Patients so desperate they’re driven to DIY dentistry: With 90% of English dentists now closed to NHS patients and a backlog of 40m appointments, more and more are turning to agonising solutions
Natasha Waterfield had been suffering terrible tooth pain for 18 months. Unable to speak, eat or sleep, she woke up one morning and thought: ‘I can’t cope with this. It needs to come out.’
Adopting a course of action most people would think extreme — she was at the end of her tether — the pensioner took a pair of pliers from her garden shed.
‘I stood in my front room, put the pliers around the tooth and tried to take it out. It took three hours, bit by bit. I was crying so much,’ she says.
This kind of DIY dentistry belongs in the medieval era, along with remedies such as tying the offending tooth to a string attached to a doorknob and slamming the door shut. But such is the shortage of dentists, people are resorting to these methods in Britain today.
Sadly, Ms Waterfield’s agonising solution to her dental pain is not an isolated case. Domestic dentistry is increasingly common as patients struggling to gain access to NHS dentists — and unable to afford private ones — are forced to find alternatives.
A flood of dentists going into private care, as well as an ever-increasing amount of red tape, have caused ‘a deepening crisis in dental care . . . creating a two-tier dental system’ says the patient body Healthwatch.
There is a backlog of 40 million dental appointments, according to the British Dental Association (BDA), with some people waiting up to three years for treatment.
Almost 90 per cent of dentists in England are closed to new NHS patients wanting check-ups, reveals an analysis by The Times last month.
More than half of all council areas in England have no NHS dentists taking on new adult patients, and just under a third are not accepting children.
The number of NHS dentists in England has fallen to its lowest level for a decade. In the past two years alone, about 3,000 dentists have abandoned NHS work — 2,000 last year, on top of 951 in 2020.
This means there are just 21,544 dentists carrying out NHS work in England — fewer than in 2020, when there were 23,733.
While the comfortably off grudgingly pay for private dentists, millions on lower incomes cannot afford hundreds of pounds for fillings, extractions and root canal work, let alone the thousands some dentists demand for dentures and crowns.
Exclusive data shared with the Mail this week by the Association of Dental Groups (ADG) reveals that because of the rising cost of living, one Briton in five can’t afford a private check-up.
With no access to NHS dentists (who charge capped fees), people are left to choose between living in pain, taking on debt or — in some cases and ill-advisedly — opening up the toolbox.
The ADG recently published a list of 20 ‘dental deserts’ in England, where Clinical Commissioning Groups (CCG) are ‘below the average’ in number and there is ‘a downward trend in the number of NHS dentists’.
Retired carer Ms Waterfield, who pulled out her tooth with pliers, lives in Lincolnshire — the worst county in England for NHS dental care.
In North Lincolnshire, just 32 dentists undertake NHS work for every 100,000 people. Over a two-year period, only a third of adults and 35 per cent of children here were able to see a dentist.
Patients are often unable to find a dentist via the NHS but then can’t afford private treatment (stock photo)
Other ‘dental deserts’ to have emerged include Staffordshire, North-East Somerset, Thurrock, Norfolk and Northamptonshire.
Ms Waterfield, who lives in Horncastle, was told the bill to remove her tooth would be £490.
‘I couldn’t even afford £20 at that time because all my money goes on bills,’ she says. ‘I was panicking. I couldn’t go back because I couldn’t afford the treatment.’
She spent weeks ‘ringing hundreds of dentists in Birmingham, Nottingham, Sheffield to get someone to help me. No one could’.
Elsewhere in Lincolnshire, Richard Pick, a hedge-cutter, says he has performed his own dental procedure by ‘sterilising pliers and pulling the painful tooth out. It hurts at the time but in the long term it’s worthwhile.’
Scunthorpe resident Kerry Brown said her father had also had to resort to DIY dentistry because he couldn’t find a dentist. ‘[He] took a swig of whisky, went in his garage and pulled his tooth out,’ she says.
Another woman described not having been able to access a dentist since moving to Boston, Lincolnshire, 18 months ago, while suffering chronic toothache. ‘I’ve honestly contemplated getting my partner or his friend to take it out for me because the pain is so severe,’ she said.
Others in Lincolnshire tell of ‘nine-year waiting lists’ and ‘242-mile round trips’ because ‘it’s still cheaper than going private’.
Many people here have tried to register as NHS patients and been refused — but were accepted at the same clinics when they registered as private patients.
Several Lincolnshire practices have had vacancies for dentists for over a year.
Hana Rafajova, 42, who lives in Boston, has found it cheaper to return to the Czech Republic, her home country, for dental work rather than pay privately in the UK. ‘I had my front-teeth bridge replaced five years ago and the price here would have been £3,000. In the Czech Republic it was £1,000,’ she tells me.
‘I went there specifically for that, and the return flights for me and my son were around £200, so it was much cheaper.’
Ms Rafajova, who teaches English as a foreign language, also visits her dentist back home for dental cleaning procedures, which cost about half the price they do in England.
‘You could go anywhere in the country and find the same situation,’ says Mark Jones of Toothless in England, a grassroots campaign group launched last year to secure an NHS dentist for anyone who needs one. ‘We’ve been told numerous stories by patients in total despair, using pliers and needles.’
In Bury St Edmunds, Suffolk, there have been long queues outside mobile dentist vans run by the charity Dentaid. One woman seen there was found to have removed 13 of her own teeth.
James Crick, who lives in the town, went on TV to say he couldn’t afford the £6,000 in private dentistry fees he was quoted to treat an offending tooth, so after days of taking painkillers and being, as he put it, ‘unable to get on with life, unable to work’, he took one of the Russell Hobbs knives from his kitchen to try to remove it himself. The knife slipped and he cut his mouth. The tooth stayed in place.
Eddie Crouch, chairman of the British Dental Association (BDA), said last month that he has met people ‘who have re-cemented crowns back into their teeth with superglue . . . back to front. The bite is completely out of place and they can’t close their mouth’.
Others have resorted to loans to pay for private care, while one woman in Bingley, West Yorkshire, needing treatment started a GoFundMe online fundraiser.
As the BDA starkly warned in a recent briefing: ‘NHS dentistry is facing an existential threat and patients face a growing crisis in access, with the service hanging by a thread.’
Shawn Charlwood, chairman of the BDA’s General Dental Practice Committee, told me this week that ‘NHS dentistry is in crisis, the like of which I haven’t seen in 35 years in my profession’.
Mr Charlwood — who lives in Lincolnshire and does not use an NHS dentist himself — warned the Commons health and social care committee last month: ‘This is how NHS dentistry will die — a lingering decline that, unchecked, will leave millions of patients with no options.’
As desperate people turn fruitlessly to their GPs for help, the shortages are exacerbating the GP crisis and ‘lapping at the doors of primary care’, according to the British Medical Journal.
Significantly, too, dentists are often the first line of defence in making referrals for cancer and type 2 diabetes, and the difficulty in accessing them corresponds with a recent rise in mouth cancer rates.
Children suffer in particular. In English hospitals, tooth extraction is now the most common procedure in six to ten-year-olds.
So why is NHS dental care in such dire straits? First, 45 per cent of dentists in England have reduced their NHS commitment and moved to private work since the pandemic began, according to a BDA survey. The same proportion say they are likely to go fully private in the near future.
This has grave consequences: one dentist serves about 2,000 patients in the course of a year, so if 2,000 dentists leave and are not replaced, four million patients are at risk of losing access.
Dentists have no obligation to carry out NHS work and can, on their first day after graduation, go straight into private practice if they so choose.
Next is the issue of underfunding. Taxpayers have the right to see an NHS dentist, yet the Government allocates enough money for dentistry to treat just half the population — resulting in ‘rationing through the back door’, in the words of former health secretary Jeremy Hunt.
Dentistry, ‘the forgotten health service’, has been in decline for 30 years. But in 2006 things took a turn for the worse when Tony Blair’s government reformed the NHS dental contract — resulting in what has today disincentivised so many dentists to do NHS work, as it often costs them money to do so.
The contract means dentists are paid set amounts for treatments, regardless of the number of teeth treated — so they receive the same for a simple extraction as for three extractions, six fillings and a root canal.
If a dentist carries out more NHS work than they have been contracted to do, not only are they not paid for the extra work done, but they have to bear the cost of any overheads and materials — so it makes no financial sense for them to take on patients with complex needs.
What’s more, if they miss their contracted quotas for NHS dental work, they are penalised by losing funding in the following year’s contract.
Three quarters of dentists surveyed by the BDA recently said they were unfairly remunerated. So it’s not surprising so many are leaving the profession.
More dentists leaving to go private has a knock-on effect on the remaining NHS dentistry staff, who become burnt out and jaded. This was made worse by Covid restrictions forcing dentists to pause their work, which created a backlog of patients — who now need more treatment than they would have done if they had been seen during the pandemic.
A spokesman for the Department of Health and Social Care said the Government is ‘working closely with the NHS to reform the dental system, and negotiating improvements to our contract with the British Dental Association’.
As for Natasha Wakefield, her DIY dentistry with garden pliers, though terribly risky, seems to have paid off.
‘Within half an hour the pain had gone,’ she says. ‘What was I supposed to do? I couldn’t afford the charges. I lived in pain for almost a year.
‘I never thought I would have to do something like that. It’s so wrong. I’ve always worked, I’ve paid my taxes. But where is it all going when you can’t even get a dentist?’