Could your dentist be destroying your teeth?

What a shock it was when, in the autumn of last year, an X-ray revealed that many of my teeth were dangerously loose, as a result of chronic gum disease. Despite my regular appointments with an NHS dentist, the disease had got worse over the years.

Even after the X-ray showed that some of my molars were at risk of falling out, my dentist said the NHS was unable to treat me. Frightened that at 36 I was facing a toothless future, I sought a second opinion from a private dentist, Dr Mervyn Druian. He confirmed I had advanced gum disease – and grounds for legal action.

“Your dentist was neglectful,” said Dr Druian, whose practice is based in north London. “You should never have been left to get into this situation.”

Dr Druian referred me to a private periodontist (gum specialist), with whom I had successful dental surgery last month. But I was left wondering why I wasn’t able to be treated on the NHS - and why nothing was done to stop the disease developing in the first place.

I’ve since discovered that I am not alone in feeling let down by my dentist, and by an NHS dental contract which, it seems, is open to abuse by dentists.

“The system isn’t fit for purpose,” says Chris Dean, director of the Dental Law Partnership, which pursues claims against negligent dentists and whose recent survey revealed that one in four of us is unhappy with our dental care. “The pursuit of money has been prioritised and resulted in manipulation of the system to maximise the dentist’s income. This is minor fraud on a massive scale.”

One problem is the shambolic payment system introduced under the current contract, brought in by the Labour government in April 2006. Salaried on a complex system of “units of dental activity,” dentists are allocated a certain number of units annually by NHS England. If a dentist has used up all their units, they are no longer guaranteed payment for carrying out NHS treatment.

Catriona Vine, 39, a London barrister, discovered this to her cost in December 2010, when three of her teeth broke. Exempt from all charges on maternity grounds, she needed crowns on each, but her dentist refused to fit them on the NHS. “He was vague about why he could not, and tried to persuade me to have them done privately, at £400 each,” she recalls.

Her dentist was in breach of his contract, according to Dean. “If you have used up all your NHS units you have to be absolutely transparent and tell the patient that NHS treatment is available elsewhere,” he says.

When Catriona threatened to complain, her dentist reluctantly agreed to do two crowns on the NHS, staggered over a period of two months. But he refused to do the third, which she eventually paid him the £400 to do privately. “It would have been helpful if he’d referred me to a colleague who could have done it on the NHS instead of treating me like an annoyance,” she says.

Before 2006, NHS dentists were paid according to the treatment they gave each patient. But now treatments are banded. Band one costs the patient £18.50 and includes a general check-up, scale and polish. Band two costs £50.50 and covers gum disease treatment, root canal treatment and tooth extraction. Band three costs £219 and treatments include crowns and dentures.

But although every treatment in each band is worth the same number of ''dental activity’’ units – and therefore the same amount of money to a dentist - some treatments take far more time to carry out than others.

“If you have a tooth with a hole in it, and a nerve inside that is dying, you can save the tooth with root canal treatment or you can take the tooth out,” explains Dean, a dentist who practised for more than 20 years. “Root canal treatment takes 90 minutes; extracting a tooth takes 10. Both treatments are in band two, so the dentist tells a patient the tooth needs to go. The system and dentists’ human frailty is combining to produce a nation where we all have gaps in our teeth.”

This is what Ian Lisle, 52, a tyre fitter from Oldham, believes happened to him. In 2005 Ian’s NHS dentist told him he’d have to have a decaying tooth extracted. Within three years he’d had a further six taken out.

“I couldn’t understand why I suddenly had to have so many removed,” he says. It seems that his dentist had failed to treat Ian’s decaying teeth, deciding simply to remove them instead. “It would have taken him much longer to carry out root canal treatment,” says Ian. “Extracting my teeth could be done far more quickly.”

He realised how neglected his remaining teeth had been when he saw a private dentist about the possibility of having implants. He decided to take legal action against his NHS dentist.

“Having missing teeth made me feel really self-conscious,” says Ian, a father of two daughters aged 24 and 19, who lost a total of 11 teeth. Last April he received £42,500 in an out of court settlement.

He has since spent the entirety of his pay-out on eight dental implants. “The industry isn’t regulated,” he claims.

All dentists have to register with the General Dental Council, and an independent regulator carries out inspections. Last year England’s regulator, the Care Quality Commission, inspected 44 per cent of the estimated 10,000 NHS practices in England. Next year, however, it intends to inspect only 10 per cent. A spokesman for the CQC said the proposed decline was due to the “lower risk from dental care”.

But the Dental Law Partnership has seen a 90 per cent increase in new claims in the past year alone, with failure to diagnose gum disease among the primary causes for legal action.

My gums first became inflamed in 2010. Brushing and flossing seemed to make no difference – they would bleed when I bit into something as soft as a banana. As I learnt later, the plaque in my mouth containing bacteria had hardened into tartar and over the next few years my mild gum disease (gingivitis) became the more severe form called periodontitis. This is when bacteria turns into a solid matter called calculus which forms “pockets” below the gum line, forcing the gum away from the tooth and attacking the bone underneath, eventually leading to tooth loss.

I’ve since learned that people susceptible to gum disease should see a dental hygienist every three to six months, to scale their teeth of tartar before it reaches this stage. “If your gums are bleeding this should take a minimum of half an hour,” says Dr Druian. “Hygienists are available on the NHS and you should have been offered one.”

But I wasn’t. And despite visiting an NHS dentist at least once every six months since 2010, and often voicing concern about my increasingly swollen and bleeding gums, I was only ever given a cursory 10-minute scale by the dentist herself, along with a recommendation to use a mouthwash and advice on how to brush and floss my teeth.

After growing dissatisfied with my dental practice, in 2012 I joined another NHS practice nearby – only to discover similarly low standards. Last year a dentist at this second practice said she could clean my teeth on the NHS but it “wouldn’t be very good”, and encouraged me to pay her £70 to do it privately. According to Chris Dean, this was a breach of her NHS contract and professional misconduct.

When the X-ray I had last summer (done not because of my suspected gum disease but because the same badly designed filling had fallen out six times in less than three years) revealed that my teeth were loose, the second dentist recommended I have root planing. Under local anaesthetic, the calculus would be removed from the roots of my teeth beneath my gums with ultrasonic scalers and hand instruments. She said the three-hour process was not available on the NHS – I would have to pay her £600 to do it privately.

But that is incorrect: the treatment falls into the second tier of NHS dentistry’s three-band treatment and should have cost me £50.50. If a treatment is available on the NHS, to deny that treatment and offer it only as a private option is a breach of contract.

Because the majority of NHS dentists also offer their services privately, the temptation either to tell patients NHS treatment is not available or to persuade them to choose a better, private service – under which prices are not regulated – must be enormous.

NHS England denies the system isn’t working. Dr Barry Cockcroft, Chief Dental Officer for England, says: “There is no evidence to suggest the current system is leading to patient neglect, or to a growth in the number of extractions. Dentists are regulated health-care professionals and in the overwhelming majority of cases always do what is right for their patients.”

The British Dental Association (BDA), however, says dentists themselves are unhappy with the current system of funding. The chair of its general dental practice committee, John Milne, says: “While many dentists would like to treat more patients on the NHS, their ability to do so is restricted by the contracts NHS commissioners are willing to provide.

“The government determines the amount of money spent on dentistry and in a cash-limited system it needs to be honest with the public and the profession about what treatments the NHS will provide and how many patients can be treated. Greater clarity is needed to avoid confusion and conflict.”

The flaws of the current system of delivering NHS dental care have been well documented by dentists, patients’ representatives and politicians, adds Dr Milne. Although reform of the dental contract is under way, progress, he says, has been painfully slow. “The vast majority of the profession quite rightly put the interests of their patients first, despite the inadequacies of the current system.”