Jeremy Laurance: How the search for free dental care became like pulling teeth

Queues of patients gathering at first light to register when a new NHS dentist opens are the starkest illustration of the crisis in dentistry. Scarborough, Portsmouth, Truro and Titchfield Common in Hampshire have all seen them.

Tony Blair's pledge at the Labour Party conference in 1999 that everyone would have access to an NHS dentist has turned to ashes. Latest figures from last year, showed that just 55.7 per cent of adults and 70.5 per cent of children had seen an NHS dentist in the previous 24 months, and two million who wanted to see one had failed to do so.

Some have become so desperate they pull their own teeth. A survey last October by the Commission for Public and Patient Involvement found that of 5,000 people questioned, three quarters said they had been forced to go private because they wanted to stay with their NHS dentist and he was switching or they could not find an NHS dentist.

One in 10 said they did not have a dentist and three respondents said they had performed DIY dentistry. A patient in Lancashire said he had removed 14 of his teeth and another in Wiltshire said he had "taken most of my teeth out in the shed with pliers".

The Government claims there are more dentists working in the NHS than ever before. But dentists are free to divide their time between NHS and private work, and they are doing much more of the latter. In 1990, they earned £1 in every £20 from private work. Now it accounts for more than half their income.

The increase in private work was accelerated in April 2006 with the introduction of a new contract. This swept away the old system of 400 separate payments and replaced it with three price bands in the interests of simplicity and transparency.

But the change, intended to end the "drill and fill" treatment philosophy, angered dentists who saw it as an attempt to curb their earnings. The British Dental Association says dentists remain opposed. "Access [to NHS treatment] has declined and morale among dentists has declined," said Peter Ward, the BDA's chief executive.

Tens of thousands of patients have sought dental treatment abroad, especially in eastern Europe, where prices are lowest. Mr Ward said: "The danger of doing this is that you need to ensure the treatment is safe and effective. We have high standards of infection control and high numbers of support staff in the UK, and dentists carry expensive medical indemnity insurance. So it is questionable whether patients will be better off in the end."