'It is been a problem here since about 1991, 'says Adrian Tyas, manager of operational services for Cornwall and the Isles of Scilly health authority.

'That was when practitioners started going private. Registration gave dentists the excuse to say, 'I am not seeing you as you are not one of my patients' 'We have always had the lowest number of dental practitioners per head of population, we believe partly because of the geography but also because the nearest dental school is 180 miles away. '

Cornwall HA set up a salaried dental service in 1992, running from a caravan, to try to offer help to people needing emergency treatment.

At first it could pay dentists only between£20,000 and£25,000, so had problems recruiting. But when the personal dental services pilot began four years ago, it was able to raise the salary to as much as£45,000. It now has 18 salaried dentists in the county, offering mainly emergency treatment to people not registered.

'We are still not able to offer routine appointments at every clinic, 'says Mr Tyas. 'We have to prioritise who can receive treatment and we are sending about 1,000 people a month to the PDS. '

As the county has problems despite this initiative, the HA is negotiating with local dentists about how regularly existing NHS patients need to be seen for check-ups.

'We feel that over time they may well be able to free up clinical time and perhaps, over a three-year period, see 10 per cent more patients, 'he says.