How to cushion the pain of a private dentist's bill

Dental insurance plans proliferate as treatment under the NHS continues to shrink

Have you tried to find an NHS dentist, who will accept new patients, in the Sevenoaks area of Kent recently? No luck? Well that is because there are none.

Sevenoaks is not alone. Across the country, NHS dentists are becoming increasingly rare, in what amounts to privatisation by stealth of the nation's dental health services. London and the South-east have been particularly badly hit.

NHS dentistry has been rolled back at a startling rate. In 1991, 95 per cent of dentists offered a comprehensive NHS service. Today, the figure is down to 60 per cent. Since 1992, dentists have de-registered 830,000 patients without choice, and many have found it impossible to obtain alternative NHS treatment.

Hans Patel, a member of the General Dental Practitioners Association's policy committee, says there is a marked fall-off of people actually visiting the dentist as a result. Check-ups are less frequent, so less preventative work can be done - including detecting mouth cancer at the early stages. People are opting for cheaper treatment, such as having teeth pulled, instead of more expensive reconstruction work.

Current NHS provisions exempt from charges non-earners such as children, pensioners and the unemployed. Non-exempt customers pay 80 per cent of costs, the rest being subsidised by the Government.

The snag is that costs per item are calculated by the Department of Health at an artificially low rate - they have been frozen since 1991. So dentists can no longer make their businesses pay. ''I'm now in the situation where my private patients actually subsidise the NHS ones. It's getting back to conditions before the NHS started,'' Mr Patel said.

Some dentists now restrict the NHS patients they see - they may see children, or old people only. Some have withdrawn from the NHS altogether. Hundreds of thousands are now being forced into the private sector, because they cannot find an alternative or feel their NHS dentist is now so pushed trying to see enough patients to make ends meet, that he or she can no longer afford to give them enough attention. There is also a broader choice of materials in the private sector - NHS dentists are restricted to the cheapest.

The cost of private treatment can be painful, as anyone who has undergone root canal work will testify. Unlike the NHS, where maximum charges are pounds 300 for any course of treatment, there are no fixed prices for private work. Dentists can charge what they like. The table gives a rough idea of costs of some of most common treatments.

When trying to find a private dentist, you should check prices and compare with others in area, to make sure you are not paying over the odds. (Of course, general competence and favour- able recommendations should be the primary consideration.)

Once you have found a dentist, there are different ways of helping bear the cost. Some dentists make it possible to pay for annual dental treatment through plans from such organisations as Denplan, CDC and Norwich Union.

Dental plan providers, meanwhile, are waking up to the huge new opportunities ceded by the NHS, and are racing to sign up dentists to their schemes.

Cover falls into a variety of categories. Capitation plans involve paying a certain amount monthly for basic, plus a further insurance element for emergency work. These account for most of the market. Suppliers include Denplan (owned by PPP), CDC, Densure, Norwich Union, Bupa Dental Cover and WPA Provident. Fees range between pounds 6 and pounds 18 per month.

Unlike medical insurance, there is no age limit, and premiums are not based on age. Some may exclude dentures, however, and more expensive crown and bridgework. All patients are usually accepted, although patients needing more treatment will end up paying more. Norwich Union will admit members to the higher levels of their scheme only after they are certified dentally fit.

Clinident's scheme, by contrast, involves splitting annual dental costs into 12, and adding pounds 24 for accident and emergency insurance. Unlike the capitation schemes, the patient can feel sure he or she gets exactly what they pay for.

Capitation plans and Clinident's scheme rely on the dentist agreeing to participate. So it may not always be easy to find one offering the scheme you select. Denplan is the biggest, with around 560,000 members among the public. CDC comes second, with about 60,000.

A less comprehensive form of cover is offered by health benefit schemes from HSA and BCWA. These give cash payments for a variety of health needs, including dental services. Benefits depend on the level of cover chosen. More expensive private medical insurance plans, like Clinicare's Cart Blanche policy, also provide cover.

So, are these plans a good idea? And how do you assess what cover you may want or need? There is no easy answer. The best guide is to tot up what your annual treatment is likely to total without a plan, and compare the figure with the annual costs of a given scheme.

Plans are attractive if you need to spread the cost over 12 equal payments a year (although discounts often apply, for full payment in advance). With some plans, all necessary work is covered, so there are no unpleasant surprises throughout the year.

In general, buying plans is only worthwhile for people who go to a dentist regularly and will make use of the services on offer. If you are the type of person dentists rap over the knuckles for hardly ever going, you probably will not get value for money.

Public versus private

Treatment NHS charge Private range (suggested)

Check-up pounds 4.00 pounds 10-20

Check-up, X-rays pounds 6.80 pounds 15-30

Check-up, X-rays, cleaning pounds 13.24 pounds 40-60

Filling (silver in back tooth) pounds 8.52 pounds 20-40

Filling (white in front tooth) pounds 8.16 pounds 20-40

Extraction pounds 7.28 pounds 10-20

Crown pounds 60.80 pounds 150-300

Dentures (full set) pounds 83.40 pounds 200-400

Source: British Dental Association