On a bracing winter morning in early December 2018, I’d taken the train from London to Winchester. The Hampshire cathedral city isn’t somewhere I know all that well, though what I’d heard – genteel, stolidly middle class, relentless topper of “best places to live” lists – certainly didn’t have much to do with poverty.
It wasn’t long until a more complex picture emerged. I’d arrived to shadow the dental charity Dentaid, whose helpers had parked their mobile treatment van outside a local homelessness centre, where a steady queue of people had already formed. Some of those I spoke to confessed to being so desperate for treatment that they’d resorted to their own brand of “DIY dentistry”. That meant precisely what it sounds like. Self-administered dental care – including extractions and fillings – applied without proper anaesthetic or professional training. This was simply reality for the rapidly growing number of people across the country who had found themselves locked out of affordable dental healthcare.
Though shocking enough then, the situation has only worsened over the intervening years. Certainly, the onset of the pandemic didn’t help matters. During the first national lockdown, 25% of UK households resorted to some form of DIY dentistry (ranging from toothache remedies to full-scale extraction), while Boots reported spectacular sales for its at-home dental kits. The sharp, surreal dislocations of spring 2020 caused existing conditions to worsen and stretched NHS waiting lists even more. It’s a situation that has shown few signs of improvement since. Recent horror stories abound. The middle-aged woman who took superglue and metal files to her mouth after 12 months waiting for NHS treatment. The man in Suffolk who couldn’t take the pain any more, before ripping two teeth out by hand. From the same county, the woman who removed at least five of her own teeth after a series of unfortunate accidents, and likely cannot afford £2,000 for a set of new dentures.
It isn’t news that the UK is facing an urgent crisis in dental care. Though, like so many other issues, its severity depends on who you are, and where. For those who can afford private treatment, stories like those above are likely to remain a gruesome abstraction. For the huge numbers of people who can’t, the threat of DIY dentistry is a looming concern. This isn’t hyperbole. We live in a country where the phrase “dental deserts” has somehow become part of the public discourse. Where whole areas of one of the world’s richest nations have no affordable dental care provision at all. According to the Association of Dental Groups, only a third of adults in England have access to an NHS dentist. For children, that figure comes in at less than half.
The choice is stark for ever-increasing numbers of people. One Welsh mother of two put it succinctly, in conversation with the BBC. There was no question of being able to afford the £1,000 a private root canal would have cost. Instead, she went for the vastly cheaper – though entirely preventable – extraction. With the steep rise in household bills, it was literally a choice between saving her tooth and heating the family home.
The intensity and scale of the problem are becoming impossible to ignore. Dr Nigel Carter is CEO of the Oral Health Foundation. “It is an awful situation for many that they are in such pain to even contemplate undertaking DIY dentistry at home. We do not advise [it] apart from very short-term fixes with temporary fillings,” he says. The foundation is “calling on the government to increase funding for dentistry and dental training to help ease the burden and provide better dental care for the public”.
Both are desperately required. Last week, the British Dental Association released the sobering results of a major new survey of high street dentists in England. Nearly half of the 2,204 respondents admitted to having heavily reduced their practices’ NHS commitments, while 75% said they would reduce, or further reduce, their own offering. About 3,000 dentists in England have moved away from NHS work entirely since March 2020, with the BDHA warning of an “unprecedented” collapse that could lead to the end of the service, barring significant government intervention. This isn’t due to indifference from practitioners. Nor did it happen overnight. Years of disinvestment (it would take £880m a year just to restore services to 2010 levels) and neglect have led to this point, combined with the lingering effects of the long-discredited 2006 NHS dental contract. Under its terms, dentists are paid a flat fee, no matter how long the treatment. One filling pays the same as 10, disincentivising more “difficult” work. Though change has long been mooted, nothing approaching a concrete solution, or timeframe, has been confirmed.
In the weeks after my 2018 visit to Dentaid, I remember thinking that the situation I’d seen surely had to represent some kind of nadir. That the reality of so many people waiting for basic, often urgent, treatment wouldn’t be allowed to continue unchecked. And that surely, the idea of others being forced into the medieval-sounding “solution” of DIY dentistry couldn’t be tolerated in any country that valued the health of its citizens. I was naive. Back then, Dentaid only had one mobile dental unit. According to a recent report, it is now about to add a fifth.