This crisis needs more than pliers and Polyfilla

The parlous state of NHS dentistry points to a wider malaise that could play into Tory hands

Nick Cohen
Sunday October 21, 2007
The Observer

The British media only know one thing about a novelist – and it is never his novels. Several years ago, the one fact the press mentioned about Martin Amis was that he had spent £20,000 on getting his teeth fixed in New York.
He needed to. The scenes of dental agony in his autobiography Experience are up there with Marathon Man. ‘My lower teeth are merely very poor,’ he remembers telling the private dentist who ended the pain. ‘But my upper teeth… I have a bridge that runs from ear to ear. All that is keeping it in, as far I can tell, is habit.’ In the index, ‘Martin Amis: dental problems’ refers the reader to 60 of the 380 pages. Amis told an interviewer that bad teeth ‘had dominated my life. I would be very much failing in my capacity as a writer if I didn’t go on about it a very great deal and by Christ, I’ve left 80 per cent of it out’.

Journalists being the way we are, the press didn’t want to know about his suffering. Vanity, not necessity, made Amis give thousands to a dentist, the gossip columnists insisted. The Daily Mail remembered that he had once said that serious writers turned to the US for inspiration as Britain no longer led the world in anything except decline. His dental work crowned his treachery, it said. Even his teeth were American.
At the time, naive readers may have believed the stories. In the Nineties, the trouble for those who could find NHS dentists was not persuading them to start drilling but asking them to stop. Dentists claimed piece rates from a Byzantine charge sheet of 400 different fees. The greedy made money by doing as much work as possible as shoddily as possible, regardless of whether it was needed. In 2000, researchers from the University of Wales estimated that of 1.1 million root fillings done in a year, 90 per cent failed to meet European standards. In almost half the operations, dentists left holes in the fillings. In one case in 20, they didn’t bother with even partially filling the cavity and left it empty.

Meanwhile, the regulatory system might have been designed to discourage whistleblowing. Along with the omerta found in all trades, NHS dentists had gagging clauses in their contracts. So it is impossible to say if the few who were disciplined at the time were monstrous rarities or simply unlucky to have been caught. Whether he was an exception or the rule, Melvyn Megitt confirmed nervous patients’ worst fears when the General Dental Council struck him off in 1999. The council heard that he deliberately snapped the braces of patients to ensure they needed more treatment.

Most barely had time to settle in his chair before he had finished drilling and jabbing. In one year, he had earned £600,000 by seeing 150 patients a day. Stewart Molloy was equally energetic. The council struck him off in 2000 for giving a man who came in complaining about a cracked tooth 18 unnecessary root canal procedures.

To its credit, Labour has been a reforming government. After the Audit Commission concluded in 2002 that ‘the current system also offers a perverse incentive for dentists to carry out work which is unnecessary or cosmetic’, ministers intervened. They cut the hundreds of charges back to three. There never was a golden age when dental care was free at the point of delivery to all. However, Labour did try to revive NHS dentistry. It recruited 5,000 more dentists and increased funding by 40 per cent.

Why then last week did a survey of 5,000 patients produce grotesque stories closer to Marathon Man than Experience, of people pulling out their teeth with pliers or filling cavities with Polyfilla? ‘Because it was easier than finding a dentist,’ explained one patient or, rather, abandoned patient. ‘Because I could not afford the cost,’ said another. Ten per cent weren’t registered with a dentist; 20 per cent were registered but missed treatment because of NHS charges.

These are small by private standards, but £194 for construction work remains a lot of money to people on modest incomes. Their number does not, of course, include dentists, who increase their earnings by cutting back on NHS work and urging their patients to go private. To be fair, they often have no choice. When the a dentist runs out of his quota of money for NHS work, he has to work privately or wait for the next financial year.

My colleagues on the paper’s health desk urged me to see Henrik Overgaard-Nielsen, ‘a radical dentist in Fulham’. I was alarmed. I like radicalism in most things, but at the dentist’s, I’d rather have a quiet traditionalist. Fortunately, Overgaard-Nielsen’s radicalism consists of a solid commitment to the NHS. He explained that the old perverse incentives have been stood on their head.

‘Middle-class Observer types with good teeth are now the ideal patients. Dentists make money now by telling a patient his teeth are fine and moving on to the next one. It’s poor patients with problems few of us want,’ he says. Overgaard-Nielsen stands out because he doesn’t turn people away. Patients come from as far away as Yorkshire.

Stories of people taking pliers to themselves or travelling half the length of England to find a dentist prepared to help them may not bother those of you who have never had to worry about your teeth. But the future of the liberal-left in Britain depends on them and stories like them stopping. They matter far more than whether there is a referendum on the European treaty – which, rightly or wrongly, few care about – or which unknown becomes the leader of the Liberal Democrats – which, rightly, interests even fewer.

If in dentistry as elsewhere, huge increases in spending fail to produce huge improvements in services, the Conservatives or Conservative policies will triumph over social democracy. Voters will prefer to keep their taxes rather than have the government spend them on their behalf. Like Martin Amis, they will conclude that the British state can’t help them and look elsewhere.