Dental Health

If you wish to make a complaint about a dentist or dental practice, try to resolve it directly with them first. Contact the dental surgery’s practice manager with details of your complaint. You can complain in writing, by email or by speaking to someone. Your complaint must be made within 12 months of receiving treatment. If you would rather not go directly to the practice, you can contact NHS England, which is responsible for NHS dental services. If you’re not happy with the way your complaint was handled – either by the dental practice or NHS England – you may wish to contact the Parliamentary and Health Service Ombudsman (PHSO). The PHSO makes the final decision on complaints that haven’t been resolved by NHS England. You can call on 0345 015 4033 or use the PHSO’s secure online form to raise your complaint (this only applies to NHS services in England). You can find further information and support for making a complaint from:

• a hospital’s Patient Advice and Liaison Service, if your treatment was carried out in a hospital
• Citizens Advice
• the Care Quality Commission (CQC) – the CQC does not settle individual disputes, but your feedback about a practice helps it to decide when, where and what to inspect

Complaining about private dental treatment

If you wish to make a complaint about private dental services, contact the practice manager of the private dental surgery. Your complaint must be made within 12 months of receiving treatment. If your complaint is not resolved satisfactorily, you may want to consider contacting the General Dental Council, which sets standards of conduct and regulates all dental professionals in the UK. It may be able to investigate your concerns. You can also contact the Dental Complaints Service on 020 8253 0800 (Monday to Friday, 9am to 5pm) or visit its website for more information.

Dentures

Dentures are removable false teeth that fit snugly over the gums to replace missing teeth. They help with chewing and eliminate potential problems caused by gaps. You should remove your dentures at least once a day to clean them. Dentures can be made of:

• acrylic resin
• metal
• a combination of acrylic and metal

Bridges

A bridge is a fixed replacement for a missing tooth or teeth. A bridge can be made of:

• porcelain bonded to metal alloys, which may contain gold, silver, nickel, chromium, titanium and molybdenum
• metal alloys containing cobalt chromium, titanium, aluminium and vanadium
• acrylic (plastic) for temporary bridges
• porcelain

Bridges may also be made of other non-metallic materials. You should ask your dentist what is most suitable for you.

Veneers

A veneer is a new surface to fit over the front of a tooth. They’re available on the NHS if they’re needed to improve the health of your mouth – but not just to improve the appearance of your teeth (cosmetic reasons). Veneers can be made of:

• porcelain
• composite materials (the materials that make white fillings)

Porcelain veneers are more realistic looking and long-lasting but also much more expensive than composite veneers.

Dental implants

Dental implants are artificial roots directly implanted into the gum and bone to hold crowns, bridges or dentures and replace missing teeth. They are not routinely available on the NHS. They are available privately but can be expensive. Each implant is essentially a metal screw made of titanium. Titanium is “biocompatible”, meaning it is not rejected by the body and the metal will fuse with the surrounding living bone.

Fillings and crowns available on the NHS can be made of several different materials.

Fillings

Fillings are used to repair a cavity in your tooth caused by decay. Your dentist will offer you the type of filling they consider clinically necessary. The most common type of filling is dental amalgam, made from a mixture of different metals. Dental amalgam fillings are hard-wearing so are often used on your back teeth. If you need a filling for one of your front teeth, your dentist may suggest a tooth-coloured (white) filling. Your dentist will offer you the type of filling most appropriate for your clinical (medical) needs. For example, if you need a filling for one of your front teeth, your dentist may suggest a tooth-coloured (white) filling, but the use of tooth-coloured fillings on back teeth is considered purely cosmetic. Fillings available on the NHS can be made of:

• amalgam (silver-coloured) – a mixture of metals, including mercury, silver, tin and copper
• composite (tooth-coloured) – made of resin and glass mixture
• glass ionomer (tooth-coloured) – powdered glass, which forms a chemical bond with your tooth and may release fluoride that helps to prevent further decay

There are a number of articles on the internet about the alleged toxic properties of amalgam. Although amalgam fillings can release low levels of mercury vapour, particularly when they are put in or removed, there is no evidence that exposure to mercury from amalgam fillings has any harmful effects on health. Talk to your dentist if you have any concerns.

Crowns

A crown is a type of cap that completely covers a real tooth. Crowns available on the NHS can be:

• all metal (such as gold or another alloy)
• porcelain fused to metal
• all resin
• all ceramic
• stainless steel – used to preserve badly decayed baby teeth in children, or as a temporary measure on permanent teeth

Your dentist will offer you the type of crown they consider clinically necessary.

There are 3 bands of charges for all NHS dental treatments. As from April 2018, the current dental charges are:

Band 1 dental treatment

This covers 1 or more treatments (as many as are necessary) from the following list :

• adjusting false teeth (dentures) or orthodontic appliances, such as braces
• applying sealants or fluoride preparations to the surfaces of your teeth
• a clinical examination, assessment and report
• marginal correction of fillings
• moulds of your teeth – for example, to see how your teeth bite together
• an orthodontic assessment and report
• a scale and polish (if clinically necessary)
• coloured photographs
• taking a sample of cells or tissue from your mouth for examination
• treating sensitive cementum (the tissue that covers the root of a tooth)
• X-rays

Band 2 dental treatment

This can cover anything listed in band 1 above, plus any of the following:

• an addition to your dentures – such as adding a clasp or a tooth
• apicectomy – removing the tip of the root of a tooth
• a mouth guard to correct your “bite” (doesn’t include a laboratory-made appliance)
• fillings
• free gingival grafts – when healthy tissue from the roof of your mouth is attached to your teeth where the root is exposed
• frenectomy, frenoplasty or frenotomy – surgery to the folds of tissue that connect your tongue, lips and cheeks to your jaw bone
• treatment for severe gum disease – such as root planing (cleaning bacteria from the roots of your teeth), deep scaling and a polish, or a gingivectomy (removal of gum tissue)
• oral surgery – such as removing a cyst, or soft tissue surgery to the mouth or lips
• pulpotomy – removing dental pulp (the soft tissue at the centre of a tooth)
• relining and rebasing dentures
• removing teeth (extraction)
• root canal treatment
• sealant to fill small holes or grooves in your teeth
• splinting loose teeth – for example, after an accident (this doesn’t include laboratory-made splints)
• transplanting teeth

Band 3 dental treatment

This can cover anything listed in bands 1 and 2 above, plus any of the following :

• bridges – a fixed replacement for a missing tooth or teeth crowns – a type of cap that completely covers your real tooth
• dentures
• inlays, pinlays and onlays – used to restore damaged teeth
• orthodontic treatment and appliances such as braces
• other custom-made appliances, not including sports guards
• veneers and palatal veneers – new surfaces for the front or back of a tooth

Treatments such as veneers and braces are only available on the NHS if there’s a clinical need for them (not for cosmetic reasons). Similarly, other cosmetic treatments, such as teeth whitening, are not available on the NHS.

All treatment that is, in your dentist’s opinion, clinically necessary to protect and maintain good oral health is available on the NHS. This means the NHS provides any treatment that you need to keep your mouth, teeth, and gums healthy and free of pain, including:

• dentures
• crowns
• bridges

Dental implants and orthodontic treatment, such as braces, are available on the NHS, but only if there’s a medical need for the treatment.

Cosmetic dental treatment

NHS dental treatment does not include cosmetic treatments that are not clinically necessary, such as teeth whitening. Cosmetic treatments like this are used to improve the appearance of your teeth and make them look more attractive, and are only available privately. If you’re interested in having any cosmetic dental treatments, you should ask your dentist how much private treatment will cost. Charges for any private treatment will be added to the charges for your NHS treatment.

Sugary food and drinks are one of the main causes of tooth decay. Acid is produced when the bacteria in your mouth break down the sugar. The acid dissolves the tooth surface, which is the first stage of tooth decay.

Sugar in food and drinks

Some sugars occur naturally in food and drink, such as fruit, honey and milk. The naturally occurring sugar in dried fruit, such as raisins, dates and apricots, can also contribute to tooth decay. Other foods have sugar added to them by the manufacturer, which is sometimes called processed food. These may include:

• cakes and biscuits
• sweets and chocolate
• flavoured milks and yoghurts
• sugary breakfast cereals and cereal bars
• jams
• fruit canned in syrup
• sauces and syrups, such as some pasta sauces, marinades and ketchup

if you’re:

• under 18, or under 19 and in full-time education
• pregnant or have had a baby in the previous 12 months
• being treated in an NHS hospital and your treatment is carried out by the hospital dentist (but you may have to pay for any dentures or bridges)
• receiving low income benefits, or you’re under 20 and a dependant of someone receiving low income benefits

Low income benefits

You’re entitled to free NHS dental treatment if you or your spouse (including civil partner) receive:

• Income Support
• Income-related Employment and Support Allowance
• Income-based Jobseeker’s Allowance
• Pension Credit Guarantee Credit
• Universal Credit (in certain circumstances)

Certificates to help with health costs

You can receive free NHS dental treatment if you’re entitled to or named on:

• a valid NHS tax credit exemption certificate
• a valid HC2 certificate – which is available for people on a low income

People named on an NHS certificate for partial help with health costs (HC3) may also get help. You’ll be asked to show your dentist written proof that you don’t have to pay for all or part of your NHS treatment. You’ll also be asked to sign a form to confirm that you don’t have to pay.

You should only be charged for private dental treatment if you agreed to have private dental work done. When you visit a dentist they will begin by examining your mouth and teeth. If they think you need treatment they should give you a written personal dental treatment plan. Treatment plans are not usually given for Band 1 or urgent dental treatment, but you can ask for one. Most dentists offer both NHS and private treatment. Your NHS dentist should always:

• explain which treatments are available on the NHS
• explain which treatments are only available privately
• make sure you know how much your NHS treatment and any private treatment will cost

Treatment plan

Before carrying out any dental treatment, your dentist should ask you to sign your personal dental treatment plan. This confirms the NHS dental treatment your dentist is going to do, and the amount you will need to pay for the treatment on the NHS. If you have talked to your dentist about having private dental treatment, details and costs for this will be listed separately on the same form. If you’re not offered a treatment plan for band 2 or 3 treatments, ask your dentist for one.

NHS dental treatment

The NHS will provide all treatment that your dentist feels is clinically necessary to keep your teeth, gums and mouth healthy. This means that if your dentist says that you “need” a particular type of treatment, it will be available on the NHS. You should not be asked to pay for it privately.

Choosing private treatment

NHS dental treatment does not cover any cosmetic treatments, for example teeth whitening, that are only to improve your appearance and not clinically necessary. However, you may choose to have this dental work done privately. In this case, you will be charged privately and your NHS dentist should make sure you know how much this will cost before treatment starts.

What if I’ve been charged wrongly?

If you think your dental charges are wrong, you should first talk to your dentist or the person at your dental surgery responsible for patient feedback. If you have paid for NHS treatment but you think you have paid too much, you should discuss this with your dentist. They will know what work was done and whether it was NHS treatment or a mix of NHS and private treatment.

You’re advised to use interdental brushes in addition to brushing as part of your daily oral health routine from the age of 12. Some people may not have large enough spaces in between their teeth to use an interdental brush, so flossing can be a useful alternative. Your dental team can show you how best to clean between your teeth.

How to use dental floss

Dental floss is a thin, soft thread. If you find floss hard to use, you can try dental tape, which is thicker. Don’t be too aggressive with the floss: you risk harming your gums. The main action of flossing is a firm but gentle scraping of the tooth from the top down. Your dental team can advise you about using dental floss.

Flossing tips

• Break off about 45cm (18in) of floss and wind some around one finger of each hand.
• Hold the floss tightly between your thumbs and forefingers, with about an inch of floss between them, leaving no slack.
• Use a gentle “rocking” motion to guide the floss between your teeth. Don’t snap the floss into the gums.
• When the floss reaches your gumline, curve it into a C-shape against one tooth until you feel resistance.
• Hold the floss against the tooth. Gently scrape the side of the tooth, moving the floss away from the gum. Repeat on the other side of the gap, along the side of the next tooth.
• Don’t forget the back of your last tooth.
• When flossing, keep to a regular pattern. Start at the top and work from left to right, then move to the bottom and again work from the left to right. This way you’re less likely to miss any teeth.

What if my gums bleed?

When you first start flossing, your gums may be tender and bleed a little. Carry on flossing your teeth as directed by your dental team and the bleeding should stop as your gums become healthier. If you’re still getting regular bleeding after a few days, see your dental team. They can check if you’re flossing correctly.

What if I find flossing difficult?

If you find flossing difficult, your dental team can give you advice about other ways of cleaning between your teeth.

Interdental brushes help to prevent gum disease by getting rid of pieces of food and plaque from between your teeth. They have small bristled heads designed to clean between your teeth, and they come in different widths to suit the sizes of the gaps. You can buy them from pharmacies and in the supermarket.

How to use interdental brushes

• aim to clean your teeth with interdental brushes once a day
• use a brush appropriate for the size of the space between your teeth – you may need to use more than one size
• insert the brush gently between your teeth, and try a smaller brush size if it feels too tight – don’t try to force the brush into the space
• work round the whole of your mouth so you don’t miss any of the spaces

What if my gums bleed?

When you first start using interdental brushes, your gums may be tender and bleed a little as you start to get rid of any plaque build-up. Carry on using the brushes, and the bleeding should reduce as your gums become healthier. If you’re still getting bleeding after a few days, get advice from your dentist. They can check if you’re using the interdental brushes correctly.