Public dentistry versus private

A common theme of the feedback I’ve via email and comments on my dental situation is that many people tend to plump for public dentistry bad, private dentistry good.

It’s a tempting division to fall back on, especially if you have a particular political axe to grind but I’m not convinced it’s entirely true.

Certainly, my most recent experience of NHS dentistry has been appallingly bad with the dentist stopping midway through root canal treatment, then booting me out the door to await further treatment at an NHS dental hospital at some future and indeterminate date.

But would my treatment have been any better if I’d been a private patient of the same surgery?

I would have been treated in the same run-down surgery, by the same staff using the same slightly dilapidated equipment (drills and suction have both broken down when I’ve been treated there).

If the dentist genuinely couldn’t finish the job as it was beyond her skills and equipment, then it would not have mattered if I was an NHS or private patient.

I suspect the only difference would have come after the point at which she stopped.

As a private patient I would almost certainly have been seen at another surgery far sooner than has been the case with the NHS.

The rest of the treatment would have been the same.

However, it would be wrong to judge NHS dentistry entirely on this one experience and, as it happens, I have a lot of experience with both public and private dental care.

When I first moved to the UK almost 15 years ago, my first encounter with NHS dentistry was truly horrific.

I had a filling come loose and went to the East London dentist the system assigned me to.

His surgery was falling apart, his equipment was ancient and worn (chrome worn off the chair, foam spilling out of the ruptured seams, paint worn off the equipment which didn’t work) and the surgery was filthy.

The dentist himself stank of alcohol while his attitude and skills were clearly beyond help.

After the initial examination, I never returned for the filling to be redone and fortunately moved to another part of London where I was registered with a new dentist. I later found out the first one had been struck off due to numerous complaints.

After that, things were on the up.

My next NHS dentist, in south London, was on a par with the surgery I now attend in Aberdeen in terms of equipment, ie it had seen better days.

But, the London surgery was spotless, the staff were excellent - understanding, welcoming and skilled, and the equipment always worked.

I might have had to wait four weeks for treatment after the initial appointment but I felt that was reasonable.

Then I went to work for a major corporation that had a tiered medical plan for staff - the higher up you went, the more money could be spent on you and the more things you’d be covered for.

When I needed wisdom teeth removed, I was put into a very, very expensive private hospital in London (my room had an en suite, looked nothing like a hospital room and would get five stars if a hotel).

I was seen by one of the top facio-maxillary surgeons in the UK and generally treated like royalty. I have to say it did leave me slightly uncomfortable but I certainly could not fault the speed at which I was treated or the quality of the care.

I then changed jobs and joined the BBC. I didn’t have private dental cover, but the BBC had an dental surgery on site in West London so I registered with them as they provided both NHS and private dentistry.

The surgery had facilities and equipment that were cutting edge and only a fraction behind the private facilities I’d seen in the UK and back in Australia, while the staff were excellent again.

There was a short wait for NHS treatment, but again I didn’t mind that.

Then it was back to corporations with tiered medical and/or dental plans for staff.

My particular plan meant not only thorough check-ups every six months, but also two free sessions a year with a dental hygienist, good quality white fillings in any tooth (unlike the NHS which only offers them at the front), plus good crowns and bridges if needed.

People further down the line got a check-up once a year, subsidised but no free sessions with the hygienist, and subsidised good quality white fillings, crowns and bridges. Basically, they paid NHS fees or just above, but received superior work and more time.

I still find it uncomfortable that staff at the bottom get limited plans that are only a little better than the NHS in what they cover - even if treatment is faster - while middle managers get more comprehensive cover and senior management get the works - often free.

Next, I moved out of London, first to Oxfordshire and then to North Yorkshire.

It was back to the NHS again, where I found the surgeries were much better than in London, the staff were very good to excellent, and the waiting times only a week or two longer.

Again, I was happy with that.

But then came the move to Scotland where I’ve found huge waiting lists to be registered with an NHS dentist, where children and pregnant women (who are supposed to be treated free) can’t even get to see an NHS dentist, where the wait for treatment (after you’ve finally found a dentist) can be two years or more, and where NHS dentists openly recommend private dentists to you if you want better or faster treatment (and I’m not the only person this has happened to).

So, I don’t think private dentisty is necessarily better than public in providing good quality, basic dentistry although, crucially, it does improve the access time.

Where private dentistry does steam ahead is in providing the privileged few with virtually instant access to treatment, access to the top people in their field and amazing facilities.

If you’re lucky enough to have substanial wealth of your own or access to vast corporate coffers, then you can not only be treated - but overtreated to the hilt.

Public dentistry on the other hand really falls apart when it becomes the underfunded captive of bureaucracy and Stalinist target-setting, while also serving as a refuge for the less skilled, less trained, less competent or, in a few cases, the total bunglers.

Personally, I was more than happy with the NHS treatment I received at all but one surgery in England; astounded but left a little uncomfortable by the extraordinarily privileged treatment I sometimes received as a private patient; and left disgusted by my experiences of NHS dentistry in Scotland.

I wouldn’t like to see an entirely or largely private system as it would leave even more people without dental care than it does now, but I do think public dentistry (like so many spheres of the public sector) needs a thorough clearout at all levels and particularly the top, a fundamental reorientation towards the patient and not the bureaucrats, and a tight focus on good quality and timely preventative and basic corrective dentistry.