As if facing the whine of the dentist's drill weren't ordeal enough, some Britons now have to stand in line for hours to get their teeth poked, prodded and pulled.
In a nation once infamous for the poor state of its teeth, hundreds of people recently lined up in one northeastern town hoping to sign up with the practice of a dentist newly recruited from the Netherlands.
PHOTO: AP
Newspapers printed photos of a line that stretched around the block and said the scene in Scarborough, North Yorkshire, was reminiscent of World War II-era rationing.
Dentists are departing Britain's publicly funded National Health Service (NHS) in large numbers, leaving a growing number of Britons without access to affordable care.
The consequences for the nation's teeth cannot be good, the experts say.
"What's going on in Scarborough is a classic example of the NHS dentist system breaking down completely," said British Dental Association chairman Dr. John Renshaw, whose practice gets 3,000 inquiries a year from people wanting to register as new National Health Service patients.
A 2002 study by the independent Audit Commission found 40 percent of dentists were not accepting new patients through the state-funded system.
Dentists are available to those who can afford private treatment, but Britain's tradition of publicly funded healthcare means most people expect subsidized treatment. Only about 1 million of Britain's 60 million people have dental insurance.
Unlike medical care, NHS dental treatment is not free, but the cost is about a quarter of what private dentists charge and is capped at ?360 (US$670) per ailment.
The long line outside Dr. Arie Van Drie's Scarborough office was similar to a scene in Carmarthen, Wales, last summer, when more than 600 people lined up outside a dental practice advertising it would take 300 new public patients. News reports said some of those turned away made threatening and abusive calls to the office.
"It's a problem that's been building and building and building," said David Collins, of the British Dental Health Foundation. "There's an awful lot of people now who are only going for treatment ... when they feel that there's a problem, when it's an emergency."
Only 44 percent of adults and 60 percent of children are registered with an NHS dentist, government figures show. Most of the rest either pay for private care or simply do not go to the dentist.
Those who do not get annual checkups likely face big bills -- and aching jaws -- when problems finally demand treatment, Collins said.
Britons have long been the butt of jokes about bad teeth. Recently, the Austin Powers films and The Simpsons played humorously on the stereotype.
The British Dental Association says universities produce too few dentists each year -- about 800 -- and calls for that to be increased to 1,000.
Collins said the real problem was not a shortage of dentists, but an underfunded public service that drives many practitioners away.
Many dentists, he said, become frustrated because the NHS reimbursement system forces them to see too many patients too quickly and pays less than they can make in private practice. As a result, many NHS dentists now split their time with private patients.
"The problem is, without a lot more money being made available the problems of access are going to get worse rather than better," he said. "The future is tremendously uncertain."
Health Minister Rosie Winterton acknowledged a shortfall of NHS dentists but said US$170 million in new funding and a recruiting program for dentists abroad should ease the problem.
In the longer term, Winterton said a government plan to decentralize the dental service, handing more control to local authorities starting next year, would cut bureaucracy and boost service.
Winterton said Prime Minister Tony Blair's government was trying to reverse damage to the dental service under the Conservative Party administrations preceding it, which she said drove dentists out of the NHS by cutting their fees and closing two dental schools.
The NHS dental budget increased from about US$1.88 billion in 1998-1999 to US$2.25 billion in 2001-2002.
Blair has made improving Britain's ailing health service a top priority. While medical care has improved by many measures since he took office, complaints about long waiting lists and inadequate care still abound.
Blair promised in 1999 that all Britons would be able to see NHS dentists within two years, and political opponents point to the long waits in Scarborough as evidence he failed.
"Finding an NHS dentist is like finding a needle in a haystack," said Paul Burstow of the opposition Liberal Democrat party.
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