Don't let the dentist bite you in the wallet

Dental care, on the NHS or private, is expensive. Sarah Bridge finds ways to ease the financial pain

The shortage of NHS dentists in some areas means that many people are having to turn to private treatments instead.

"We have seen increased traffic on our site of people looking at what dental cover plans are available," says Richard Mason of the online price comparison site InsureSupermarket.com.

"This could be because it is getting harder to find an NHS dentist, or because people are aware that it is important to plan for your dental care, but the interest is definitely up."

Going private isn't cheap. It can cost four times as much to see a private practitioner rather than a NHS dentist. Just a simple examination, scale and polish and one filling can cost you more than £100 in the private sector.

The introduction of new contracts for dentists is likely to lead to even more practitioners leaving the NHS. So, how prepared are you to deal with the cost of looking after your teeth?

Dr Penny O'Nions of the medical insurance brokers the Onion Group says: "The first thing you should do when trying to organise your dental care is to go to your local health authority. It will tell you if there are any NHS dentists in your area, or where the private ones are. You should also ask your friends for a recommendation."

If you do have to take the private route, do not despair. "Before doing anything, check with your employer," O'Nions advises. "Many companies now offer menu-based employment schemes including medical and dental insurance, which can be a very economical way of doing it.

"If they don't already have a scheme in place, it might be worth getting up an employee petition to get one. As most people find it hard to find a NHS dentist, then most people will have to go private. If your employer can help with that, so much the better."

Charlie McEwan, the director of communications at the medical insurer WPA, adds: "An increasing number of employers are offering dental cover as part of their employment package. It is an employees' market out there, and a company can make itself more attractive by offering these kinds of benefits."

If you have drawn a blank with the NHS and with your employer, there are other options. You can either choose a "pay as you go" approach - hoping for the best but running the risk of getting hit with a big bill if you need dental treatment in the future - or you can try to minimise the cost and the financial uncertainty.

InsureSupermarket compares more than 35 different schemes and levels of dental cover, and will try to find the schemes that are most suitable for you, as well as outlining what levels of cover you can expect. The three main options are "capitation" schemes; insurance; and cash plans.

Denplan, underwritten by AXA PPP healthcare, is the largest capitation provider, with 1.5 million patients and 6,000 dentists signed up to its scheme.

The schemes require members to be examined first by a Denplan dentist who will rate your teeth depending on how much work he or she thinks you need.

Perfect teeth would slot into the lowest category. Dodgy gnashers, as sported by the likes of Austin Powers, would be at the other end of the scale. You would then have to pay a monthly amount based on the condition of your teeth. The average cost is £16 and you are then covered for all procedures, such as examinations, fillings, bridges, crowns, root fillings and mouth cancer treatment, though the plan does not cover cosmetic procedures, such as teeth whitening.

Denplan also offers a cheaper plan, Denplan Essentials, which covers just routine and preventative care such as examinations and X-rays.

Emma Slater of Denplan says: "Patients know exactly what their care will cost and the treatment that their payments will cover, thus avoiding unexpected large bills and enabling them to plan ahead and budget for their care."

But O'Nions says: "The problem with a capitation plan is that your dentist decides how much the work on your teeth is going to cost. If you move to a different area, your new dentist might value the work differently."

Another possible solution is dental insurance, such as WPA's Providental plan. For an annual payment of £134.87 (£12.48 a month) or £171.69 if you are aged between 50 and 69, you are covered for standard dental treatment of up to £250 a year, dental emergencies, injuries costing up to £20,000 and serious illness.

Under its shared ownership scheme, now a standard part of dental insurance, you have to pay 25 per cent of all costs, up to an annual maximum of £500.

"Dental insurance is really a very simple product," says Charlie McEwan of WPA. "You can go to any dentist, it is one rate for everyone, and you don't have to visit a dentist to have your teeth rated, like you do with Denplan."

The final option is to sign up to a cash plan, which is a way to spread the cost of your dental treatment. The market leader in this sector is HSA, while other providers include Bupa and the Saturday Hospital Savings Fund.

For a small sum each week - from £2 to £6 with HSA, for example - you can then claim back money to cover the cost of dental check-ups and treatment, up to fixed levels.

Paying £6 a week to HSA would entitle you to claim back £150 to cover dental costs, with a further £150 for optical care. Many people forget to claim, which is why the plans offer such generous payouts.

The choice might seem a little bewildering, and budgeting for dental treatment may not be as thrilling as saving up for a Caribbean holiday or something ore fun. So what do the experts recommend?

Richard Mason of InsureSupermarket says: "Our basic advice for people who have to pay privately for dental care, is to first go to their nearest Denplan dentist for an assessment. If you have perfect gums and great teeth with hardly any fillings, then you are likely to get put into the cheapest band and might only have to pay £5 a month for a good quality product.

"If you are like most of us, though, with rather less than perfect teeth, you could be paying a lot more and so it would be better to have a look at dental insurance." Cash plans, Mason says, have administration costs and limited payouts, which make them less attractive.

If you want to keep it simple and go it alone, Mason says that you are unlikely to have to pay more than £1,000 a year in dental costs, and so the simplest way is to put aside £1,000 in a high-interest savings account. That should more than cover any costs and your money is earning interest at the same time.

"I would always go for insurance rather than capitation," adds Penny O'Nions. "If, under capitation, you pay £10 a month but then have an accident which costs £1,000 to fix, you are going to have less-than-perfect teeth, and good teeth are going to be highly valued in the future. Whereas with insurance, if you don't have any problems, then that's great - if you do, then you win because it will not affect your premiums."

But she adds a word of caution: "Remember that what you may want, and what the insurance company is prepared to pay for, might differ. You might want veneers, but if caps are cheaper, then that's what they'll pay for."

What the National Health Service has to offer

Next week, the NHS dental service faces its biggest shake-up in nearly 60 years. The new rules, which come into force on 1 April, could be good news for the 25 million people in England and Wales who are signed up with an NHS dentist.

Gone will be the mind-bogglingly confusing price list for patients - which included more than 400 prices for different treatments - and instead, a three-tier tariff takes its place.

People formerly exempt from charges - children, pregnant women and those on means-tested benefit - will continue to be so, while other NHS patients will pay one of three bands depending on the work needed doing.

These are £15.50 for a basic check-up, £42.40 for fillings, and £189 for more complex work including dentures and crowns (£12, £39 and £177 in Wales). No NHS course of care can now cost more than £384.

However, many dentists have so far failed to sign up to the new contract, objecting to switching from having a contract with the Department of Health to their local primary care trust. This has led to fears of a shortfall in dentists, and some patients may receive letters telling them to go private or find another dentist.