.png)
3 hours ago
1
Linda Colla holds an imaginary tooth between her forefinger and thumb and pulls it. Then she adds some rotation. Extracting her own teeth required wiggling and twisting, she explains. “It took me a couple of weeks to get each one out, because they just loosened and loosened and loosened. I used a tissue to get a better grip.”
We meet in her bungalow near Ottery St Mary in Devon, which she shares with her labrador, Cleo, and her jack russell, Josie. Before our meeting, she told me over the phone that she had kept the yanked teeth. I ask to see them. She disappears and returns with a small box. “They’re a bit grim‑looking now, because they’ve been out for a while.”
The three teeth in the box are yellow, certainly, but actually don’t look too bad. They weren’t, she says. “There was nothing wrong with the teeth; it was gum disease.”
She points to a front incisor. It was the first to come out. Then a canine and finally a big molar. “It sounds very dramatic, pulling them out. But actually they were already loose,” she says. There was some pain on extraction, but they had been causing her constant pain before that. “It was too painful to eat. They just had to come out.”
I find it difficult to listen to Colla’s story. A few days before meeting her, I had an extraction. This was on the NHS, after a wait of six months; another patient cancelled their appointment, so I replaced them and had the extraction done in hospital, under local anaesthetic. I can’t imagine having to do it myself.
Colla, who is 75, started having problems with gum disease and her teeth in her 30s. “It was probably too much coffee, too much wine and smoking,” she says. She was living near Nottingham and had an NHS dentist when she started having her teeth replaced by dentures in her late 30s. Over the years, her real teeth were gradually supplanted by false ones, attached to a plate.
In 2018, Colla moved to east Devon. She contacted various dental surgeries and was told either that they didn’t take NHS patients or that they didn’t have the capacity to take any more. “One receptionist said they’d love to take more NHS patients, but with the budget given by the government they can only take a certain amount.”
She went on a waiting list. “I got an email once – or was it a text? – asking if I still wanted to be on the list. I said yes, but I haven’t heard anything since.” She presumes, seven years on, she is still on that list.
To have a tooth removed privately costs at least £150. Colla couldn’t afford that; she used to work as a charity area manager and a dog warden, among other things, and now receives pension credit. When her three remaining real teeth became too painful to live with, about three years ago, she felt she had no choice but to take matters into her own hands.
She is by no means the first person to do so. Put NHS dentistry into a chair, get it to say ahh, shine a bright light on it and you will see a picture of neglect and decay.
Thirteen million people in England – 28% of the adult population – have an unmet need for dentistry, according to an analysis in July by the British Dental Association (BDA). That includes 5.6 million people who tried and failed to get an appointment in the past two years; 5.4 million who didn’t try because they thought they wouldn’t get one; and 1.25 million who were put off by the cost. The number of people on waiting lists for an NHS dentist is estimated to be about 780,000.
For new patients, the service has effectively ceased to exist. In December, ONS data showed that 94.1% of people in England who didn’t have a dentist and tried to access NHS dental care in the previous 28 days were unsuccessful. There is some regional variation. London is a bit better, at 71.6%; the south-west, where Colla lives, is the second worst, at 96.7%. These are not healthy numbers.
What’s more, when the BDA and the Daily Mirror called up 100 practices listed on nhs.uk as “accepting new patients when availability allows”, they found that 86 were not accepting new patients. Some practices reported a waiting list of up to 10 years. In March 2023, YouGov found that 10% of Britons had carried out their own dental work; 34% of those had pulled out – or tried to pull out – their teeth.
Shawn Charlwood, a member of the BDA’s General Dental Practice committee, is well aware of the problem. “This is people in pain, with swelling, not able to sleep, not able to go to work, not able to look after their children, just desperate for dental care, and in the end resorting to filling their own teeth, re-cementing crowns and bridges, pulling their own teeth out.”
He attributes it to two decades of underfunding and an NHS contract that is “unfit for purpose”. This contract is an agreement between a dental practice and the NHS that specifies the number of treatments the practice will provide each year. “Successive governments have essentially kicked that can down the road,” says Charlwood. “Of any sector in the NHS, dentistry has seen the greatest real-term reduction in financial support and we’ve got a contract that doesn’t allow dentists to deliver care to those who most need it.”
The NHS dental contract is complicated. Practices vary in how much NHS dentistry they provide, depending on the size of the contract they have with their local branch of NHS England. They are paid a fixed sum for a specific amount of dental work; when that money is used up, their only option is to offer private care.
Treatment comes in three bands. Band 1 includes examination, advice and scale and polish; band 2 includes fillings, root canals and extractions; and band 3 includes bridges, crowns and dentures. But the practice is paid one fee for treatment within a band. “Whether you need a small number of fillings or a large number of fillings and a lot of treatment, you would still fall into that band, so the dentist would be paid the same,” says Charlwood.
Patients with a higher disease burden require more time in the chair, which is incompatible with the rigid system of targets for NHS dentists. Some small changes have been made to the contract recently, “but, in essence, if you haven’t seen a dentist for a long time and need a lot of work, the contract really does not support dentists to deliver that care”, says Charlwood. “That is fundamentally the problem – and many dentists are subsidising NHS activity through their private activity and patients. Clearly, that isn’t what we want; we want NHS dentistry to stand on its own two feet.”
Colla is more than happy to have a go at the previous government. “The NHS has been starved of funding for years. We’ve had the Tories for the last 14 years and they’ve made an absolute hash of everything. But when you put people like Boris Johnson in charge, what do you expect?”
What about the Labour government? Charlwood says it started off making the right noises. The BDA met the health secretary, Wes Streeting, the Monday after Labour won the general election: “He absolutely agreed that NHS dentistry was in crisis.” For the first time in the 76-year history of NHS dentistry, it was a doorstep issue during the election campaign. YouGov polling for the BDA in May showed that access to dentistry was a bigger concern than education or even crime. The access crisis combined with the cost of living crisis means that millions who can’t afford to go private, such as Colla, have nowhere to go.
Seven months after the election, how is the government doing? “To be honest, we’ve not seen a lot of progress,” says Charlwood. “You could argue that, since July, things have objectively become a little bit worse. The budget added new costs for practices. We’re employing receptionists, nurses and other staff and their employer national insurance contributions will have gone up.
“I think the profession has been very patient, but goodwill is in short supply and patience is running out. Frankly, ministers need to offer something for the thousands of demoralised NHS colleagues thinking twice about what they’re going to do next. Many practices are finding it hard to deliver the care to patients and balance the books as well; they are having to subsidise NHS activity through their non-NHS activity.”
If something isn’t done soon, Charlwood says, the service will continue to decline and it will become ever more difficult to get NHS dentistry – for children as well as adults. NHS data suggests that 45% of children did not see an NHS dentist in the year to March 2024, while a significant number haven’t seen a dentist for longer than that. On average, 119 extractions of children’s teeth are undertaken every working day in England, two-thirds of those because of tooth decay; this decay is the principal reason for hospital admissions for children aged five to nine. Like gum disease, says Charlwood, tooth decay is preventable.
The state of children’s teeth and the lack of care for them is what most upsets Colla, now that she has pulled out the last of her teeth. “They have got their whole lives ahead of them and this is the legacy they have got: bad oral health for the rest of their lives. I mean, we’re going back to the 1800s, aren’t we? When I was a kid, you had dentists coming around the schools, checking the teeth.”
Charlwood says England spends a smaller proportion of its health budget on dentistry than any other European country: “Not just Germany, Holland, France, but every European nation – the whole lot.” He says the state of the country’s teeth is apparent even just on a walk down the high street. “I notice it clearly – it’s what I’m interested in – and I think it’s embarrassing and it’s not necessary. As well as pain, swelling, infection, the ability to work or go to school, there are all the social issues if you’ve got poor dentition – job interviews, interacting with people in face-to-face roles – that all become more difficult.”
Colla says: “You do not realise what teeth mean to you until you lose them. Teeth are confidence-builders … When they took out my front teeth, I cried.”
After pulling out her last three teeth, Colla was left with visible, confidence-sapping gaps, which the state wouldn’t fill for her. For that, she managed to cobble together the money to go private. “He didn’t charge me for the initial consultation, which was good of him. Then it was nearly £300 to put three on the plate.”
She has plans for the ones she pulled out. “When I’ve got the money, I shall cover them in gold and hang them round my neck. Why not? People have done worse than hang teeth around their neck, haven’t they?” she says, laughing. For now though, her teeth go back in the box.
