ToothDo you suffer from odontophobia? Or perhaps it’s the fear of the hole it will leave in your bank balance that puts you off going to the dentist.

Just how long is it since you were recumbent surrounded by mirrors, drills and probes with a light dazzling in your eyes? Since the number of NHS dental practitioners has reduced, so too it seems has the number of times we visit the dentist, often leaving it until the toothache becomes unbearable.

Since April 2006 when dental reforms were put through, not only has it become more difficult to find an NHS dentist, but some surgeons have been keeping quiet about treatments still available under the NHS and charge patients hundreds of pounds for private treatment.

So what happened to the world of dentistry and why is it an area that seems to have stepped out of the limelight without anyone noticing?

Knowledge of oral hygiene has existed since at least the Ancient Egyptians, with various concoctions that were sluiced around the mouth in an attempt to stop the rot or kill the small tooth worms that were thought to make cavities!

Tooth extraction was done with forceps or ‘key’ – when rotated it gripped the
tooth tightly extracting it, gum and bone. Jaws were sometimes broken!

The first breakthrough was in 1683 when Dutch scientist Antony van Leeuwenhoek identified oral bacteria; this opened the doors to a whole new world of dentistry; including William Addis toothbrush in 1780 and the use of amalgam for fillings in the 1830s.

There is surprisingly very little in the way of dental legislation other than the 1921 Act and The Dentists Act 1984 that regulates who can actually practice dentistry.

Fluoride has also played a big part; the first fluoride toothpaste was marketed in Britain in 1958. Although there is concern about fluoride levels in drinking water and children under 3 years should not use fluoride toothpaste. The Water Fluoridation Act was passed in 1985 and the level of fluoride in water is now controlled by the Water Industry Act 1991 (amended by the Water Act 2003).

Barbers, wig makers and blacksmiths would dabble in dentistry.

But what happened to the industry after the reforms of 2006 and were the consequences of ‘quantity not quality’ significantly more damaging to our teeth?

The 1970s saw a big change in the way dentists operated; at this time there was very little in the way of preventative dentistry and the Labour Government decided on a policy of payment per NHS treatment. Therefore a check-up inevitably lead to follow-up appointments to have fillings i.e. more treatments = more money.

Not surprisingly the budget set aside for dentistry started to run out and by the 1990s NHS funding was reduced and many dentists simply stopped treating NHS patients.

The 2006 dentistry reforms led to around 2,000 dentists leaving the NHS because they disagreed with the new arrangement. Dentists are now paid a flat rate based on their ‘unit of dental activity’ (UDA), the targets for which are set each year.

2010 celebrated 150 years since the first dental licence was issued.

The reforms also mean the patient knows exactly what they are paying for: there are three bands of payment and you pay the same whether it is for one or three fillings. The system is run by the local Primary Care Trust (PCT).

However, many people are unaware the PCT is obliged to find an NHS dentist on their behalf that may mean being added to a waiting list, but given the cost of private dental treatment, it is probably worth the wait:

  • NHS check-up, £17.50
  • NHS filling (incl check-up), £48
  • Private check-up, £42
  • Private filling, £76+

However, over the last 10+ years, there has been a move towards preventative treatment and whereas tooth extraction was considered to be the only answer to dental problems, dentists will now rebuild teeth or replace missing teeth with implants or bridges. Over the next 20 years computers will play an increasingly important role making diagnosis and treatment far more reliable.

X-ray scanners can now produce 3D images of the mouth, bone and tissues and from that the computer will be able to manufacture replacement teeth. There is also the development of reproducing teeth from stem cells; it has already been done in mice.

But here is my closing thought: if you are amongst those patients who ended up with several unnecessary fillings during the 1970s due to the government’s ‘pay-per-treatment’ policy, if this excessive dentistry can be proven, perhaps it’s time to seek compensation for the pain and suffering you endured but more so, the damage that was consequently caused to perfectly healthy teeth.

Just a thought …

Mind The Gap – It’s Getting Bigger

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