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Dentist shortage has Britons pulling teeth

LONDON — A shortage of National Health Service dentists in England has led some people to pull out their own teeth — or use super glue to stick crowns back on, a study says.

Many dentists abandoned Britain's publicly funded health-care system after reforms backfired, leaving a growing number of Britons without access to affordable care.

"I was not surprised to hear those horror stories," said Celestine Bridgeman, 41, of London. "Trying to find good NHS dentists is like trying to hit the lottery because the service is underfunded."

The National Health Service provides care to the vast majority of Britain's people, often for free. Unlike doctors who work for the health service, dentists work on a contract basis and can leave whenever they wish.

Though private treatment by dentists is available, the tradition of publicly funded care means most people rely on it. But now there are fewer dentists to see patients.

In April 2006, the government reformed National Health Service dentistry in an effort to increase patients' access to treatment and to simplify payments. Dentists objected, complaining it reduced income. Some dentists cut the number of health service patients — or stopped taking them altogether.

Forty-five percent of dentists surveyed said they no longer accept National Health Service patients.

"This survey underlines the significant problems caused by both dentists and patients by the new dental contract," said Susie Sanderson, executive board chairwoman of the British Dental Association, a trade union of thousands of dentists.

"The picture it paints, of patients unable to access care ... and anxieties about the new charging system, is an all too familiar one," she said.

The study released Monday by the commission contained no figures detailing the National Health Service dental shortage. But earlier this year, then-Health Minister Rosie Winterton told Parliament more than 2 million people were unable to find an NHS dentist.

The survey of 5,212 patients and 750 dentists in England found 6 percent of patients resorted to self-treatment, including one person who extracted 14 of his teeth with pliers. Other patients reported using super glue on crowns after they popped off, the study said.

"These findings indicate that the NHS dental system is letting many patients down very badly," said Sharon Grant, chairman of the Commission for Patient and Public Involvement in Health, the independent body that commissioned the study. The survey found nearly 20 percent of patients have gone without dental treatment because of the cost. Thirty-five percent of those not now using dental services said they cannot find an NHS dentist near where they live.

"It felt like being put on the streets when my NHS dentist changed to private," the survey quoted one unidentified patient as saying.

U.S. dentists say Americans can also go without dental care, but for differing reasons.

Sally J. Cram, a spokeswoman for the American Dental Association and a practicing dentist in Washington, said an ADA survey released in 2006 found that about 30 percent of American adults said they had not seen a dentist in the past year.

She said the reasons "run the gamut from people who are very frightened to people for who dental and oral health is not a priority; some folks who don't have the money; some folks who live in an area where there isn't a dentist nearby."

David Albert, a dentist and the director of the division of community health at Columbia University's College of Dental Medicine, said as many as half of all Americans don't have dental insurance.

"Access is a big issue in the United States," Albert said. "Even if you have medicaid coverage, finding a sufficient number of dentists that accept it is difficult."

Cram also mentioned obvious and not so obvious problems linked to people handling their own dental work, saying it can lead to an array of ailments including infections and jaw problems.

"Super glue is water soluble, so it's going to wash away over time, and that crown's going to fall out eventually," she said.

In the British study, 78 percent of private dental patients left the National Health Service because their dentist stopped treating NHS patients or they could not find an NHS dentist. Only 15 percent claimed they switched to get better treatment.

Edward Leigh, 37, an IT consultant from London, said the government should reconsider its reform.

"The few wild stories are probably untypical, but there is a clear problem with the way the contracts of the dentists have been handled," he said.