Published: 12/09/2002, Volume II2, No. 5822 Page 17

With enough ironmongery in my mouth to quicken the heartbeat of every passing scrap dealer, I guess I am as well qualified as anyone to write about NHS dentistry.

I spent much of my teenage years acquiring the kind of dentition that today sets off security alarms at airports. It is surprising that I chose a career which, over more than a quarter of a century, included trying to manage dental services; but I did.

Now I see dentistry is to be the subject of yet another initiative, the latest of many - civil servants must really hate dentists.Yet most of them are kind, caring people who want nothing more than to give people the sort of Hollywood smiles previous generations only dreamed of - and, of course, to make as much money as they can.

Not that there is anything wrong with trying to make an honest buck, though the dental profession hardly did itself any favours in the early years of the NHS by filling and drilling to such an extent that free NHS dental services had to be brought to an early end in 1951.

Since then charges have become an accepted part of life.

Their ever-increasing scale, however, has meant that NHS dentists became hard to find across wide swathes of the country.Many patients shrugged their shoulders (or perhaps gritted their teeth) and accepted that they had no option but to meekly pay more for private care.

That did not help those who fell between two stools: those just a mite too well off to be exempt, but who didn't have enough spare cash to spend on a 'luxury' like having their slowly dissolving teeth fixed privately.

And that has been a scandal.

So what needs to be done about the dearth of NHS dentistry?

It ought to be merely a question of supply and demand. Too few dentists means that they will have the whip hand and can dictate what they charge; on the other hand if the supply of dentists exceeds the demand, then dentists will be forced back into the NHS - on the government's terms.

That is the theory, and it ought to be working.

In 1990 there were just 26,000 dentists in the UK: today there are 33,000. But curiously, although there are 7,000 more dentists, the number working in the NHS has only increased by some 3,000 And in that 12-year period the number of adults registered for NHS dentistry has only crept up by 6 per cent. The numbers 'benefiting' from NHS dentistry seem to have stabilised at around 48 per cent of the population.

But if there are so many more dentists, why are so few working in the NHS?

The answer lies in hard cash and the changing face of dentistry.

There used to be big money in drilling and filling. In the days when dentists got paid on the same basis as ditch diggers - by the cubic yard - there were big incomes to be made by anyone armed with a Black and Decker and a bucket full of mercury amalgam.

But dentistry and public demand have both moved on.

Preventative dentistry has been tremendously successful: things like fluoride toothpaste, fissure sealants and dental education have led to a generation of patients growing up needing few, if any, fillings.

But the gradual decline in demand for extractions and fillings has been matched by an increase in the demand for cosmetic dentistry - something which Americans have taken for granted for decades, and which UK dentists now do rather well.

In August the latest grand plan for improving dental services, NHS Dentistry: options for change made its appearance, hot from the desk of chief dental officer Dame Margaret Seward.

It has been said of the British Army that it has always been tremendously well equipped - to fight the previous war.

This document, too, is aimed at the past.The target has moved.

Driven over the last dozen years by self-interest, science, affluence and fashion, dentists have unwittingly found a balance point between NHS and private care.

Not many years ago, NHS dentistry was a disgrace.Now, by a process which owes far more to luck than judgement, market forces have produced something approaching equilibrium.

Though there are undoubtedly pockets of the country which need a spot of NHS polish, I hope Dame Margaret resists the urge to recklessly drill into the roots of a service which has been quietly putting itself to rights in the face of government neglect.

Steve Ainsworth is a former primary care manager.