You and Your Dentist

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You and
your dentist
a guide for
patients
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Contents
Introduction 1
Frequently asked questions 2
Glossary 11
Useful addresses 14
This booklet is supported by an educational grant from

Introduction
Going to the dentist is not like going to the doctor. Most people only
go to the doctor when they are unwell, whilst most people who visit
their dentist are well and have no symptoms. This can mean that a
visit to the dentist is low on some people’s list of priorities. Anxiety
and fear about going to the dentist can also put people off making
the appointment. Some people do not know how to find a dentist,
whether to be treated on the NHS or privately, what kind of service
to expect from the dentist, what treatments are available, and what
to do if something goes wrong.
The Patients Association believes in patient choice but you can only
decide what is right for you and your family by having access to
accurate and independent information. This booklet aims to answer
the most common questions about dentistry and to help you to
make informed choices about your dental care.
Over the past 30 years, dental health has improved considerably.

In 1968 about 20% of adults had no natural teeth left. By 1998, this
figure had dropped to only 8%. More comfortable treatment,
fluorides in water and toothpaste, and a greater awareness of the
benefits of healthy teeth have all contributed to this change for the
better. Nevertheless, there remains room for improvement.
According to government figures, only about 50% of us visit a
dentist regularly. Thirty per cent go irregularly or only when in pain
and 20% do not visit a dentist at all.
With regular visits to the dentist, a healthy diet and good self care,
most dental disease is preventable. Maintaining the best dental
health for life is the objective of modern dentistry. We hope that this
booklet helps you and your dentist to achieve this goal.
1
Frequently asked questions

How many dentists are there in the UK?
There are about 30,000 dentists registered with the General
Dental Council in the UK. Of these, about 18,000 work in
general practice and about 4,000 work in hospitals,
community clinics, educational establishments and
such like.
Why is dentistry not ‘free at the point of delivery’?

When the NHS was set up in 1948, there was a nine month
period when dentistry was genuinely free. However, the
government at the time had grossly underestimated the
number of people who would seek dental treatment and
so began to charge patients a flat rate of £1.00 for all regular
dental treatment. Since then, dentistry has always
maintained a fee structure.
How do I find a dentist?

Most people find dentists by asking family, friends,
neighbours or colleagues for a recommendation.
Alternatively, you can look in the Yellow Pages where
dentists practising in your area will be listed, or you can
contact NHS Direct (see Useful addresses) or your local
Health Board in Scotland which will have a list of NHS
dentists in your area. Lists of both NHS and private dentists
are available from public libraries. If you have special needs
(for instance if you are very frightened of seeing a dentist
or if you need a particular specialty) you can call the British
Dental Association or the British Dental Health Foundation
or visit their websites. Both these sites have a search
facility to enable you to find a dentist in your area (see
Useful addresses).
What should I look for in a dental practice?

It is a good idea to visit the dental practice you are
interested in before you register. A good practice should be
clean and tidy and the staff courteous and welcoming. Ask
whether NHS and/private patients are accepted and what
treatments are available. A good dentist will ensure that
regular check-up or treatment appointments are available
within a reasonable time and that emergencies are normally
available within 24 hours. Out of hours emergency cover
should be available. Opening times should be broadly
convenient for patients.
2
The dentist should be friendly and communicative. He or she

should put you at your ease, listen to your concerns and discuss
any questions you may have. Treatment options should be outlined
and the risks involved explained. Cost implications should be
addressed openly.
Examinations should be thorough and should include your teeth,

the condition of your gums and examination of the mouth lining.
Any previous medical or dental conditions or problems should be
taken into consideration.
Plans for future treatment should be written down for you in certain
circumstances or on request.
The roles of other staff in the practice, such as dental hygienists

or health educators and their part in your treatment, should
be explained.
Good dental treatment should be unhurried, caring and as gentle

as possible. There should be committed attention to pain control
during and after treatment.
How do I find an NHS dentist?

NHS Direct (see Useful addresses) or your local health board in
Scotland will have a list of all the NHS dentists practising in
your area. They should be able to provide you with a list of
names of addresses but they will not be able to make any
recommendations. You can also look in Yellow Pages where
some NHS dentists advertise.
Do I have a right to NHS treatment?

There is no obligation for dentists to offer you NHS services even
though they are included in a health authority’s dental list. Dentists
are independent practitioners who are free to choose whether they
accept NHS patients, private patients or both. Once you have found
an NHS dentist who will accept you as an NHS patient, then the
NHS will contribute to the cost of treatment you receive. Once you
have been accepted and have registered with your dentist, you are
entitled to receive NHS treatment from the dentist you registered
with for the registration period of 15 months. If your registration
lapses (usually due to non-attendance) then the dentist can decide
whether to accept you for NHS treatment again.
3
Is it difficult to find an NHS dentist?

Over the past few years in many areas of the country, some
dentists have reduced their NHS commitment. However,
more than half of the family dentists in the UK are still
seeing three quarters of their patients under the NHS
so NHS dental treatment is being provided. If you have
difficulty finding an NHS dentist, ask NHS Direct or your
health board for help.
What if I can’t find an NHS dentist

and need treatment urgently?
NHS Dental Access Centres have been established in many
areas. These offer NHS treatment and their priority is the
treatment of emergencies and seeing those patients who
are unable to access NHS care elsewhere. You can find
your nearest Dental Access Centre by calling NHS Direct
(see Useful addresses). NHS Dental Access Centres only
provide emergency treatment during normal working hours.
Out of hours this is provided by the Emergency Dental
Service. Contact NHS Direct for further information.
How do I find a private dentist?

Unlike NHS dentists, private dentists are not listed with
NHS Direct. Personal recommendation is usually the best
way to find a private dentist or you can look in Yellow Pages
where private dentists will often advertise. Some companies
offering dental plans keep listings of dentists who are
registered them. You can also look at the websites of
the British Dental Association, the British Dental Health
Foundation or Denplan (see Useful addresses).
How do I find a specialist?

If you have special needs, your own dentist should be able
to refer you to a specialist if he or she does not offer these
services themselves. Alternatively, you can contact the
British Dental Assocation who will be able to help you
(see Useful addresses).
Can I go to any dentist?

Yes you can. Dentists, unlike doctors, do not have a
catchment area. If you are registered with a particular
dentist and move out of the area, you do not need to change
your dentist if you do not want to. It may be more
convenient to register at a dentist near your work.
4
Can I mix private and NHS treatment?

Yes you can. All dentists in general practice are free to provide
treatment to patients either on the NHS or privately. This does
not apply to dentists employed by health authorities in Dental
Access Centres or clinics. Discuss the options with your dentist
before you embark on treatment and obtain a written statement
outlining which treatment is provided under each system and
the associated cost.
Can I have any sort of treatment on the NHS?

No. There are some treatments, particularly some cosmetic
treatments, that are not available on the NHS. You are entitled to be
offered the treatment necessary to secure and maintain your dental
health as an NHS patient. This does not necessarily encompass
any kind of treatment. The individual dentist will advise you on
what treatment is available on the NHS to ensure your dental
fitness. They may also suggest alternative treatment under
a private arrangement.
How much does NHS treatment cost?

The following figures are meant as a guide. They are correct until
31st March 2002. The actual amount may vary according to the type
and amount of treatment provided.
• Check-up £ 5.12
• Check-up and 2 small X-rays £ 8.64
• Check-up, scale and polish £ 13.20
• Check-up, 2 X-rays and a scale and polish £ 16.72
• Filling (silver in back tooth - large) £ 14.08
• Filling (white in front tooth) £ 10.28
• Extraction £ 9.16
• Crown (precious metal) £ 70.72
• Dentures (full set upper and lower) £ 111.16
• Maximum NHS charge £ 360.00
Who has to pay for treatment?

Everyone has to pay unless they are entitled to free treatment.
People exempt from paying NHS dental charges include:
• Children under 18 years of age;

• Young people under 19 in full-time education;
• Women who are pregnant or who have a child under 12 months;
5
• Anyone receiving Income Support or Job Seekers

Allowance. Some people receiving Working Families Tax
Credit or Disabled Persons Tax Credit may be also be
entitled to free treatment;
• Families with a certificate for full help with the cost of
NHS services.
Pensioners, the unemployed or students are not

automatically entitled to free treatment unless they come
under one of the above categories or if they can claim for
help with charges because of low income. You should ask
your dentist or the receptionist for an HC1 form or pick up
an HC11 form entitled Are You Entitled to Help with Health
Costs? These are available from post offices.
Who sets charges for NHS dental treatment?

The Government sets NHS dental charges. Patients who
are not entitled to free treatment from the NHS have to pay
80% of the cost of treatment up to a maximum of £360.00
(up to 31st March 2002 - this figure is reviewed on an
annual basis).
How much does private treatment cost?

Private fees are set by each individual dentist. There are no
national guidelines to regulate the cost of private dental
treatment. Private fees are a contractual matter and must be
agreed between the dentist and the patient. Your dentist will
explain to you before treatment starts what the fees are and
how they are calculated.
Why are there variations in the price

from one practice to another?
Private charges will relate to the overheads of the dentist
and to the variety of treatments available. Costs may vary
across the country and may reflect the differences in
expenses from one area to another.
What can I expect to get for the extra money

I am paying to my private dentist?
If you choose private treatment your dentist may be able to
offer you a wider range of treatments than can be obtained
with NHS services. This is particularly true of cosmetic
treatments such as white fillings or porcelain crowns on
back teeth that are not available on the NHS.
6
Private care should also mean that your dentist has more time
to spend with you and can therefore provide you with a more
personal service.
How can I tell that private dental treatments

offered to me are what I really need?
Everyone has individual needs and a good dentist should give you a
full explanation of what has been found when your mouth is
examined. A discussion should then take place between you and
your dentist looking at the treatment options and costs. You can
then agree a treatment plan with your dentist proceeding only once
you completely understand, and are happy with, what is proposed.
It is a useful practice to ask for a written treatment plan so that
you have a record of what has been agreed and how the treatment
will proceed.
Are there any controls on dentists?

All dentists, both NHS and private, are regulated by the General
Dental Council (GDC). They must abide by the GDC’s guidance on
professional and personal conduct, Maintaining Standards.
In recent years the NHS has introduced Clinical Governance which

requires all dentists to consistently review the quality of their work.
They do this through regular updating at courses, through ‘peer
review’ where they compare their results with other local dentists,
and by clinical audit where they measure the quality of the results
they obtain in their practice. This currently only applies to
NHS dentists.
Some private schemes and the British Dental Association now also
provide accreditation for dentists. In general, accreditation means
that the dentist has undertaken to meet certain professional
standards and, in some cases, has agreed to be regularly inspected.
Denplan’s Excel accreditation scheme operates throughout the UK

and accredited dentists must agree to thorough annual inspection of
their practice to standards approved by the Patients Association.
Patient records are also reviewed for good treatment and patients
are given an ‘Oral Health Score’ which measures the continuing
health of their mouth and ensures thorough examinations. Patients
are also regularly consulted for their views about the services
provided by the accredited dentist.
7
What does the dentist expect from me?

You should try not be late for your appointment and, if you
are unable to keep an appointment, give the dentist good
notice. Dentists often have to work to tight time schedules
and if you are late, or miss an appointment, this will almost
certainly inconvenience other patients and result in a direct
loss of income to the practice and its staff. Dentists may
charge for appointments missed without good notice.
This applies to NHS and private practices.
Do explain your dental problems to your dentist as clearly

as you can. This helps your dentist to make the correct
diagnosis. It may help to write this down in advance.
If you are taking medicines or having other treatment, let the

dentist know and take along any medicines of which you are
unsure of the name or purpose to show your dentist.
If you are very nervous, let the practice know in advance.

They will be sympathetic and will have the opportunity to
allow extra time for you.
Dentists often operate out of hours schemes which they may

organise themselves or there may be a local rota or one
operated by the NHS. Only contact the dentist out of hours if
there is a genuine dental emergency and bear in mind that
certain treatments can only be carried out during normal
hours when support staff are available.
How do I complain if I am dissatisfied with the treatment

I have received from my NHS dentist?
If you have a complaint about the treatment you have
received from an NHS dentist, discuss this first with the
dentist who may be able to resolve the issue. The services
of a Dental Reference Officer may be used. A Dental
Reference Officer is an official dentist who can examine
patients and assess the quality of completed work. Your
NHS dentist can arrange this examination.
If you are not satisfied with the result you can ask the health
authority for an independent review.
In serious cases a Complaints Panel may be convened to

hear the complaint formally and, ultimately, the Health
Ombudsman may hear appeals against a decision of the
Panel. These bodies may order a refund of NHS fees paid
8
and must publish their findings, in confidence, to you and

your dentist.
In particularly serious cases, a complaint may be brought to the

General Dental Council. If the Council’s conduct committee finds
a dentist guilty of a serious professional misconduct, the dentist’s
professional registration may be suspended or erased. The Council
cannot, however, order compensation or repayment of fees.
Do ensure that you make your complaint in writing and that you
keep notes of face-to-face discussions and telephone conversations.
You may wish to have somebody with you when you make your
complaint to help you make notes. Remain calm and polite but do
be firm and persistent.
For further information ask for the Patients Association’s booklet

Making a Complaint.
How do I complain if I am dissatisfied with the treatment

I have received from my private dentist?
In private practice, complaints should firstly be brought to the
attention of the dental practice concerned. Some dental plans,
such as Denplan, may help to look into complaints if they are not
resolved at practice level but they do not have powers to compel
dentists to provide solutions to issues. Such plans can, however,
exclude offending dentists from their accreditation schemes.
Otherwise, private patients will need to take their case to law. In the
first instance you should seek advice from a Citizens’ Advice Bureau
or consult a solicitor. Bear in mind that legal actions may be
expensive to bring and can take considerable time to conclude.
For further information ask for the Patients Association’s booklet

Making a Complaint.
Can I get a second opinion?

Sometimes you may want to obtain a second opinion about your
condition or the treatment recommended by your dentist. You may
wish to arrange to see a dentist who specialises in the particular
problem, either working in a specialist practice or in hospital.
See How do I find a specialist, page 4.
How are private dentist’s fees structured?

Private fees should always be explained in advance of commencing
any work. Many practices have a list of typical private fees. Private
9
fees may be charged for in three ways:
• Fee per item: each type of treatment or care has its

own price;
• Fee for time: charges are related to the time taken for
the treatment: some materials costs may be charged
in addition;
• Capitation: most dental plans, such as Denplan, charge a
fixed monthly fee which varies according to the amount
of work expected to be needed by a particular patient.
The monthly cost is predictable and covers most routine
work (usually not cosmetic work or implants).
In most cases, prescriptions and laboratory fees (for crowns,
bridges or dentures, for example) are charged for separately.
What methods are available to me to pay

for private dental treatment?
You can pay directly to the practice for each course of
treament. Most practices will ask you to settle your bill as
each stage of treatment is carried out.
Another option is to take out dental insurance. A regular

premium is paid, usually monthly or yearly, and when
treatment is needed a claim form must be obtained, filled in
and returned to the insurers with the dentist’s bill. It is
usually necessary to pay the dentist yourself and then claim
back the cost.
Make sure that you read the terms and conditions of the
insurance in advance before completing your application
and check with your dentist how much of his or her fees
would be covered by the insurance. Check your policy for
any exclusions such as problems evident at the time of
taking out the insurance.
Another option is dental loans - some practices can offer

special loan arrangements run by financial organisations
tailored to cover the costs of dental treatment.
Can I gain access to my dental records?

You have a legal right of access to your dental records,
subject to certain rules. The dentist must give access within
40 days of a request for access from the patient. Patients are
also entitled to copies of records, again subject to certain
10
rules. Dentists may charge a reasonable administration fee for

copying records.
Can I take my records from my old dentist to my new one?

No. Original dental records are normally kept by the dentist who
carried out your treatment. It is a legal requirement for the dentist to
keep your records for a certain period of time.
A new dentist will make new records for you relevant to his or her
diagnosis and appropriate to the treatment undertaken.
Can my dentist give me a general anaesthetic?

Only doctors who are specialist anaesthetists can give dental
anaesthesia.
Where can I get a general anaesthetic for my dental treatment?

You may be given a general anaesthetic in hospital
or at a specialist clinic.
Glossary
Abscess
An abscess is an infection located at the root of a tooth. Abscesses
are very painful and, if not treated with antibiotics, draining or
apicectomy, can lead to the loss of the tooth.
Apicectomy
An apicectomy is the process by which the dentist cleans out an
abscess at the root of a tooth. This is normally carried out on a
tooth that has already been root-filled.
Bleaching teeth
The colour of teeth can be lightened with hydrogen peroxide
(bleach). Tooth bleaching is completely safe as long as your
dentist’s instructions are followed.
Bridges
A bridge replaces a missing tooth (or teeth) by fixing the
replacement to the natural teeth at each side of the gap. Bridges
are made of metal and porcelain or sometimes just porcelain.
Chronic peridontitis
This is next stage on from gingivitis (see entry). Some of the
bone that supports the teeth is lost due to gum disease which
may cause the teeth to have to be taken out. This condition may
be avoided or treated by good oral hygiene and root planing
(see entry).
11
Crowns
A crown completely covers a weak tooth above the gum
line. Crowns are made of metal or porcelain, or porcelain
with metal inside for strength.
Endodontics
Endodontists specialise in root filling teeth. Teeth which are
seriously damaged or where the tooth nerve has died or
has become infected (abscessed) may need root filling
to survive. This treatment has become increasingly complex
and demanding and whilst general dental practitioners may
be able to carry out routine endodontics, more complex
cases may need referral to a specialist.
Extraction
This means ‘taken out’. Teeth are generally only taken out if
they are very decayed or damaged or sometimes for
orthodontic reasons to create more space in an otherwise
crowded mouth (see also Peridontology).
Gingivitis
This is inflammation, redness and swelling of the gums. It is
caused by plaque and tartar deposits and can be treated by
thorough brushing at home and professional cleaning.
Halitosis
Halitosis is bad breath often caused by oral bacteria. Good
oral hygiene and attention to diet can help, and your dentist
can advise.
Implantology
Missing teeth can now be replaced by titanium or porcelain
fittings screwed or fitted into the jaw. The result is often
indistinguishable from a natural tooth. The alternatives,
dentures and bridges, can thus be avoided.
Oral surgery
Oral surgery involves the jaws or face, the removal of
wisdom teeth, cysts, buried tooth roots and other problems.
Surgical dentists are specialists who have completed
additional training usually in practice. Oral surgeons are
usually hospital consultants who are trained both in
medicine and dentistry.
12
Orthodontics
Orthodontists specialise in straightening or correcting the growth
of teeth. Although in the past this service was only usually
available to children, today it is not uncommon for adults of any
age to benefit from modern orthodontic treatment. Treatment may
involve wearing removable or fixed appliances (‘braces’) which
gently reposition teeth over a period of months. Treatment may be
quite lengthy and involves good oral hygiene and co-operation by
the patient.
Peridontology
Peridontology concerns itself with the treatment of gum diseases
and disorders. Whilst mild gum problems may be treated in
general practice, more complex cases are dealt with by
peridontologists.
Root planing and curettage

Root planing and curettage is used to scale parts of the teeth
below the gum line that cannot be reached with a toothbrush. It is
used to treat pockets of infection and peridontal gum disease.
Wisdom teeth
Wisdom teeth are the last teeth to appear at the back of the mouth
from late teens onwards. A common problem is lack of space.
Veneers
A veneer is a thin layer of tooth-coloured material that is put onto
the front of the tooth to make it look better, either to correct the
shape or colour of the tooth.
13
Useful addresses
British Dental Association
64 Wimpole Street
London
W1G 8YS
Phone 020 7935 0875
Fax 020 7487 5232
Email inquiries@bda-dentistry.org.uk
www.bda-dentistry.org.uk
Word of Mouth Helpline 0870 333 1188
British Dental Health Foundation

Eastlands Court
St Peter’s Road
Rugby
Warwickshire
CV21 3QP
Phone 01788 546365
Fax 01788 541982
Email feedback@dentalhealth.org.uk
www.dentalhealth.org.uk
General Dental Council

37 Wimpole Street
London
W1G 8DQ
Phone 020 7887 3800
Fax 020 7224 3294
Email information@gdc-uk.org
www.gdc-uk.org
Dental Practice Board for England and Wales

Compton Place Road
Eastbourne
East Sussex
BN20 8AD
Phone 01323 433550
Fax 01323 433517
Email helpdesk@dpb.nhs.uk
www.dpb.nhs.uk
14
NHS Direct
Phone 0845 46 47
www.nhsdirect.nhs.uk
Patients Association
PO Box 935
Harrow
Middlesex HA1 3YJ
Helpline 0845 608 4455
Fax 020 8423 9119
Email mailbox@patients-association.com
www.patients-association.com
Denplan Ltd
Denplan Court
Victoria Road
Winchester
SO23 7RG
Phone 01962 828000
Fax 01962 84084
Email denplan@denplan.co.uk
www.denplan.co.uk
Date of publication: October 2001
15
Notes
16
Patients Association
PO Box 935 Harrow Middlesex HA1 3YJ
Tel: 020 8423 9111
Fax: 020 8423 9119
Helpline: 0845 608 4455
Email: mailbox@patients-association.com
www.patients-association.com
Registered charity no. 1006733
Written by Mary Hicks

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A9603 denplan blet A5.

qxd 16/9/02 8:29 am Page 1

Frequently asked questions 2

This booklet is supported by an educational grant from

Over the past 30 years, dental health has improved considerably.

Frequently asked questions

Why is dentistry not ‘free at the point of delivery’?

How do I find a dentist?

What should I look for in a dental practice?

The dentist should be friendly and communicative. He or she

Examinations should be thorough and should include your teeth,

The roles of other staff in the practice, such as dental hygienists

Good dental treatment should be unhurried, caring and as gentle

How do I find an NHS dentist?

Do I have a right to NHS treatment?

Is it difficult to find an NHS dentist?

What if I can’t find an NHS dentist

How do I find a private dentist?

How do I find a specialist?

Can I go to any dentist?

Can I mix private and NHS treatment?

Can I have any sort of treatment on the NHS?

How much does NHS treatment cost?

Who has to pay for treatment?

• Children under 18 years of age;

• Anyone receiving Income Support or Job Seekers

Pensioners, the unemployed or students are not

Who sets charges for NHS dental treatment?

How much does private treatment cost?

Why are there variations in the price

What can I expect to get for the extra money

How can I tell that private dental treatments

Are there any controls on dentists?

In recent years the NHS has introduced Clinical Governance which

Denplan’s Excel accreditation scheme operates throughout the UK

What does the dentist expect from me?

Do explain your dental problems to your dentist as clearly

If you are taking medicines or having other treatment, let the

If you are very nervous, let the practice know in advance.

Dentists often operate out of hours schemes which they may

How do I complain if I am dissatisfied with the treatment

In serious cases a Complaints Panel may be convened to

and must publish their findings, in confidence, to you and

In particularly serious cases, a complaint may be brought to the

For further information ask for the Patients Association’s booklet

How do I complain if I am dissatisfied with the treatment

For further information ask for the Patients Association’s booklet

Can I get a second opinion?

See How do I find a specialist, page 4.

How are private dentist’s fees structured?

fees may be charged for in three ways:

• Fee per item: each type of treatment or care has its

What methods are available to me to pay

Another option is to take out dental insurance. A regular

Another option is dental loans - some practices can offer

Can I gain access to my dental records?

rules. Dentists may charge a reasonable administration fee for

Can I take my records from my old dentist to my new one?

Can my dentist give me a general anaesthetic?

Where can I get a general anaesthetic for my dental treatment?

Root planing and curettage

Word of Mouth Helpline 0870 333 1188

British Dental Health Foundation