Patrick and John get their teeth into dentistry

I was keen to find out whether experiences with private dental treatment and the NHS were similar to my own, so I had a chat with John Ward, one of our long-term community members. Here’s what happened.

Patrick: Thanks for joining me John – I’ve been thinking about dentistry. Not because my teeth are in any particular disorder (yet), but because of some of the poor experiences I’ve had in the past.

When I was with an NHS dentist, I knew that when I walked through the door, I was also entering a private clinic.

When I sat in the chair for my first NHS consultation and check up, there was basically a refusal to do anything with my teeth until I had booked an £80 appointment with the private hygienist. That type of upselling unfortunately doesn’t seem to be uncommon – do you have any similar experiences to this?

John: Firstly, I’d just like to emphasise that I’m extremely satisfied with my present dentist and the treatment I receive!

I’ve not been able to have dental treatment on the NHS for some years, ever since I left London in 2005. I was not in a priority category for NHS dentistry and the practices in our area were not taking on any new NHS patients.

I did have regular check-ups and treatment as necessary and this was covered under an insurance scheme for a monthly payment.

The dentist would assess the likely requirement each year and it seemed to be going up routinely irrespective of the amount of dental work actually performed.

If more advanced work was required then the premium was raised thereafter despite the fact that the dental work usually lessened the need for further intervention. When that dentist retired I decided to leave her practice and use a dentist in Norwich.

Patrick: So you’ve been with a private dentist for more than 10 years?

John: Yes, I have been having private treatment, some of it quite extensive since, due to previous problems, I had to have some reconstructive work and a partial denture. 

I do occasionally talk to people who have an NHS dentist and compare the treatment I receive relative to their experience. There seems to be no doubt that NHS patients receive a second rate – albeit competent – service.

Whether they are subject to upselling I do not know but, judging by what I see while I’m waiting, I do seem to get a superior service.

I wonder if NHS dentistry is an economy service possibly designed to encourage patients to ‘go private’.

Patrick: It’s interesting what you say about NHS dentists being “designed to make people move private”. As well as the hygienist service, I have had all my fillings done privately due to the fact that white fillings are rarely offered on the NHS.

I don’t have a particular criticism of this, only that NHS and private dentistry seems to be completely entwined.

I have one experience that makes the situation more complex. I had discovered that my teeth were sensitive and informed my NHS dentist – he told me that two of my teeth had worn down, likely from grinding my teeth during the night.

The solution? A mouth guard. I asked him whether I could get a standard one from the shop, but he advised (correctly, I believe) that a bespoke mouth guard fitted to my teeth would be best. I agreed.

After my normal check up and a little Xray, he handed me a piece of paper to sign. ‘Band 3: £269.30’ was ticked on this document – quite pricey I thought for a mouth guard. I asked him why it cost so much and he said that this type of treatment could only fit in Band 3, and not the others.

I said I would like to think about it and not sign. He told me that was OK, but I would have to pay £22.70 for today’s check up and then, if I decided I wanted the mouth guard at a later date, I’d have to pay the full £269.30 on top of this.

Despite this, I still wanted to go away and do some research on costing in my own time. I paid £22.70 and left.

I later found that a mouth guard could cost anywhere from £80-200. Still less than £269 I thought. I decided to do something a bit cheeky – call the dentist I had just left. I asked the receptionist: “Please could you tell me how much a mouth guard moulded to my teeth would cost if done privately?”.

“Yes, let me check with the dentist quickly.” The dentist she spoke to was the same dentist who had tried me to sign for a Band 3 payment on the NHS moments before. She returned to the phone: “Hello, it would cost you £80 if done privately.”… Thoughts on that John?

John: That sounds quite opportunistic and, basically, sharp practice. 

Leaving aside NHS work, dentists are acting commercially and can set their prices at any level they like according to what they think the market can bear. An existing patient might be charged more than a new one because the practice considers the existing ones are captive. With a new one they hope to gradually ratchet their income up over time, little by little. 

The profession has never felt the full blast of consumer inquiry or been transparent on its prices. 

Patrick: It’s funny you should say that, John. You may not know it, but Which?’s very first super-complaint was on dentistry.

We found issues with dentists not displaying price lists or giving people the proper option between private and NHS treatment – the Office for Fair Trading responded by demanding action from the dentistry industry and the government.

But when we investigated this same issue 10 years later – not much had changed. It just shows how long change can take.

John: That’s interesting. Personally I would like to see a scale of charges for the NHS work displayed in every practice and on their website with a priced explanation of enhancements that could be procured as a private patient.

If a private patient is content with an NHS treatment or service then they should pay the NHS rate, not a higher rate. Any higher price should be justified by a higher quality of service, more sophisticated treatment, and more time in the chair.

Unless that is done, and dentists still refuse to accept new NHS patients on their lists, the growing number of people with no choice will be discriminated against.

Patrick: So what do you feel the main problem is?

John: In my view the main deficiency is the lack of a clearly visible scale of charges. My practice gives me a treatment plan if the regular check-up reveals that specific non-routine treatment is necessary but the out-turn price can differ from the plan price if complications arise, which is fair enough but by that point it is too late to do anything else.

You can’t take the treatment plan to a different dentist for the work to be done and there is a general belief that a lower price will lead to an inferior treatment or more pain and suffering. Our dentist is one of those people we hesitate to get on the wrong side of.

Patrick: Let’s put that to the community – have you had a bad experience with an NHS or private dentist? Have you ever felt like you were being upsold private treatment, or the most expensive on offer? 

Let us know if your experiences are anything like mine and John’s in the comments. Over to you.