Sunday, May 07, 2006

In a Dentist Shortage, British (Ouch) Do It Themselves - New York Times

In a Dentist Shortage, British (Ouch) Do It Themselves - New York Times

Mr. Kelly's predicament is not just a result of cigarettes and possibly indifferent oral hygiene; he is careful to brush once a day, he said. Instead, it is due in large part to the deficiencies in Britain's state-financed dental service, which, stretched beyond its limit, no longer serves everyone and no longer even pretends to try.

Mr. Kelly, interviewed in a health clinic here as he waited for his son to see a doctor, last visited a dentist six years ago, in Sussex.

Since moving to Rochdale, a working-class suburb of Manchester, he has been unable to find a National Health Service dentist willing to take him on.

Every time he has tried to sign up, lining up with hundreds of others from the ranks of the desperate and the hurting — "I've seen people with bleeding gums where they've ripped their teeth out," he said grimly — he has arrived too late and missed the cutoff.

"You could argue that Britain has not seen lines like this since World War II," said Mark Pritchard, a member of Parliament who represents part of Shropshire, where the situation is just as grim. "Churchill once said that the British are great queuers, but I don't think he meant that in connection to dental care."

Britain has too few public dentists for too many people. At the beginning of the year, just 49 percent of the adults and 63 percent of the children in England and Wales were registered with public dentists.

And now, discouraged by what they say is the assembly-line nature of the job and by a new contract that pays them to perform a set number of "units of dental activity" per year, even more dentists are abandoning the health service and going into private practice — some 2,000 in April alone, the British Dental Association says.

How does this affect the teeth of the nation?

"People are not registered with dentists, they can't afford to go private and therefore their teeth are going rotten," said Paul Rowen, the member of Parliament for Rochdale. Rotting teeth and no one to treat them are among his constituents' biggest complaints, up there with gas prices and shrinking pensions. Just 33 percent of the Rochdale population is signed up with a state dentist, down from 58 percent in 1997.

Nor is the level of care what it might be. The system, critics say, encourages state dentists to see too many patients in too short a time and to cut corners by, for instance, extracting teeth rather than performing root canals.

Claire Dacey, a nurse for a private dentist, said that when she worked in the National Health Service one dentist in the practice performed cleanings in five minutes flat.

Moreover, she said, by the time patients got in to see a dentist, many were in terrible shape.

"I had a lady who was in so much pain and had to wait so long that she got herself drunk and had her friend take out her tooth with a pair of pliers," Ms. Dacey said.

Some people simply seek treatment abroad.

"I saw it on the Internet," said Josie Johnson, 42, of London, describing how she heard about a company called Vital Europe, which offers dental-and-vacation packages to Hungary. "It's a quite small country, and I thought, they specialize in dentistry — so that's what I might do."

Socialized medicine is a failure

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