No pain, but who gains?

IF NATIONAL HEALTH provision is being nibbled away at the edges, then someone has already taken a big bite out of its dental services. Patients have always had to pay part of the cost of dental care, but it is increasingly hard to find a dentist willing to accept you as a NHS patient.

One in four adults is now a private dental patient, according to figures from the British Dental Association (BDA). Even those on the NHS have to pay 80 per cent of treatment costs up to pounds 340, with the state paying the remainder. Children, those on low incomes and pregnant women are still entitled to free treatment.

More than a million people already have private dental insurance to spread out the cost of charges and protect them against any particularly hefty bills. This figure may seem surprisingly high in a country where teeth are not considered a priority, and the toothy American grin of a Monica Lewinsky is greeted more with mirth than envy.

So are private dental plans worth having? The average adult patient spends nearly pounds 35 a year on NHS dental treatment, hardly a figure to break the bank or worth covering with insurance.

Should you need more than a routine check-up and silver filling, costs can mount. Root canal therapy can cost up to pounds 160, a bridge pounds 170 and precious metal crowns more than pounds 250.

Dental care plans divide into two types. Under capitation schemes, you register with a dentist and pay an agreed monthly sum for dental care.

Not all dentists offer these schemes. The alternative is an insurance or cash plan scheme, where you receive treatment at any dentist and the insurer pays toward the cost of any bills.

Capitation schemes are not strictly insurance. They are offered through dentists, but administered by insurers such as Denplan, Bupa and Cigna. The schemes meet the cost of routine check-ups, extractions, fillings, preventive care and hygienist work. More expensive treatment, such as cosmetic dentistry, orthodontics and laboratory work are usually excluded.

When you join the scheme, the dentist grades your oral health, then charges you accordingly. Dental plans typically cost between pounds 5 and pounds 15 a month. They will not necessarily save you money. They are designed to encourage you to take a proactive role in caring for your dental health and reduce the need for treatment through preventive care.

So who is likely to pay for these schemes? Going to the dentist is not everybody's favourite experience. Dental plan providers like to quote a Mintel report saying that one in five patients was prepared to pay pounds 12 a month toward dental cover. Denplan, the market leader, has 850,000 policyholders, with the number of customers rising by nearly 20 per cent annually, so the demand is out there.

You may even be covered by your employer, as dental care is becoming a popular staff perk. The Association of Industrial Dentists estimates that 12 million working days are lost each year through dental problems, and nearly one in 10 employers now offers dental cover.

Denplan's average monthly fees range from pounds 7 to pounds 22, with the average cost pounds 12, similar to the average pounds 11 monthly subscription to Bupa DentalCover. Costs vary according to the state of your dental health, the cover required, and the dentist's hourly rate.

The Denplan Care scheme covers all routine dental care, including check- ups, fillings, X-rays and preventive care, and even a 24-hour telephone helpline for emergency treatment. Supplementary cover includes pounds 600 per claim worldwide emergency treatment, up to pounds 10,000 toward dental injuries sustained in a motor or sports accident, pounds 60 cash for every night spent in hospital following dental treatment, and oral cancer cover of up to pounds 12,000.

For work involving laboratories, say for crowns and bridges, the plan covers the dentist's time, but excludes the cost of the laboratory.

Alternatively you can use a conventional insurance scheme, where you can use any dentist you wish and the insurer pays toward the cost of any treatment you receive. These policies often come in the form of cash plans, which pay lump sum benefits toward your health costs.

Some, such as the Hospital Savings Association (HSA), pay toward a wide range of services, including physiotherapy and chiropody. The HSA plan costs from pounds 1.50 to pounds 12 a month for family cover, depending on the level of benefits you require.

The Western Provident Association (WPA) has a specially-targeted dental cash plan, which covers both routine and emergency treatment, as well as serious dental problems.

Adult subscriptions to the WPA scheme range from pounds 1.74 a month for up to pounds 1,000 emergency cover a year, to pounds 8.25 a month for a more comprehensive plan. This plan offers pounds 10,000 toward dental injuries or other serious problems, including cancer, and will also pay half the cost of routine dental bills up to a maximum payout of pounds 135 a year.

Cash plans are simple to arrange as the subscription is the same for everybody..

Just over half the population is registered with a dentist. Dental phobia doubtless plays its part, as does laziness, but so does the growing difficulty in finding a dentist who will accept you as a NHS patient.

Research suggests that one in three of us faces difficulties in finding a dentist. The low-cost way of taking good preventive care of your teeth is a capitation plan, whereas a cash plan can help with the incidental costs of dental problems.

Bupa: 0800 237 777; Cigna: 01475 492 350; Denplan: 0800 401 402; HSA: 0800 150 150;

WPA: 01823 623 380.

caring for your teeth

HOW MUCH DOES IT COST?

NHS Private

Check up pounds 7.68 pounds 15-25

and X ray

Medium filling pounds 9.60 pounds 25-40

Crown pounds 59.68 pounds 125-200

(precious metal)

Source:BDA