Cover the fees - or he'll see you next

The NHS dentist is becoming extinct, forcing people to pay for private care. Even though there are about 32,500 qualified practitioners in the UK, with 13 undergraduate dental schools and 800 new students each year, there are "sadly too few" dentists to cope with demand for NHS treatment, concedes John Hilsdon of the British Dental Association.

Finding an NHS dentist is becoming increasingly difficult. Figures from the Dental Practice Board reveal that 18.2 million adults are registered with a dentist; 10 years ago, this figure was 25 million. The decline is not due to falling demand for treatment: people have been known to queue overnight when a new NHS surgery opens. It is cost and lack of availability that are putting people off.

At the heart of the problem is a long-standing row between dentists and the Government over pay levels. Many dentists claim private work is now the best way to provide proper care, despite the higher prices patients inevitably have to pay. The Consumers' Association also bemoans the lack of a clear charging system.

A government-backed working group is due to report on the issue in March, and it is hoped that this report will herald a clearer pricing system and better complaints procedures.

For patients, the real pain involved in dental treatment comes when they receive the bill. While NHS dentists charge the same across the country, prices for private treatment vary. And if you have to make several trips to the dentist, "going private" could easily cost you upwards of a thousand pounds.

One way of cutting costs is to take out a payment plan for dental work, otherwise known as a "capitation" scheme. The type of plan you opt for will depend on the state of your teeth. Under a typical capitation scheme, a dentist will examine you to assess how much treatment you are likely to need in the future. The insurer then uses this information to set the premium charged each month.

Denplan, the UK's biggest provider of such schemes, has more than 1.2 million patients and 6,500 dentists on its books. It offers five treatment price bands. Denplan Care, for example, costs an average of £17 a month and covers basic treatments such as X-rays and fillings, and restorative work such as new crowns. It does not cover teeth whitening or other cosmetic treatments. If your teeth are in good condition, a cheaper package is available, excluding restorative work, for an average of £11 a month. Both deals include emergency cover.

Dental insurance policies work differently to capitation schemes: generally, there are no initial dental checks and you pay upfront for treatment. Your insurer then reimburses you. How much you pay depends on the cost of dental care in the area where you live. In large cities prices tend to be higher so the policy may be more expensive.

Boots, the high-street chemist, ventured into the dental healthcare market six years ago and has signed up 40,000 patients. It offers three dental plans, starting at £9 a month for a basic policy covering the cost of most NHS treatments, rising to £19.50 a month for more extensive cover. On a basic policy, Boots will pay £76.50 towards the cost of a crown, but if you have "level 2" cover, you'll get £150.

Other insurers simply offer a payment plan with one fixed price. The medical specialist WPA Providental, for example, charges 18- to 49-year-olds £10.99 a month for cover for up to £250 worth of routine treatment a year. Policyholders pay a quarter of the cost of any treatment; the insurer meets the rest.

Cash plans from providers such as healthcare mutual HSA can also help cover the cost of treatment; payment can start from as little as £1.35 a week.

When choosing a policy - be it a capitation scheme or a dental insurance deal - look closely at which treatments the insurer is covering and how much is paid out per claim. You should also check how many treatments you are allowed to claim for each year. Boots, for example, won't pay for more than four fillings over 12 months. The maximum it will pay out in a single year is £1,000, to include both routine and emergency treatment.

With nearly all insurance policies, there is a "qualification" period before you can claim for routine treatment - usually three months. Emergency claims are covered after two weeks in most cases, but this is worth checking.

You should also be prepared to pay for some of the cost of your treatment, depending on your dentist's fees, as the insurer's payout won't necessarily cover the full amount. And many insurers won't cover you for treatment identified by a dentist before you took out the policy, or for orthodontic work such as braces.

To compare charges for 41 different dental policies, go to www.moneysupermarket.com

Finding an NHS dentist

Count yourself lucky if you can walk into an NHS dental surgery and sign on right away. You can ask at any practice to be registered as a patient, but expect a long waiting list at most of them.

If you have recently moved house but have had no luck finding a dentist in your new neighbourhood or close to your workplace, log on to www.nhs.uk for links to other practices or visit the Dental Practice Board's website at www.dpb.nhs.uk/patient/patient.shtml.

Once you have found a dentist, make sure you go for regular check-ups. If you leave it longer than 15 months between visits, you could be dropped from your dentist's list of patients.

NHS patients are usually expected to pay 80 per cent of the cost of treatment, but in many cases people are exempt from payment. Treatment is free for children under 16, anyone under 19 in full-time education, mothers-to-be and those whose babies are under 12 months old.

People receiving benefits or on low incomes also qualify for financial help.

If you need treatment out of surgery hours and your dentist is not on call, NHS Direct (0845 4647) can give you details of dentists providing emergency cover in your area.