A shocking investigation into extortionate charges by NHS dentists

Lying prone, gazing into the face of my goggle-eyed dentist, I wondered which was worse - to lose my tooth or my savings? She held my upper-left second molar, attached to a post that had worked loose, between her thumb and forefinger. Seconds earlier she had yanked it from my gum. Now began the bartering that is a part of modern dentistry in Britain.

"That will be £650 to make a replacement post and crown," she said, in a clipped tone that invited me to decide fast or spend the rest of my life sucking gruel through a straw.

I paused. "Er... " There was a silence. Then she said: "Or... I could try cementing it back, but it will probably work loose again in six months."

I paused again, wondering wildly what was best. I was still on my back, while she hovered above, staring at me menacingly through her binocular lenses. My wife would berate me for accepting second-best, I thought. But I was not going to be brow-beaten into having an expensive treatment I didn't need.

Suddenly she changed tack. From being the brisk, businesslike private dentist, brooking no opposition, she adopted a soothing tone. It was the classic bad-cop, good-cop routine.

"I tell you what we will do. Let's x-ray it and see how the root looks and then we can decide," she cooed.

She took off her goggles and raised the chair so I was sitting up. Instantly, I felt more in control.

We examined the x-ray together. It showed the root filling, done many years earlier, was poor and there was a shadow at the tip indicating an abscess, probably old. It really needed re-doing, she said sympathetically.

But by now I had summoned the strength to resist. No, I said, I would prefer to go with the re-cementing option - and see how it went. Rule number one for dealing with medics: when in doubt, choose the least intervention. I left the surgery with my tooth in place and a bill for £120.

Dentists spend years learning how to drill and fill teeth. But the skill they really need is the ability to negotiate. My wife recently agreed to treatment that will cost over £1,000 - a ludicrous sum when I saw what it covered. But her dentist sweet-talked her into believing it was worth it.

The Office of Fair Trading identified this problem in 2003, when it noted that charges varied widely, often without justification, and some were extortionate. It found the cost of an examination ranged from £9.50 to £40 and a large filling in a back tooth from £85 to £327. Such differences were difficult to justify and "the market is not working well for consumers", it concluded.

Protecting patients from the vagaries of the market is what the NHS is for. But NHS patients pay 80 per cent of the cost of their care. The market mentality has penetrated so far that there is no longer any real distinction between private and NHS. There is just expensive dentistry and slightly less expensive dentistry.

I ended up in the clutches of a private dentist after consulting three NHS dentists in the last year, of each of whom I despaired. When my upper-left second molar worked loose last November, a Polish dentist near my home fingered it gently, took an x-ray and told me he did not dare extract it in case he broke the post. I would have to wait for it to fall out.

Three months later, when my private dentist finally removed it, decay had set in. The Pole was inexperienced - hired to handle the low-rent NHS work while his British colleagues focused on the lucrative private work. It is the typical pattern - introduce a two-tier service, and the one for the poor becomes a poor service.

A few months previously, when another crown became detached, I had visited a different surgery. The NHS dentist took two x-rays and declared the crown damaged. I would need a new one. He was patronising and rude, and I didn't believe him. I went home, borrowed some do-it-yourself dental glue from a neighbour, and stuck it back myself.

That dentist was the partner of my usual NHS dentist, a fearsome lady whom I had thought knew what she was about. Only too well, it turned out. In earlier work, I had had two crowns replaced but she had told me I could only get one done on the NHS. For the other I had paid privately.

This, I later learnt, is against the rules. Dentists cannot mix and match NHS and private - a course of treatment must be one or the other. But as the OFT report made clear, dentists routinely flout the rules.

A couple of bad apples doesn't mean the whole barrel is rotten. But after going through four dentists in a year, and finding each of them wanting, my confidence is low.

Tony Blair pledged in 1999 that everyone would have access to an NHS dentist. We are still a long way off - figures published in March showed 56 per cent of adults had been seen by one in the previous two years. But it is a pointless target. NHS dentistry is no longer worth its name. The market has seen to that.