How to Pay for Dental Treatment
“Even if I could somehow work up the courage to see a dentist, I wouldn’t be able to afford dental treatment.”
There is no doubt that the cost of dental treatment can be a major deterrent from seeking help. Usually, there are a variety of treatment options available to fit different budgets. Financing options vary from country to country – this page covers the UK.
We have a separate page with information on how to finance dental treatment in the U.S. here:
Financing Dental Treatment in the UK
You can pay for dental treatment on the NHS or as a private patient.
There is of course the NHS. On the whole, NHS dentistry is of adequate quality, and it is not possible to buy any cheaper. Many NHS dentists are trying to do the best they can under the restraints of NHS funding. Don’t expect to have the same choice of treatments and materials (or time) available as you would in the private sector, even if the government says otherwise.
The NHS charge bands in England and Wales from 1 April 2019 are as follows:
- Emergency dental treatment: £22.70 (Wales: £14). This covers emergency care in a primary care dental practice such as pain relief or a temporary filling.
- Band 1: £22.70 (Wales: £14). This charge includes an examination, diagnosis and preventive advice. If necessary, it also includes X-rays, scale and polish and preventive care such as the application of fluoride varnish or fissure sealant if appropriate.
- Band 2: £62.10 (Wales: £45). This charge includes all the necessary treatment covered by the Band 1 charge, plus additional treatment, such as fillings, root canal work or removal of teeth.
- Band 3: £269.30 (Wales: £195). This charge includes all the necessary treatment that is covered by the Band 1 and Band 2 charges, plus more complex procedures, such as crowns, dentures, bridges and other laboratory work.
Scotland and Northern Ireland are still operating under the old fee-per-item NHS system. The maximum charge for a single course of NHS treatment in Scotland and Northern Ireland is £390; some treatments will require prior approval before a dentist can start working with you. There is no charge for an examination. You can find some examples of treatment charges here.
Some people are entitled to free NHS dental treatment, for example if you are on low income benefits. You can find out more about free and paid NHS treatment here:
- Who is entitled to free NHS dental treatment in England?
- What is included in each NHS dental band charge?
- How much will I pay for NHS dental treatment?
Community Dental Services (aka Salaried Dental Services)
If you suffer with extreme dental phobia (or if you are housebound), you may be able to avail of the Community Dental Services. These are provided on the NHS, and the usual NHS charges apply.
Unlike “normal” NHS dentists, dentists who work for the Community Dental Service are paid an income directly by the NHS. They will have more time to spend with you, may not be as restricted in their choice of materials, and usually offer various sedation options. Community Dental Officers cater to special needs patients and, in many areas, to dental phobic patients as well. This service is not available to people with dental phobia in all areas, or waiting times may be long – it’s a bit of a postcode lottery.
Our Special Needs and Dental Care page explains how to find out what services are available in your area.
Why is NHS dentistry in such a mess?
In 2006, a new contract for NHS dentistry in England and Wales was introduced which ostensibly was going to make things easier for consumers by introducing only 3 possible prices you will pay, depending on the complexity of the work needed (bands 1, 2 and 3). But for dentists, the new contract was a disaster. Basically, NHS dentists in England are now paid for providing a certain number of “Units of Dental Activity” (UDAs) per year (this is not the case in Scotland, where dentists are paid per item of service). Here’s the problem: within each band, dentists receive exactly the same amount of UDAs regardless of how much treatment they provide! For Band 1, they get 1 UDA, for Band 2, they get 3 UDAs, and for Band 3, they get 12 UDAs. Say for example a dentist provided a small filling for a patient, which falls into Band 2. They would get 3 UDAs for that. But say they provided 5 fillings and 3 root canal treatments which would obviously take much much longer to do and would take more appointments – they would still get only 3 UDAs.
The big problem with this is that dentists are required to produce a certain (very high) number of UDAs per year, otherwise they get kicked out of the contract. Trying to get the required number of UDAs means they may have to rush things, and few have the extra time available that most people with dental fear or anxiety need to feel comfortable.
You can see now why some NHS dentists provide as little treatment as possible. Also, they will want to space out treatment, because the charge for each band “expires” after 2 months. This way, they can receive more UDAs for the same amount of work, which will help with reaching the target. The following graphic illustrates what has been happening since the new dental contract was introduced:
The graphic shows that teeth which in the past would have been saved with root canal treatment were more likely to be removed after the introduction of the 2006 contract. And preventive care like cleaning teeth (scale & polish) has taken a back seat, because dentists get the same number of UDAs regardless of whether they just take a quick look, or do an exam, x-rays and cleaning.
You can read more about the 2006 NHS Dentist Contracts here.
In December 2010, the then Health Minister Lord Howe finally admitted that the UDA system isn’t working. Three different pilot schemes in different parts of England were introduced to see which model will be used in the future. It remains to be seen whether the introduction of new models will actually improve anything, as the amount of money available per person for dental care is way too low to provide quality dentistry for everyone.
The situation in Scotland and Northern Ireland is slightly different in that dentists there still get paid on a fee per item basis. However, the renumeration can be very low depending on the procedure in question, and similar caveats may apply.
It’s not all gloom and doom!
All the above might suggest that it is no longer possible to get good quality dental treatment on the NHS. However, it still exists. Here is what one poster on our forum has said:
“I have lurked on these boards for a while now as I am dental phobic and was looking for some information and help as I knew I needed treatment … In fact I had not seen a dentist in 30 years. Anyway I visited four dental receptionists and did not like the feel of the places, I became sick and dizzy and just could not go through with booking an appointment … One day I woke up in awful more throbbing pain, and reluctantly rang another dentist which appeared to cope with anxiety and they were so helpful and empathic and said I could visit straight away. I was treated with respect and empathy. The bottom line is I have been allowed to have treatment at my pace in small doses. I did not know that I had serious gum disease and a couple of problems with my teeth too… Had I not got help when I went I would have lost my teeth, I have learnt that it is better to get help now than leave it too late. Basically I was scared of everything I thought I was going to faint on my first appt, I felt hot sick dizzy, my hearing goes all fuzzy and feared the worst, I could not even sit in the chair, I cried, became like a frightened toddler but my dentist and their staff were so helpful … I have started my treatment and it’s so good to not have pain and the awful tastes in my mouth and also my teeth look so clean now i am no longer ashamed. I can smile. Because I was so ashamed I couldn’t even open my mouth to show a dentist inside my mouth as they were so disgusting… Its not easy but little steps do desensitise you even if its just sitting in the chair and then having a mirror in you mouth and then slowly being able to lie back in a chair etc if it’s at a pace you can manage you can get there. I want to also add that my dentist is NHS and they are brilliant, I have not felt pain and my teeth & gums are improving.”
It is possible to find caring NHS dentists. Here are some tips:
- Visit several practices until you find one that you like the feel of.
- You are more likely to get quality NHS care in mixed private/NHS dental practices. This is because the private patients to some extent “subsidise” the NHS patients. Some dentists view the provision of NHS treatment as a charitable endeavour of sorts. Also, in some practices there is a good balance between patients who have minimal dental needs and those who have high dental needs, and this somewhat balances out the UDAs and allows the practice to offer a higher standard of care to NHS patients.
- Dentists tend to start out working in the NHS to gain experience and then move into private practice. On the one hand, this may make it difficult to build up a lasting relationship with a dentist you get on well with. On the other hand, some dentists who have recently graduated will have a special interest in helping people overcome their fears, and may appreciate the opportunity to develop their skills in this field. Read the biopics on dental practice websites!
- In some mixed practices, more senior dentists do continue to provide NHS treatment to existing NHS patients, but new NHS patients may be assigned to recently qualified dentists. If there’s a particular dentist you’d love to see and they provide NHS treatment, do ask if you can see that dentist – you never know your luck.
If you can afford it, we recommend you go private. The advantages are that more time can be spent with you to get to know you and your fears, and you can avail of better treatments and materials. Obviously, just because a dentist is private doesn’t mean they’re any good, so shop around and get recommendations from acquaintances, friends, colleagues, family, GPs, and/or the internet. Also see what they have done in terms of further dental education (additional diplomas, courses, etc. can indicate that they have a real interest in furthering their skills and providing the best care possible).
There are huge differences in the fees which private dentists charge for their services – they should have a price list available so that you can compare! Some of the differences can be explained by location, but even within the same area, price differences can be enormous.
Many dentists now offer their own payment plans which can be good value – check their websites!
Denplan or Dental Insurance
If you are considering taking out dental insurance, there’s a comprehensive explanation of dental insurance on the Money Saving Expert site: www.moneysavingexpert.com/insurance/dental-insurance
How dental coverage works in different countries – from our message boards