People in mid Wales are becoming unwell through lack of affordable dentistry as yet another NHS dentist switched to private care.

Residents branded the lack of access to dental care a “travesty” and “disgusting” whilst children, the vulnerable and the elderly are left without care for years.

It comes another dentist at popular practice MyDentist on North Parade, Aberystwyth, ditched their NHS services for private care. The practice sent out letters to patients in January informing them the dentist would now only see them privately.

Meanwhile the Welsh draft budget published in December 2023 threatened yet another fee rise for NHS dental treatments to help pay for social care and higher education.

But people in Ceredigion, Powys and Gwynedd are struggling to find an NHS dentist to go to, regardless of fees, as many practices have lost their NHS dentists or are unable to recruit more whilst some practices have returned their NHS contracts altogether.

‘Dentistry deserts’ is a phrase often used to describe the increasingly wide geographical areas where no NHS dentists can be found.

People are now travelling from Aberystwyth to Cardiff, some as far as Benidorm in Spain, to seek affordable treatment as practices and health bodies both blame ‘difficulties with recruitment and retention of NHS dentists’ as the issue.

But the impact of these ‘deserts’ is stark. A heart patient in Aberystwyth is unable to control his diet due to faulty dentures that he can’t afford to fix.

Young people are going up to nine years without dentistry including a seven-year-old whose baby teeth are rotting endangering her adult teeth, and a pregnant woman who is concerned for her health after a tooth cracked, whilst worried for her twin four-year-old boys who have yet to be seen at all.

Richard Allott from Aberystwyth has been left unable to feed himself properly due to faulty dentures, despite needing to follow a careful diet due to his heart disease.

When his NHS dentist left the North Parade practice in 2022 he was told he would need to go private, as there were no other NHS dentists available.

The single parent and carer said he hasn’t seen a dentist now since February 2022: “I’m restricted on what I can eat which isn’t good as I suffered a heart attack a couple of years ago.

“My front teeth will go soon [from gum disease caused by heart issues] and I need dentures to replace them. I was quoted £300 upwards per denture tooth. As a single parent, I can’t afford to go private.”

MyDentist’s response to a complaint he sent said: “MyDentist North Parade has been operating for some time with reduced NHS clinicians, due to a number of unfilled NHS dentist vacancies.

“Regrettably, due to the on-going situation at the practice, where demand for NHS care is well in excess of NHS dentists, we are unable to offer NHS appointments to every previous patient that contacts us.

“The local health board have been made aware of our situation.

“We do have other NHS dentists still in situ at the practice, however, they are already at maximum patient and appointment capacity and cannot accommodate any NHS patient transfers from the dentists that have left the practice.”

Ann Darcy Wilson
Ami Wilson, 46, with her daughter, Darcy, aged seven. Darcy has been waiting to be registered with an NHS dentist her entire life (Picture supplied)

Ami Wilson and her two daughters from Cwm-Llinau have been on a waiting list for an NHS dentist for nearly nine years.

The only dental work the family have had has been emergency care, such as her seven-year-old whose front teeth are rotting and Ami’s wisdom tooth which made her “almost pass out” from pain.

Her youngest, Darcy, seven, is struggling with tooth rot which is at risk of infecting her adult teeth if not extracted soon.

The family were forced to go to emergency appointments over an hour away for Darcy, who is now waiting for a referral to have the teeth removed under anaesthetic after the Newtown and Rhayader clinics were unable to treat the neurodivergent child sensitively enough.

Ami, a 46-year-old trainee therapist and single mum said: “This has been going on since early 2022, it’s diabolical that it’s taken this long to sort Darcy out whilst she’s in pain.”

Ami herself was in ”horrific pain” due to a wisdom tooth growing through the side of her jaw at a “crazy angle” needing her to take 10 days off work.

She said: “At the emergency appointment in Newtown they cleaned it and I nearly passed out from the pain.

“It needs removing but I must go to the practice on three different occasions with the same problem before it will be taken out on the NHS. It’s ridiculous.”

Meanwhile, her 17-year-old Jorja hasn’t seen a dentist since she was nine and will soon be out of the age range for free children’s NHS dental care despite needing braces.

Ami said: “She’ll turn 18 soon and so we’ve missed the boat on getting her treatment done as a child.

“Thankfully her self-esteem is good so her teeth don’t bother her, but it can cause major problems for teens with bullying and feeling self-conscious.”

This echoes many other parents in the area whose children “have gone from junior school to sixth form without seeing a dentist”.

Residents described feeling “pressured” to go privately for a “higher level of care” whilst being unable to afford even routine appointments.

Many people didn’t want to be named publicly for fear of ramifications if they spoke out about dentists’ practices across Aberystwyth and further.

The North Parade MyDentist recently told Lucy Jones (not her real name), 72, she would no longer be seen by an NHS dentist after attending the clinic for over 40 years.

The retiree from Aberystwyth has a HC2 certificate qualifying her for free dental care but has not found an NHS dentist available to use it.

She now faces driving to Cardiff to receive NHS treatment, whilst being unable to leave her partner with Alzheimer’s at home alone.

She said: “I’m totally frustrated. I phoned around every dentist for a radius of at least 30 miles and all said the same thing, that ‘they were not taking on any NHS patients’. Dentists it would seem are all going private in droves.

“Where does this leave me and thousands of others here in Ceredigion who cannot afford these charges?

“I don’t blame the dentists, I blame the government, apparently, we put the least resources into dentistry than any of the EU countries. What a complete travesty for us all!”

The North Parade dentist who switched to private care, Kinesha Rodrigues, said in a letter to patients on 5 January: “The decision to make this change has been a difficult one but necessary to allow me to continue to provide a high-quality service.

The letter adds the change will allow the dentist to “spend more time with my patients, maintaining and improving their dental health whist also reducing appointment wait times.”

In response to the dire situation, Elin Jones, MS for Ceredigion, said: “People are finding it extremely difficult to access NHS dentistry in Ceredigion – whether that’s because they are currently not on any list locally or because their dentist practice is closing or giving back its NHS contract.

“There is a lack of money in the system to make it attractive enough for dentists to continue to provide NHS work and also, in rural areas in particular, a lack of dentists and dental staff.

“That’s why I am supporting the case for a dental school to be developed at Aberystwyth University.

“It is currently under discussion, and I’ll be continuing to make the case to the health minister for such a dental school in Aberystwyth to train NHS dentists and dental support staff more generally.”

“There is a lack of money in the system to make it attractive enough for dentists to continue to provide NHS work,” says Ceredigion MS Elin Jones

So, is it a case then that dentists just greedy — or is dentistry as we know it “unsustainable”?

The Covid-19 pandemic broke an already fragile dental system, with a year of dental appointments lost due to lockdowns.

Six million fewer courses of NHS treatment were provided in 2022 compared to pre-pandemic levels according to UK health charity Nuffield Trust, and funding from UK government in 2021/22 was £500m lower in real terms than in 2014/15.

In 2006 the UK Labour government changed the payment system for NHS dentists from a fee per treatment approach to a point system which divorced how much they were paid by how much the treatments actually cost to perform.

Dentists now get three points per patient they treat, with a yearly point target each year. This means regardless of what treatment they give an NHS patient, be it a quick check-up or an extensive root canal, they’re paid the same.

As a result, dentists are “losing money” treating NHS patients, with many across Wales handing back their NHS contracts due to stress and lack of morale after calling for the system to improve for 18 years.

Last year a study from the British Dental Association (BDA) Cymru discovered out of 250 dentists in Wales, over a third planned to reduce their NHS contracts, whilst 13 per cent said they would stop their NHS contracts altogether.

Patients are now opting for the cheapest over the best treatment options, going for tooth removals which cost from £50 over a complex treatment that could cost more than £300 but save the tooth.

For people like Sophie Evans, 27, this means being forced into “considering dentures” before she reaches 30.

Sophie, an administrator from Aberystwyth, was struggling with sore and swollen gums when she attended North Parade MyDentist in 2022.

She said she felt “forced to go private” and pay £2,156 to access a root canal after her NHS dentist left, or have the tooth taken out at a cheaper price: “I phoned 111 crying about the price I was quoted privately, and they said there was nothing they could do.

“I’m 27 years old and already have a lack of molars as I had to have some removed to allow my canines to grow down correctly, I don’t want dentures yet!”

She travelled to Lampeter 25 miles away for private care with the help of her family, which saved her from using the little savings she had from her low salary job.

The Senedd’s Health and Social Care Committee’s report on dentistry published in February 2023 acknowledged the 2006 system “discouraged some dentists from taking on high needs patients, particularly in areas of high deprivation where poorer access to dental services already exists”.

Oral health has been found to link to overall health outcomes, with the number of teeth significantly correlating with life expectancy. But for some in Ceredigion, it’s affecting them before they’re even born.

Victoria Grant Phillips is expecting her third child but was told by North Parade MyDentist she would need to go private to fix a cracked tooth, despite an NHS initiative encouraging pregnant women to seek dental care.

Despite a letter from her mid-wife, she was forced to pay £600 for the repair plus extra for the cap.

The mum from Aberaeron is now waiting for an NHS dentist to take on her two four-year-olds: “I really do think it’s disgusting behaviour by this branch, I am still at a loss as to what to do about my boys.”

What’s being done in Wales?

One of the main findings from the Senedd’s report on dentistry was that the extent of Wales’ dentistry ‘crisis’ is unknown, with no clear data on how many people are currently waiting to see a dentist.

In April 2022 dental practices were asked to choose between continuing the 2006 points model and a new trialed model which focuses on “prevention and needs-based care”.

This new General Dental Services Contract reform reduces check-ups from every six months to one year with the aim to “release capacity”, potentially giving appointments to up to 112,000 new patients a year.

However the reform was met with criticism, suggesting practices had limited notice and consultation whilst ring-fencing appointments for new patients were being made by “holding back long-standing patients” to hit targets and avoid contracted penalties.

BDA Cymru is now calling for a “collaborative approach to design and implementation” of a needs-led preventative care approach but that “there is no magic fix to a problem that lies fundamentally in underinvestment”.

A Welsh Government spokesperson said: “It is always disappointing when a dentist decides to reduce or end their NHS commitment. When this happens, the funding remains with the health board to replace the NHS dental service.

“We have continued to invest in NHS dentistry over the last five years – funding today is £25m higher than it was in 2018-19. We are committed to reforming NHS dentistry to ensure there is access for those who need it.

“As a result of our reforms to date more than 300,000 people who have historically not been able to get a dental appointment have gained access since April 2022.”