Paying for dental care

Dental care sits awkwardly in the health service. NHS dentistry exists, and for a great many people it is free, but it is not free at the point of use for most working adults the way a GP appointment is, and finding a practice that will take on an NHS patient has become the harder half of the problem. Private care fills the gap, sold in several different forms that are easy to mistake for one another.

What the NHS charges for

In England, NHS dental charges work in three bands, and the charge is for a complete course of treatment rather than per item. A course that needs four appointments costs the same as one that needs two.

• Band 1 covers the examination itself, along with diagnosis, X-rays, advice on prevention, a scale and polish where it is needed, and fluoride varnish or fissure sealant.
• Band 2 covers everything in band 1 plus fillings, root canal treatment and extractions.
• Band 3 covers everything in bands 1 and 2 plus the laboratory-made items: crowns, dentures and bridges.

Urgent treatment — something that needs dealing with quickly, such as acute pain, a swelling or a lost filling — is charged at the band 1 rate, and still counts as one charge even if it takes more than one appointment.

Charges are set nationally and revised each year, so the current figures are best taken from the NHS website rather than from anywhere that might be out of date. The structure matters more than the amounts: what determines the cost is which band the treatment falls into, not how long it takes or how many visits it needs.

The arrangements are not the same across the UK. Wales has its own banded charges. In Scotland the dental examination is free to everyone and treatment is charged as a proportion of its cost up to a maximum for each course of treatment, which is a different model rather than a cheaper or dearer version of the same one. Northern Ireland has its own scheme again. Anyone comparing what a neighbour paid should check they are comparing the same system.

Who pays nothing

NHS dental treatment is free for:

• anyone under eighteen, and anyone under nineteen in full-time education
• anyone pregnant, and anyone who has had a baby in the previous twelve months
• NHS hospital inpatients treated by the hospital dentist, and outpatients of the hospital dental service, though dentures and bridges may still be charged for

It is also free to people named on an award of Income Support, income-related Employment and Support Allowance, income-based Jobseeker's Allowance, or Pension Credit guarantee credit; to those on Universal Credit whose most recent assessment showed no earnings or earnings within the permitted limit; and to holders of a valid NHS tax credit exemption certificate or an HC2 certificate. An HC3 certificate reduces the cost rather than removing it.

Several things that sound as though they ought to count do not. Contribution-based Employment and Support Allowance and Jobseeker's Allowance, Incapacity Benefit, Disability Living Allowance, Housing Benefit, Council Tax support and the savings credit part of Pension Credit do not exempt anyone on their own. Nor does a medical condition, however much dental treatment it causes.

Claims are checked after the event. Written proof is needed at the appointment and a form is signed to confirm entitlement, and claiming free treatment without being entitled to it attracts a penalty charge on top of the original cost. Where entitlement is uncertain — a Universal Credit assessment that varies month to month, for instance — it is worth asking the practice or checking before signing rather than afterwards.

The Low Income Scheme exists for people who are not on a qualifying benefit but would struggle with the charge, and produces the HC2 or HC3 certificate. It is applied for separately and is widely unused by people who would qualify.

Finding an NHS dentist

There is no registration with a dental practice in the way there is with a GP. Nobody is assigned a dentist, and a practice has no obligation to see someone it has not treated before, which is why the question is not which dentist a person has but which practice near them is currently accepting NHS patients.

Availability varies enormously by area and changes month to month. The NHS website lists practices and whether they are taking new NHS patients, though the information goes out of date, so ringing round is usually necessary. A practice that is full may hold a waiting list. Going private for one course of treatment does not forfeit the right to NHS treatment later.

For something urgent, the route is the practice first if there is one, and NHS 111 otherwise, which can direct people to an urgent dental service. A dental abscess with facial swelling, particularly with difficulty swallowing or opening the mouth, is not something to wait out: it needs same-day attention, and the hospital if the swelling is spreading.

Private fees, plans and insurance

Three different things are sold under overlapping names, and the differences matter.

Paying privately per item is simply buying treatment at the practice's own fees, with no ongoing commitment. It covers work the NHS does not provide at all — cosmetic whitening, most adult orthodontics, implants in most circumstances — and it is also the route many people take simply because no NHS place is available.

A dental plan, or capitation scheme, is a monthly payment to a practice, usually administered by a third party, that covers examinations, hygienist visits and an agreed range of routine treatment. The monthly amount is normally set after an initial assessment and reflects the state of the person's mouth, so someone with a lot of existing work pays more. These are not insurance: they are a way of spreading the cost of ongoing care at one practice, and leaving the practice generally ends the arrangement.

Dental insurance is a policy from an insurer that reimburses dental costs up to limits. It behaves like other insurance, which means the exclusions are where the substance lies.

Whichever is under consideration, the questions are the same and are worth asking in writing:

• What exactly is included, and is laboratory work for crowns and dentures inside or outside the figure?
• Is there a waiting period before cover starts, and are pre-existing problems excluded? Most policies exclude anything already needing treatment, so insurance taken out because of a problem will not cover that problem.
• Is there an annual limit, and a limit per item or per claim?
• Is cosmetic treatment covered? Almost always not.
• Is emergency and out-of-hours treatment covered, and does cover extend abroad?
• What happens on moving house or changing practice?

Whether any of it is worth having depends on how much treatment the person is likely to need, which is partly predictable. Someone with healthy teeth and gums, exempt from charges or paying band 1 once or twice a year, is unlikely to recover the premiums. Someone with a long history of fillings, crowns and root treatments may well.

What a practice must set out

A dentist working within the NHS must make clear which treatment is available on the NHS and which is being offered privately, and must not present private treatment as the only option when an NHS equivalent exists. For anything beyond a band 1 course, a written treatment plan setting out what is proposed, under which band, and at what charge should be provided before work starts. Mixed courses, where part of the treatment is NHS and part private, are allowed but should be itemised clearly enough to show which is which.

Where a charge is disputed, or where it is unclear whether something offered privately could have been provided on the NHS, the practice's own complaints procedure comes first, and NHS England handles complaints about NHS treatment beyond that.

The cheapest dental care

Almost all dental treatment is the consequence of something preventable, and the gap between a band 1 charge once a year and a course of crowns is very largely a gap in prevention rather than in luck. Brushing twice daily with fluoride toothpaste, cleaning between the teeth, keeping sugar to mealtimes, not smoking and going for the check-ups at whatever interval the dentist advises cost almost nothing and remove most of the demand for everything above band 1.

See also dental check-ups, cleaning teeth and gums and tooth decay and cavities.