A gaping hole that needs filling

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The Independent Online

How did they know when to turn up? Some of the hundreds of people who queued outside a new NHS dental practice in Scarborough last week had been there since just before dawn, patiently waiting for the doors to open. John Renshaw, chairman of the British Dental Association and a Scarborough dentist, said there had not been scenes like it since before the Second World War. 'It makes us look like a third world town', he complained. Actually, judging by photographs, it was more like a bread queue in the former Eastern bloc, and might come as a shock to potential migrants who are thinking of coming to Britain.

The state of dentistry in this country is nothing short of a scandal. In effect, it has been privatised by stealth so that in some areas - not just on the Yorkshire coast, where up to 17,000 people have been unable to register - it is impossible to get treatment on the NHS. Even when a surgery opens, it soon becomes over subscribed and the dentist may decide not to offer the full range of treatment. Hard-up friends of mine have tried all sorts of wheezes to get round this problem, including presenting themselves for emergency treatment at dental hospitals. At least one had her mouth wrecked by a careless NHS dentist and went off to have the damage repaired in Latin America; in this respect echoing John Renshaw's remark about some British towns resembling a third world country.

Another, told by an NHS dentist that she needed to have a tooth removed, sought a second opinion from a private practitioner and discovered there was an alternative treatment, which was in theory available on the NHS. Finding someoneprepared to carry it out was another matter, as she found out when no NHS dentist in her area was prepared to see her.

Yet going private, which is what almost everyone I know has done these days, presents its own problems. When you are lying back in a chair with your mouth open, you are not best placed to argue when a dentist announces that you need hundreds of pounds' worth of treatment. Few people in this country have dental insurance, which means that most of us pay out of our own pockets and there is little outside scrutiny of bills. This is fine if you trust your dentist, but in recent years they have become the middle-class equivalent of plumbers, widely suspected of carrying out unnecessary work and over-charging.

My dentist is brilliant - and private, inevitably. He is the only one who has ever taken seriously my irrational terror of any form of dental surgery, the legacy of brutal treatment by an NHS dentist in childhood. His solution is not sedation but a pair of video glasses, which allows me to watch films while he does whatever he needs to in my mouth and just about makes the experience tolerable. ('What did you think?' he asked after I had watched a couple of episodes of The Young Ones as he worked on a tricky filling. When I admitted I hadn't enjoyed them much, he remarked: 'Pity. Rik's coming in later.') A couple of years ago, he offered two solutions to a minor but recurrent problem on the left side of my mouth: two crowns, at a cost of £900, or more vigorous flossing. I chose the latter.

People on low incomes have no choice, which is why so many people queued for hours in Scarborough. Some have to do without dental treatment altogether - one woman, the mother of an 11-month-old baby, said she had been without a dentist for five years - or they have to scrape together the money for private treatment, without knowing whether the expense is justified.

Everyone knows that this is the situation yet after almost seven years in power, the government has neither tackled the problem nor come clean about the fact that it seems to have given up on providing NHS dentistry for everyone who needs it. Presumably ministers would prefer us - those of us who can afford it - to take out dental insurance, and leave NHS dentistry for people on state pensions and income support. At the moment we have the worst of all worlds, a two-tier system that is failing the poor and leaves the rest of us anxiously swapping names and addresses of private dentists, in terror of being ripped off.

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