A move from NHS dentistry into private practice, combined with dentists'general reluctance to work in 'unattractive'areas, is leaving great swathes of the population without dental care. Lynn Eaton reports

Only a sado-masochist can enjoy a trip to the dentist.

The thoughts of drilling and filling, scraping and polishing are enough to keep most of us as far away from the dentist's chair as possible.

Small wonder, then, that many of us fail to keep regular checkups. But since changes in the dental contract were introduced in the early 1990s, regular checks are the only way to make sure you are still on the books of an NHS dentist when the need is more urgent.

Prime minister Tony Blair is determined to bring dentists back into the NHS fold.

In 1999, the government set itself a tough target that, by September this year, everyone should have access to NHS dental treatment if they want it.

It is no easy goal. Nowadays, if you are still on an NHS dentist's books and able to access relatively inexpensive treatment, you are one of the lucky ones.

According to the government, as many as 2 million people lack dental care. For them, the chances of being able to find an NHS dentist when they need one - usually when they are in pain - are slim.

A 1999 report from market analyst Laing and Buisson revealed that up to one in four people now receive private dental treatment, often because they cannot find a dentist willing to treat them on the NHS. Other patients were making round trips of up to 100 miles to get the NHS treatment they were entitled to, it said.

The difficulties were rooted in changes made by the Thatcher government in 1990, with the introduction of a payment system based on the registration of adult patients, rather than just a feeper-item basis.

Although dentists welcomed the emphasis on prevention, they feared the new deal would lower their income, so they worked harder to cover their expected losses. In fact, there was an overspend in the general dental services budget in 1991-92 of£190m as a result. So the government, inevitably, reduced the fee scale for the following year, initially by 23 per cent but finally by 7 per cent.

Dentists did what anyone else in their position and with their professional clout would: they voted with their feet and moved into the private sector.

A 1993 survey by the British Dental Association found that 75 per cent of general dental services dentists received at least threequarters of their earnings from the NHS. Just 12 per cent received less than a quarter of their earnings from the NHS. By 1999, only 58 per cent received at least threequarters of their earnings from the NHS, and 18 per cent received less than a quarter.

Junior health minister Lord Hunt feels optimistic about the chances of changing things round: 'We are aiming to deliver the pledge. We are working very hard with health authorities at the moment.

'I've always felt dental services should be a core part of what the NHS provides, ' he says.

'Oral health is important. It should be part of the health service. '

This is not just about addressing oral health, it is part of the wider agenda of tackling social exclusion: 'We know there are huge variations in people's oral health, ' says Lord Hunt.

'As part of our genuine drive on health inequality we need to see this as an important component of trying to raise standards and ironing out inequality. '

The government has introduced a number of initiatives aimed at encouraging more dentists to work in the NHS, including salaried dental services (rather than the traditional contractual status), the introduction of dental access centres for people needing emergency treatment, and various incentive schemes.

Health authorities have also been asked to put together a list of their existing NHS dentists, which can be passed on to NHS Direct, which will then be able to give anyone who calls them details of where they can get treatment in their local area.

But one of the biggest concerns is the unequal distribution of dentists around the country.

In oral evidence given to the health select committee looking at access to NHS dentists, Judith Husband, a recently qualified dentist, spelled out what it meant for her and others joining the profession: 'I would choose to set up business in the South now, having experienced both working up north and in the South.

'It makes more business sense to set up a practice in an area where the demographics suggest that we have socially got people who will want to come and see us, ' she said.

'It is not simply that there are not enough dentists, which there are not, and it is not simply that people want to go to dentists and they cannot. It is that there are lots of dentists in some areas and none in others.

'When we have got free choice as individuals, why should we work in an inner city where we have got junkies shooting up in the bathroom, when we could have a nice, pleasant life?'

Wakefield, the parliamentary constituency of committee chair David Hinchliffe, struggles to find NHS dental care. So he is outraged by the prospect of more dentists being concentrated in the South.

The committee's report, published in March, called for an urgent review of the dental workforce and the way it is paid.

The BDA estimates that a further 1,000 dentists are needed if all 2 million people not on an NHS dentist's list are to get onto one.

But it is not just about recruiting more dentists; it is about working better with the ones we have, says Lord Hunt.

'If there is one thing I really want to do, it is to get health authorities engaged with the profession again. The last government introduced a contract which completely hacked off the profession.

'Since then, there has been a disengagement between the profession and the NHS.

'We have got this chance to sort out NHS dentistry once and for all.

'What I really want to happen is for health authorities and the profession to sit down and sort out how they are going to do this.

'I can't single-handedly do this from the department, ' he says.

And, while he can't stop dental treatment being an unpleasant experience for most of us, at least he might make it a less expensive one.