Open your wallet wide

Dentistry is in a scandalous state, with patients in danger of being overcharged for poor treatment that may not even be needed. Jeremy Laurance offers some tips for the dentally challenged

With NHS dentistry in the doldrums and private dentists charging extortionate prices, is there anything a dentally-challenged patient can do? Shop around is the usual advice from consumer organisations. But this is not so easily done. What should you look for? Even something as obvious as a price list can be hard to find. It helps if the dentist is kind, reassuring and has a good chair-side manner. But it is the quality of the treatment that counts – and there is no guarantee of that.

With NHS dentistry in the doldrums and private dentists charging extortionate prices, is there anything a dentally-challenged patient can do? Shop around is the usual advice from consumer organisations. But this is not so easily done. What should you look for? Even something as obvious as a price list can be hard to find. It helps if the dentist is kind, reassuring and has a good chair-side manner. But it is the quality of the treatment that counts – and there is no guarantee of that.

I went to the dentist to have a filling replaced. The first one I tried told me I would need a root treatment as the nerve was exposed. The cost, privately, would be £200 plus a further £90 for the filling. He didn't do NHS work. Also, two of my other fillings were cracked and ought to be replaced, he told me. I did not stop to discuss the cost of those. I was trying to organise a holiday in Turkey at the time, and the cost of the flight was, coincidentally, £290. Which, I wondered, would benefit my health more – the filling or the flight?

A week earlier I had visited a dentist near my home who offers NHS and private treatment. He advised me, after a cursory check-up, that I needed to have three crowns replaced. I could have them done on the NHS, he said, "but if you want them to last you really have to go private". Downstairs at the reception desk I asked for a price list. There wasn't one. But the receptionist, consulting a dog-eared sheet in front of her, said the cost of a crown would be £87 on the NHS or between £400 and £450 privately.

What, I wondered, could account for that five-fold difference – and what would be the difference in the end result? I had no means of knowing whether I needed the three crowns, just as I had no means of knowing whether I had two cracked fillings. And did I dare risk NHS treatment?

Last week I consulted a third dentist, who also offers NHS and private treatment. After X-rays and a meticulous inspection she spent five minutes discussing the state of my teeth with me, pointing things out on the X-rays, and then she printed out a treatment plan. Having established that I wished to remain an NHS patient, the print-out quoted the NHS prices. The missing filling that the first private dentist told me would cost £290 to replace was listed at a cost of £10.64.

The erosion of NHS dentistry over the last 20 years is an invisible scandal. It attracts no protests and no comment, and barely breaches the consciousness of most politicians. Dentists lack the glamour of doctors. They do not save lives or heal the sick. The privatisation of dentistry has happened by stealth, helped along by governments who introduced charges for NHS treatment (now amounting to 80 per cent of the cost).

In recent years private dentistry has been growing fast, increasing by 60 per cent between 1997 and 2001. Spending is now more than £1bn a year. Money that we previously spent on other things – books, records, holidays – we now spend on looking after our teeth. Unlike with books, records and holidays, however, it is very difficult to know what you are getting from a dentist.

The recent Office of Fair Trading investigation into private dentistry found that dentists were imposing inflated charges without justification. Ten million adults received at least some private dental treatment, paying prices that show wide variations, ranging from £9.50 to £40 for an examination, from £10 to £54.25 for a simple filling, and from £85 to £327.85 for a molar tooth root filling.

Although price differences may reflect differences in quality, the report said: "It is far from obvious that this is true for such wide ranges. Moreover, the lack of price information could result in consumers... paying far more for their dental treatment from one dentist than they would from another without any justifiable difference in the quality of service received."

Charges for NHS treatment, which apply nationally, are below the lowest private prices at £5.32 for an examination, £5.62 for a simple filling and £56.88 for a molar root filling. These represent 80 per cent of the NHS cost, with the Government paying the remaining 20 per cent.

Almost all the 11,000 dental practices in the UK do both NHS and private work, but many dentists provide only a limited range of NHS treatments. That is in breach of their terms of service. One dental practice cited by the OFT advertised NHS services but only offered check-ups on the NHS and not treatment. The report said that higher earnings from private work "means that dentists may have an incentive to encourage patients to have private treatment even where there is an acceptable alternative".

It is extremely difficult to resist the conclusion, when you are lying in the dentist's chair being told that there are two options for treatment, NHS or private, the latter costing five times as much as the former, that you are putting your teeth at risk by choosing to stick with the NHS.

The General Dental Council says in its guidance that patients should be told what treatment is proposed and what it costs, and should be given an itemised bill at the end. (A survey carried out for the OFT showed that less than half of dentists complied with this.) What patients want to know, however, is whether they are getting the treatment they need – no more, no less – at an appropriate price and of a quality that is assured. On none of those points can the council offer any guarantees.

In the Complete Family Guide to Dental Health (Thorsons, £6.99), Anne Sherman (my former NHS dentist, as it happens, who practised in Hackney, east London for more than 25 years before retiring in 2001), described a patient who received an estimate from a private dentist of £58,000 for a "full mouth rehabilitation".

Profiteering is one thing, appropriate treatment is another. In 1999, a Manchester dentist alleged to have earned more than £600,000 from the NHS in a year was struck off by the General Dental Council for drilling and filling unnecessarily.

A favoured investigative method of consumer magazines is to despatch a reporter to visit a clutch of dental surgeries and compare what treatment they advise. When Reader's Digest carried out such a survey of 25 dentists round the country, the reporter came back with a recommendation for nothing more than a scale and polish from one dentist, while another suggested three fillings, four crowns and the extraction of a wisdom tooth at a cost of more than £1,000.

So how do you choose a dentist and hope to avoid disaster? Ask for a price list. If the surgery doesn't have one, that is the first warning sign. Assess their chairside manner. Is it reassuring? The inspection can be revealing: a quick glance with a mirror is not enough. A dentist who examines each tooth individually, checking crevices with the probe, pushing the mirror into awkward places, is doing the job conscientiously.

After that, it's a matter of trust. There are never any guarantees. But if the dentist has got off to the right start, there is a better chance that your trust will be rewarded.