Open wide: the rot at the heart of British dentistry

The dentist’s surgery, which sat, innocuous, on a quiet residential street, had been decorated in various shades of tooth. Even the noise was white. A screen above the desk showed a fairy-lit pool, fed by a dainty waterfall. The receptionists’ voices were gentle and sibilant, confirming appointments in tones so soft they sounded towelled. The effect, as I vibrated with anxiety, was one of almost violent hush.

A couple of years ago I fell over while out running and cracked four of my front teeth. Since then, something evil has been happening around the nerve of an upper cuspid without me knowing, something malevolent and fiendish and identifiable only through X-ray – an X-ray, incidentally, that my eyes initially understood as a sonogram and searched its shadows for a baby. My local dentist told me I’d need to be referred for root-canal surgery. He said it as if I was going to hit him. I did not hit him – I was dismayed, yes, but grateful to be one of the only people I know lucky enough to be registered with an NHS dentist. And while the prospect of a stranger digging around in the raw meat of my tooth was vexing, there was some small relief in knowing I wouldn’t have to pay £800 for that unpleasantness.

Something rotten has happened to dentistry in the UK. In 1990, spending on private dental care made up only 14% of the market, but in 2024 that had risen to 69%, with around a third of people relying on it. They’re relying on it because care, especially complex care like root canals, has become incredibly hard to access on the NHS. And that’s because NHS dentists frequently find themselves losing money on these complicated procedures, for which they’re awarded “points”, based on the band of treatment rather than on the time spent with patients. This means (reported the BBC) that someone who needs two crowns, root canal work and three filings “would generate the same number of points as someone needing just a single crown”. The British Dental Association described the NHS dentist contract as “ridiculous and discredited”, and in March the UK’s competition watchdog launched a review into the £8bn private dentistry market after the price of a consultation increased by nearly 25% over a two-year period. The BBC talked to dentists who said patients had been “lied to” and told they couldn’t be seen on the NHS in an “attempt to force them to go private”. Another said colleagues would “hard sell” private work and make NHS treatment look substandard.

My friend had a root canal the week before mine, and before her appointment was presented with a consent form that, on page two, crept beyond questions of oral health and towards questions about whether she might like whiter teeth and “younger skin”. She looked around. Since her last appointment there were new posters for laser hair removal and Botox. “I was there to get my sore tooth fixed,” she told me. “I wanted a health space, not a cosmetic salon, and conflating the two set off some insecurities. I realised also – it’s treated as a luxury to have healthy teeth.”

I climbed the stairs to surgery room four and lay down silently. The tray of instruments, all of them silver and ending in needlish points, was situated behind my head, so the first I saw of each utensil, each endodontic bur, each barbed broach, plugger or syringe, was when it was about to enter me. There were two injections then 45 minutes of extreme intimacy – at one point I believe I held three fists in my mouth. And while I was terribly scared at first, and maintain that nobody should have to hear the sound of their own bones being drilled, I walked away realising that perhaps a hygienist appointment was worse than a root canal, what with the lack of anaesthesia and the hygienist’s jazzy sadism.

At home, in the mirror, the slight swelling inflated the nasolabial fold by the corner of my mouth, giving the brief effect of Botox or fillers. Had it not been for the continuous thin dribble that streamed from the corner of my mouth for the next hour, I would have smiled.