In Suffolk, Karen Stone is dreaming of a roast potato. Specifically, the golden, crisp crunch of it. Or perhaps even, a big juicy steak to chew on.
But with only seven teeth left in her mouth, the 59-year-old can only consume very soft foods. As oral health inequality widens in the UK, she’s resorted to do-it-yourself dentistry – aka pulling out her own teeth – as she’s unable to access NHS treatment.
‘I had a really loose tooth which I twisted, and twisted, and twisted, until I could pull it out,’ Karen tells Metro.co.uk. ’It is quite scary to do that, but the relief is unbelievable. But then of course, the next one starts getting loose.
‘Gradually over time, because you’ve got no teeth, as you chew, your remaining teeth get loose and they move.
‘Which is why,’ she adds, ‘once you’ve lost a few… you’re going to lose them all eventually.’
According to The Oral Health Foundation, a quarter of UK households opted for some form of DIY dentistry during lockdown, with 8% having at least one person who has tried to pull out a tooth. In response, it’s launched a new public awareness campaign, Safe Smiles, which aims to highlight the importance of safe dentistry.
While this form of tooth extraction may sound Dickensian, it’s estimated that 30 to 35 million dental appointments have been missed due to the pandemic – and the number of NHS dentists working in England is set to reach a decade low, according to the Association of Dental Groups.
Additionally, the NHS dental statistics biannual report says that in the 24 months leading up to 31 December, 2021, just 35% of the adult population were seen by an NHS dentist.
The British Dental Association reports that dentistry went into the pandemic on a lower cash budget than it received a decade ago – amounting to cuts in real terms of 30%, with half of the population completely unfunded to receive NHS treatment.
While the recently announced multibillion-pound ‘catch up programme’ for the NHS vowed to tackle non-urgent surgery, maternity and mental health services, it did not offer a penny to dentistry – which means patients will face waiting times of more than three years, according to Healthwatch England.
It’s not just instances of tooth decay or gum disease which are going untreated either, but oral cancers, where survival rates plummet without early detection. It’s dentists on the frontline who detect these cancers, which kill more Britons each year than car accidents.
‘There is a clear problem,’ says Neil Carmichael, Chair of the Association of Dental Groups (ADG). ‘We cannot offer more people NHS treatment, or solve the problem of ‘dental deserts’ without more dentists.
‘In the year to March 2021 the NHS lost a record 951 NHS dentists in England. Our estimates are that we could be seeing a similar exodus this year. Brexit, Covid-19 and contracts have all impacted the total capacity of the dental workforce.’
Karen explains that despite never having had major problems with her teeth, when she needed to re-fit her top denture, she was refused NHS emergency dental care because of Covid.
Then, after an accidental fall in an Asda car park – which knocked three bottom teeth out – she was told to try private care, but being on universal credit and PIP, she can’t afford it.
Two sets of dentures will cost her approximately £2000, and she’s still trying to raise money via a Go Fund Me page for treatment.
In total Karen thinks she’s pulled out at least five of her own teeth. Something that impacts her physical and mental health every day, she says. Eating has also become extremely difficult, and she is prone to choking.
‘I can’t be sure if this is connected, but I’ve developed IBS recently, and when I go to the toilet, sometimes I see whole bits of food in there, because I can’t chew properly,’ she admits.
The sight of her toothlessness also makes the grandmother makes her feel ‘down and depressed’, and it is limiting her personal life too.
‘I have been a single woman since my partner died four years ago,’ Karen explains. ‘I was on the dating scene but I’m too embarrassed now. They’re not going to want to introduce someone to their family who has got no teeth! I was a normal, happy woman. Now, I just feel like, what’s the point of going on? I’m ashamed of myself, but I know it’s not my fault.’
On the other side of Suffolk, in Sudbury, Nick Cohen, 43, has also been unable to access NHS dentistry, and is now too embarrassed to leave his house.
What started out as toothache in 2020 escalated to more severe problems, and he was put on endless waiting lists for NHS treatment. Eventually, Nick was in such extreme pain that he pulled two teeth out himself in 2021, on separate occasions. One at the front, and another at the back of his mouth,
‘I did it with my fingers,’ he recalls. ‘I was wobbling the tooth backwards and forwards until it was loose enough, then I literally grabbed it. put all my strength into it, and pulled it hard. I took painkillers, and it was quite painful.’
Nick believes his teeth could have been saved if he had been able to access dental care when he needed to, but the NHS practice he had been on the waiting list for became private and it became disbanded.
While he did manage to have his four front teeth pulled out by an emergency dentist, he has nothing to replace them with, as emergency NHS care is typically for tooth extraction only, with the provision of dentures not provided.
With his mouth in its current state, Nick says it continues to be ‘traumatic’ and ‘distressing’. He is so embarrassed about his lack of teeth, that he refused to share any recent photos of his face with Metro.co.uk.
‘It’s causing me a lot of distress, and it’s isolating me – I feel quite lonely and in despair,’ says the diabetic, who is unable to work due to a long-term disability. ‘It’s also causing me discomfort with eating, and really piling on my mental health issues, and making me feel low and depressed.
‘My teeth are literally falling out, left, right and centre, because I can’t get any treatment or go to see a hygienist,’ he adds. ‘I’ve got nothing to replace them with.’
Ultimately, Nick believes dentists have a duty of care, and are leaving people to suffer.
‘There’s a big pay gap between NHS and private dentistry,’ he says. ‘Dentists have all just jumped ship to get more money, and the government aren’t helping to open up more spaces. They don’t care about the lower class people who can’t afford private treatment.
‘I think private dentists have the capacity to at least open the door one day a week, for NHS dentistry, considering the pay scale they’re on. It’s sheer greed otherwise.’
Since 2008/9 dentists working in the NHS have experienced cuts in real incomes of up to 40%, according to the British Dental Association.
Dr Jabir Kazi lives in West Yorkshire and qualified as a dentist in 2017. He is currently working privately – but said if he had known the reality of working in dentistry, he would have chosen a different vocation, or moved abroad.
Like many in his profession, Dr Kazi blames the universally discredited target-based NHS contract, which was introduced in 2006 across England and remunerates dentists solely on their activity.
Long before the pandemic fuelled access problems, it was dubbed ‘unfit for purpose’, not only receiving criticism from dentists, but two governments, a Health Select Committee and the Chief Dental Officers for England and Wales. It has generated chronic recruitment and retention problems.
The contract – which is still in place today – gives NHS dental practices targets to hit, known as units of dental activity (UDAs), and they are financially penalised if they didn’t hit them. Treatment is divided into three bands; the most complex care – such as the provision of crowns, mouthguards, bridges or dentures – requires dentists to pay the lab fee themselves, which can equate to as much as several hundred pounds per patient.
‘It’s not good to have someone doing your treatment who gets hit in the pocket,’ says Dr Kazi. ‘If you do the best thing, you’re getting penalised. Whereas, a patient who has very low needs – for example maybe they just need a check up – is the perfect patient.’
He adds: ‘The government has to actually decide if they want to fund an NHS or not. Under NHS dentistry, the quality of care that’s available is emergency firefighting at best, and dentists are actually losing money to see patients – especially if they have high needs.’
Dr Kazi likens NHS dentistry to playing in a tennis match, where the umpire takes your tennis racket away. You’re still expected to play, and give your best possible work, with the crowd booing you in the stands.
Then there’s the fact that the UK is now number one for litigation in the world, which can cost dentists approximately £5000 a year in professional insurance. One survey of 2000 UK dentists found almost a fifth had seriously thought about suicide, with the threat of complaints or litigation the most common source of stress.
‘By the time you come home, and look at your finances, there’s nothing left, or you’re more in debt than you were before,’ he says. ‘You’ve been taught these amazing, wonderful techniques, and there’s lots of different things you can do. And then you work in a system which really limits what you can offer, without having to face huge financial penalties.’
For Dr Kazi, practising privately enables him to progress his career, have a better work/life balance, and exhibit his hard-earned skills.
‘The actual changes that we can make to people’s lives – either functionally, or aesthetically – can be really profound,’ he explains. ‘But the public needs to be aware that dentistry is a surgical profession, and it’s very expensive.
‘It would be nice to help people who are less able,’ adds Dr Kazi. ‘However, I’ve come to the conclusion that I’ve just got to do the best for whoever comes through my door.’
In Cheltenham, Anya* tells Metro.co.uk that although she comes from a family of dentists, it didn’t stop her having to resort to DIY dentistry herself during lockdown.
‘Back in Scotland, where I grew up, I’ve always had the privilege of getting affordable dental care,’ she explains. ‘But obviously with Covid I wasn’t able to travel. I was in agony for a year with wisdom tooth pain. I couldn’t get an NHS dentist, and the cost at a private practice was so extortionate – it could have been up to £1000 – and there was just no way I could afford it.’
Instead, the 31-year-old marketing professional got a kettle of boiling water and poured it over some nail scissors, then ‘cut the gum surrounding my tooth away’.
‘I was at a desperate point, where I was in so much pain – and knew why I was in so much pain – that I knew I had to do something,’ Anya recalls. ‘There was a tonne of blood, and I really wouldn’t recommend it. I’ve managed to alleviate the pain, but I haven’t solved the problem.’
Anya hasn’t told her family about her DIY efforts, as she said they would be shocked and cross with her. She said it’s absurd, crazy and disappointing that she couldn’t get NHS treatment, adding that dentistry is seen as sub-par to medical care.
‘If I was talking about performing minor surgery, there would be outrage,’ she says. ‘But dental care seems to fall into a weird subcategory.’
The UK’s dental crisis is something that needs to be urgently addressed, according to the campaign group Toothless in England, which acts as a hub for a network of ‘Toothless’ campaign groups across the country.
‘This is not just an issue that has come up because of the pandemic,’ insists the group’s founder Mark Jones. ‘This lack of NHS dentistry has been with us for well over a decade. It’s unfair, unwieldy and financially unviable. It’s not attractive for newly qualified dentists as they simply can’t cover the costs of providing NHS treatment.’
Currently, Toothless in England is campaigning for six demands to be met, including an NHS dentist for everyone and revenue to cover the 50% of the population that are unfunded by the government.
Meanwhile, Nigel Carter, CEO of the Oral Health Foundation, warns that the shortage of dentists has become a long term problem in the UK.
‘We need to be training more dentists, and expanding NHS provisions,’ he explains. ‘Since the 2006 NHS dental contract, there’s been a 10 per cent increase in population, and no increase in volume of treatment.
‘There’s been a drift to private practice since about 1990. For dentists wanting to expand, the only way that they can do that is by making some of their provisions private. It’s not the dentists fault that they’re moving so they can try and make more money, it is a question that there is not enough NHS provision in the system.’
One source of hope is the current intake of dental students, which is a bigger cohort than usual. However, given that it takes five years to train dentists, it’s not much use to those in need of treatment now.
‘It shouldn’t have to be like this,’ says Karen, with her seven teeth left, and two more on the verge of being pulled out. ‘NHS patients should be the bread and butter, because there are more of us than there are people that can afford to go private. Yet, we’re made to feel like you’re a bit of an inconvenience.
‘The whole point of having the NHS is that it’s there for those who need it,’ she adds. ‘Yet, I feel like my life’s been put on hold – just because I can’t get an NHS dentist.’
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