Stephen Dorrell, the Secretary of State for Health, is preparing legislation which would bring far-reaching changes to the work of Britain's 17,000 dentists.
The Bill, which could be in the next Queen's Speech, would give local health authorities powers to "buy" health care from dentists for NHS patients for the first time.
The main aim is to allow health authorities to tackle evidence of worsening dental health, particularly for children in some areas, by setting local targets.
It would end the system of "demand-led" care under which dentists respond to patient demand and are then paid a fee for their services. The new system is likely to be coupled with tighter controls on the cost of items which can be provided on the NHS, ruling out more expensive courses of treatment or some types of dentures. There could also be clearly defined catchment areas in which patients would have to live.
Mr Dorrell plans a series of pilot schemes in seven or eight towns.
However, the move could mean that some patients whose dentists withdrew from providing care on the NHS could have their care restored. Local authorites would purchase the care directly from the dentists. Ministers believe this will help them to defend their record on the health service more effectively at the general election.
The collapse of NHS dental care in many areas came after the Government cut fees for dentists by 7 per cent in 1990. The cut provoked an exodus as dentists moved to the pivate sector because they felt it was not worth working for the NHS.
In some areas, particularly the Home Counties, many practices ceased offering NHS care. In Berkshire, for example, dentist earnings from the NHS have dropped by 30 per cent since 1990.
That has led to accusations of a two-tier dental service, in which some poorer families may have to go without regular check-ups.
Dentists who remained on the NHS lists are concentrated in poorer areas. In Gateshead, South Tyneside, the fees paid to dentists on the NHS have gone up 130 per cent since 1990.
Areas such as the North-east, where dentists have stayed with the NHS, may see their budgets held down under the change from demand-led care to purchasing by health authorities.
One dentists' leader said: "They cannot pay for the whole of the health care. At some stage, some government is going to have the courage to say we cannot do everything.
"One of the things suggested by the Commons select committee on health was that there should be a basic level of service but you have to pay for bits on top of that."
Ministers are still drawing up the Government's list of legislation for the Queen's Speech. They are looking for a package to show the Government has not run out of ideas in the approach to a general election.
A spokesman for the Association of British Dentists said: "We are waiting to hear what the Government says, but we have a problem over how you relate it to the demand-led process."Reuse content