially those who are anxious. We also check out the hygiene of these places and do random checks on the dentists once they are on the site."
The BDHF dental helpline offers free, impartial dental advice to consumers on 0845 063 1188 between 9am and 5pm, Monday to Friday or by e–mailing firstname.lastname@example.org.