What's your pain threshold like?

As NHS dentists disappear, insurance plans are queuing up to fill the gap. Jean Eaglesham assesses what they have to offer

The disclosure last week that one NHS dentist was paid pounds 604,000 by the Department of Health for work carried out on patients, in addition to what the patients may have paid, underlines the increasing financial pain in going to the dentist.

The principle of cradle-to-grave cover, cheaply or even freely available to every citizen, has been abandoned. True, free treatment is still on offer to certain groups, including children and pregnant women. But three in four who receive NHS dental treatment have to pay for it. At present, patients pay 80 per cent of the cost, up to a maximum of pounds 325 for a course of treatment.

The set charges for NHS treatment are still far lower than typical charges for private treatment. Access to NHS treatment is not, however, automatic. The creeping privatisation of the dental profession means that people who do not qualify for free treatment are finding it difficult to find a dentist who will agree to treat them as NHS patients.

One in three people claim it is difficult to find a local NHS dentist, according to a survey conducted for the British Dental Association. The problem is worst in the South-east where more than half of respondents said it was difficult.

The BDA says its members are reluctant to take on NHS patients because of government underfunding. Others see the shift to private provision as inevitable. "Technological improvements mean the cost of treating a single patient can easily run into thousands of pounds," notes Marilyn Orchaton, of Clinident, an insurer.

Whatever the cause it seems clear that few people can rely on being covered indefinitely by the NHS. "Most dentists understand that free dentistry for all is an unrealistic dream," says Peter Sanders, of Bupa. This pessimism is echoed by a survey commissioned by the BDA last year, which found that most MPs questioned believed that NHS treatment would be available only to children and people on low incomes in 10 years.

This is all music to the ears of the big medical insurers, who are queuing up to offer plans to help cover the cost of dental treatment. Provided your teeth are reasonably healthy, however, you may be better off resisting their blandishments and forking out instead for the treatment as and when you need it. The BDA says: "Pay as you go may be cheaper than private dental plans for patients who visit their dentist once or twice a year."

Private dental plans come in one of three main guises.

Capitation schemes, which offer cover for routine dental treatment, such as check-ups and fillings, are the most common type. They are principally a way of spreading the cost of treatment by making a payment each month. The cost depends on the level of cover, your dentist's estimate of how much treatment you will need over the next year and their hourly fees.

The advantage of these schemes is that you cap the cost of standard dental treatment in any one year. But they also have drawbacks. The cost of the most expensive treatments (such as bridgework repairs, crowns and root canal work) is often not fully covered. If you have opted for the cheapest level of cover, they are likely to be excluded.

Capitation schemes also mean that you are restricted in your choice of dentist; less than one-third of dentists offer capitation schemes. Your choice is also restricted by the dominance of Denplan, part of the PPP Healthcare group, which controls more than 86 per cent of the market.

Other dental insurance policies give you the freedom to choose any dentist, but there are not that many policies from which to choose.

You need to weigh up the cost of the premiums against the likelihood that you may need to claim. WPA, which offers one of the few stand-alone dental insurance policies, estimates that claims for routine dental care, which you are almost certain to make, will repay around a third of the annual pounds 86.25 premium.

If you have got private medical insurance (PMI) it is worth checking what dental cover it provides. A handful, such as Clinicare's Carte Blanche, will offer extensive dental benefits as part of the package. Legal & General's Lifetime HealthCare policy offers an annual pounds 200 cash reserve that can be used to pay for routine dental expenses, although policyholders must pay the first pounds 25 of any claim.

But in most cases the cover is more limited. Prime Health, for example, offers cover for emergency (non-routine) treatment only as part of its main PMI policies; and to get even this level of cover added to other Prime Health medical policies, you will have to pay an additional premium of pounds 3 a month. If your employer offers you PMI as a perk, this may cover dental treatment. If not, you can probably pay to get dental cover added.

Jean Eaglesham works for `Investors Chronicle'.

PRIVATE DENTAL PLANS

Insurer Plan name Typical monthly

premium

BUPA 0800 230230 DentalCover pounds 6 to pounds 19

CDC 0181 848 1028 CostCare pounds 7.97 to pounds 10.50*

Clinident 01438 746868 Dental Plan n/a

Denplan 01962 828000 Denplan Care pounds 5 to pounds 15

Densure 01256 221001 Capitation Plans pounds 7.50 to pounds 17**

Norwich Union 0800 336825 Dental Care pounds 6 to pounds 17

Comparing the costs and benefits of private dental plans is difficult since premiums generally vary according to the individual, while the level of cover also varies significantly between plans. This table is a guide to the rough level of charges you can expect to pay for a given plan; it is not a comparison of those plans or the cover they offer. If your dentist tries to sell you a plan, check the cover very carefully before you agree to buy.

*pounds 10.50 for London, pounds 7.97 elsewhere. ** Plus one-off pounds 15 joining fee.