This may hurt a little: Rise in hospital admissions for last-ditch tooth extractions

The inexperience and pay structure of NHS dentists are the root causes of a steep rise in hospital admissions for last-ditch tooth extractions, say government critics. Nina Lakhani reports

The biggest year-on-year rise came in 2006 after controversial dental contracts were introduced – the number of patients rose by more than 21,000 in one year. Extractions in Scotland, where the new contract does not apply, have steadily decreased over the same five-year period.

Dentists are now paid for every procedure they carry out, which critics say discourage them from undertaking more complex, time-consuming work. These complex cases are either referred to dental hospitals or patients are forced to pay for private treatment.

And NHS care is increasingly provided by newly trained dentists as their older, more experienced peers move into more profitable private practice. Less experienced dentists are much more likely to refer patients to hospital for extractions rather than carry out the work themselves, claim senior dentists.

Norman Lamb, the Liberal Democrats' health spokesman, who was given the extraction figures in a parliamentary answer, said: "It seems that this is another example of the failure of the dental contracts to deliver better access to dentists across the country and these are figures which the Government cannot reject or explain away.

"I am hearing from people who still cannot see anNHS dentist and are therefore neglecting their teeth or waiting until it is an emergency. Other patients have to pay extortionate amounts for private treatment to save a tooth or else wait weeks, often in pain, to get a tooth extracted on the NHS.

"These are the unpalatable and unacceptable choices people are facing, and ministers need to get their heads out of the sand and admit that dental care remains in disarray."

According to a survey by Simply Health published last week, 35 per cent of adults are finding it difficult to get the dental care they need on the NHS – a 12 per cent increase on last year. Figures show a rise in the number of dentists doing NHS work and an increase in the amount of taxpayer money spent on dental care, but the number of patients treated on the NHS has fallen substantially. And research by the Patients Association has found evidence of a postcode lottery in the level of care available.

Yet the Government has repeatedly rejected claims that the situation has deteriorated, insisting its policies are producing real improvements across the country.

Professor Tara Renton, head of oral surgery at King's College London Dental Institute, confirmed the drift towards hospital extractions. She said: "We have definitely seen a 20 to 30 per cent increase in the number of referrals from dentists since the introduction of the dental contract, the majority of which are for extractions. The acute dental care walk-in clinic has seen their queues increase as well.

"On the other hand, complex procedures such as root canal work are less available these days. The PCTs are obviously not happy about the increasing cost of hospital dental care, and they are trying to sort this out by setting up specialist dentists in the community and by monitoring referrals so that they can take those dentists referring too many patients to task. Their intentions are good but this takes time."

Anthony Halperin, a senior dentist and a Patients Association trustee, believes too many NHS dentists are now inexperienced and lack the confidence to extract teeth and carry out complex, "tooth-preserving" procedures in their surgeries. "The new payment system means dentists get the same money for fairly simple, quick procedures as they do for more time-consuming procedures, which are therefore not worth their while. I'm sure these two facts are responsible for the surprising increase in the number of hospital extractions," Mr Halperin said.

A British Dental Association spokesman said it was impossible to draw firm conclusions from the figures without further analysis, but thought it was unlikely the new contracts were solely responsible.

Meanwhile more people are travelling to Europe for cheaper dental treatment with nearly 50,000 dental tourists in 2007, according to Treatment Abroad. Hungary is one of the three most popular destinations and Smile Savers Hungary reports a 60 per cent rise in patients since January 2007.

Simon Purchall, founding director of Smile Savers Hungary, said: "A lot of people come to us after years of putting off dental work. By the time things have gotten really bad they either cannot find an NHS dentist, or if they can, they are not willing to accept the solution offered such as dentures, and cannot afford the high prices charged by UK private dentists for modern solutions such as implants."

Ivor Chestnutt, professor of dental public health at Cardiff University's School of Dentistry, said the cost of more complex treatment may be driving some patients to rely on free, last-resort procedures: "While no one answer can explain the rise, one issue could be cost. While only 5 per cent of patients in Wales said costs were an absolute barrier to attending the dentist, some people do find costs stop them going as often as they would like. It can be very expensive if you are treating an abscess or an infection to have problems removed and a tooth crowned, so some people may choose to get an emergency extraction."

A Department of Health spokesperson said: "Extractions are usually a last resort. The total increase in hospital extractions over five years is just 1 per cent of extractions carried out, taking account of the four million carried out by high-street dentists. The number of extractions has remained steady and is lower per head than in Scotland."

Additional reporting by Jack Sidders

Delayed cost: 'I wish I had found a dentist years ago'

Melody Carter, from Southampton, has had difficulties finding an NHS dentist in several parts of the country. Now, the charity fundraiser is to get a tooth removed at her local dental hospital because she cannot afford private work that could save the tooth.

"I went to university in Guilford where it was impossible to find an NHS dentist willing to take me on. While there, I got toothache in 2003 but left it for ages until I couldn't bear the pain any longer. I went to my parents' dentist in Surrey as an emergency and they paid a small fortune for me to have root canal work. After that, everything seemed fine until this February, when the same tooth started to really hurt. Once again I didn't have an NHS dentist as I'd been unable to find one in Southampton, and was on a waiting list. The PCT found me an emergency clinic where I was told the tooth was infected because the tip of a file used for the root canal work had snapped off and been left behind. I was told that NHS dentists weren't experienced enough to do this kind of reparatory work, so I had two options: either I pay to see a private specialist who might be able to save my tooth, or I have it extracted free at the hospital. Paying for private treatment is totally out of the question so I'm booked in for an extraction on 15 April. I feel like I've been left with no choice. I'm planning my wedding for next spring but I'm terrified that if I can't get the work done in time I'm going to look awful in the photos. I really wish I'd found a dentist when I was a student as this might never have got this far. I can't believe I'm having a tooth taken out at the age of 25."