Dentistry provided by the National Health Service in the United Kingdom is supposed to ensure that dental treatment is available to the whole population.
[1] Most adult patients have to pay some NHS charges, although these are often significantly cheaper than the cost of private dentistry.
This means that the NHS provides any treatment you need to keep your mouth, teeth and gums healthy and free of pain".
[8] This has forced many patients to pay much higher sums for private treatment,[9] and has been criticised by the British Dental Association as having "failed to improve access to care for patients and failed to allow dentists to provide the modern, preventive care they want to deliver".
He suggested that those needing urgent treatment should go to see their GP, prompting the British Medical Association to observe that a General Practitioner was no substitute for a qualified dentist.
[10] There are repeated stories of shortage of NHS dental services, especially in remote areas such as Skye[11] and Cornwall.
Dave Cottam of the British Dental Association said there was a, "perfect storm" of failed contracts, recruitment problems and underfunding.
Cottam added, "These access problems are no longer affecting a few 'hotspots', but are now the reality for millions across every English region.
[20] Patients with learning difficulties and with dementia have been issued with penalties because they made honest mistakes ticking the wrong box in complex forms.
People on low incomes are deterred from seeking dental care that they need because they fear being fined.
In 1990 a new contract introduced capitation payments for treating children up to the age of 16 and registration for adult patients.
[26] The contract introduced in 2006 was said by the British Dental Association in 2016 to be not fit for purpose, rewarding dentists for meeting government targets for treatment and repair, but not for improving patients' oral health.
Practices in reality operate a list system and are regularly reported as closed to NHS patients, though open to those who pay privately.
The performers (dentists) providing the treatment get a proportion of the payment, usually below 40%, and have to pay laboratory bills such as for the construction of dentures and crowns out of their cut.
[29] The British Dental Association is keen to see reform, having campaigned vigorously against the "flawed, target-driven arrangements" introduced in 2006 that are currently in place.
In Scotland and Northern Ireland, the system works differently and relies upon a mix of capitation payments alongside Item of Service charges.
[33] The BDA said that the 2006 contract did not meet its purpose of improving access to NHS dentistry and concentrating on prevention, and had been criticised by patient groups, government, the Health Select Committee and the Chief Dental Officers for England and Wales.
It highlighted the areas of England with the lowest number of NHS dentists per 100,000 population and expressed the need for a levelling up of access.
A lack of access to NHS dentistry presents risks not only for oral health, but also in relation to early detection of mouth cancers and type two diabetes.