As dentistry faces the 'worst crisis in its history', even finding a dentist is ...

With pain throbbing through her lower jaw, author Hilary Freeman made countless calls in an attempt to secure an urgent appointment with a dentist.

Hilary, 50, had developed toothache in her lower right molar in January this year after biting down on a hard piece of food — but her usual NHS dentist said that, as she hadn’t had an appointment with them in the past two years, they wouldn’t prioritise seeing her.

With other local dentists either closed or unable to fit her in, Hilary called the NHS helpline and managed to get an emergency appointment at an Urgent Dental Care Centre about a half-hour drive away (a network of these centres was set up during lockdown when dental practices were closed).

Finally in the chair, the mother-of-one was told that she had cracked her tooth, which is usually treated with a filling.

However, all Hilary could be offered as emergency treatment was a temporary filling to stabilise and desensitise the tooth until a treatment slot to put in a permanent solution was available — but there was no way of knowing when that would be.

‘I begged to be put on the dentist’s own waiting list so that the treatment could be completed and a permanent filling could be put in,’ says Hilary, a broadcaster and journalist from East London.

‘But there was no room on the surgery’s waiting list so I had no choice but to have a temporary filling.’

Six-week wait in emergency cases

What happened next highlights the flaws in such a system as the stop-gap treatment led to six months of pain and complications.

‘I developed an infection that may have arisen because the tooth wasn’t treated properly in the first place, and I ended up spending nearly £1,000 on private treatment to sort the problem out,’ says Hilary. ‘It was absolutely awful and completely unacceptable.’

Her experience is just one example of the wide-scale difficulties patients — mainly NHS but in some cases private, too — are experiencing in accessing dental care.

Figures show how the pandemic has had a seismic impact — and there is little sign of it abating.

According to the British Dental Association (BDA), the trade union body, a staggering 35 million NHS dental appointments have been ‘lost’ in England alone since the start of lockdown in March last year because of added time now being needed for cleaning between procedures.

The pandemic virtually shut down dentistry. In May last year 83,000 NHS dental treatments took place compared with the usual average of 3.3 million, according to the patient watchdog Healthwatch England.

It has left a huge backlog of work, with some patients now being warned they must wait up to three years for a routine appointment or six weeks for emergency care.

Problems accessing NHS dental care are now the number one complaint raised with Healthwatch England, accounting for 25 per cent of all calls (compared with 5 per cent pre-pandemic). And 40 MPs from both sides of the House of Commons recently published an open letter to the Government calling for action.

‘Dentistry is now the No 1 issue raised with Healthwatch and our own mailbags can attest that lack of access to dental services is a problem felt in every corner of the country,’ the MPs wrote.

This follows a call from the BDA and Healthwatch England demanding the Treasury put in place the building blocks for a sustainable recovery following the pandemic to deal with the ‘eyewatering backlog’ in dentistry.

Worst crisis in dental history

‘There’s no doubt that dentistry is facing the worst crisis in its history,’ Jacob Lant, head of policy, public affairs, research and insight at the watchdog told Good Health. ‘So many people are contacting us in pain because they can’t find an NHS dentist who can take them on for new treatment even if they have been a regular at a practice before.’

There are concerns that some NHS patients are being pressured to go private in order to receive the treatment they need. After Hilary developed an infection in her mouth just weeks after having the temporary filling, the only way she could get treatment was to go private. ‘I was in so much pain, my face was swollen and I didn’t know what to do,’ she says.

‘In desperation, I managed to see a private cosmetic dentist close to where I live at a cost of £150 and was put on antibiotics. When the infection subsided, I was given a filling, which cost another £400. I had no choice but to pay.’

But the infection returned two months later. ‘The tooth was really badly cracked and the filling hadn’t completely sealed the crack, allowing infection to get into the tooth. My face was swollen and I was in searing pain. It was awful. I couldn’t sleep or do anything.’

Hilary was prescribed a second course of antibiotics, at a cost of £20, then paid another £100 for a further check-up, where she was told that the tooth was so badly cracked that she’d probably need root canal treatment, which would cost another £1,500.

‘I was horrified. I just couldn’t believe it,’ she says. ‘I’d already spent more than £500 and I just couldn’t afford it. I put off the treatment for a couple of months as the antibiotics had settled the pain, but I knew it could come back. My only other option was to have the tooth out — which I did last week. It still cost £300 [again privately]. I went through months of pain and all that cost because I couldn’t see an NHS dentist.’

Jacob Lant believes it is ‘possible’ that other dentists, like Hilary’s, are using a clause of their practice contract — where if someone hasn’t been seen for two years they are no longer prioritised over routine patients seeking urgent treatment and are technically ‘off the books’ — to not see patients.

The key problem is that while dentistry was closed down during lockdown, the relaxation of the Covid restrictions in England, which came into force in July this year, didn’t apply to dentistry.

When lockdown began, practices were instructed to suspend all face-to-face care. Since June 2020 they have been working to strict infection control procedures and restrictions that have radically reduced patient numbers.

No easing of covid measures

The restrictions include maintaining gaps between appointments of up to an hour to clear the air after aerosol-generating procedures (AGP), used in crowns or fillings, which produce a spray of water that could potentially transmit the virus.

‘There are so many factors reducing productivity,’ says Dr Michael Clarke, who runs an NHS and private practice in London and is chairman of the Federation of London Local Dental Committees.

‘On July 19, England moved to the final stage of easing Covid restrictions but this hasn’t been the case for dentistry. Processes such as patients having to wait outside the premises, having their temperature taken on arrival, dentists and nurses having to gown up before doing interventional treatment and, of course, letting the room lie ‘fallow’ between treatments, all reduce productivity.

‘Some practices may have ways of mitigating delays, such as ventilation ducting to draw out the air and replenish fresh air, but it still creates a waiting time.

‘NHS England has told NHS practices that they are obliged to meet 65 per cent of their pre-Covid activity levels or face financial penalties. But that means if you saw 100 patients a

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