By SARAH LYALL
Published: May 7, 2006
ROCHDALE, England, May 2 — "I snapped it out myself," said William Kelly, 43, describing his most recent dental procedure, the autoextraction of one of his upper teeth.
Now it is a jagged black stump, and the pain gnawing at Mr. Kelly's mouth has transferred itself to a different tooth, mottled and rickety, on the other side of his mouth. "I'm in the middle of pulling that one out, too," he said.
It is easy to be mean about British teeth. Mike Myers's mouth is a joke in itself in the "Austin Powers" movies. In a "Simpsons" episode, dentalphobic children are shown "The Big Book of British Smiles," cautionary photographs of hideously snaggletoothed Britons. In Mexico, protruding, discolored and generally unfortunate teeth are known as "dientes de ingles."
But the problem is serious. Mr. Kelly's predicament is not just a result of cigarettes and possibly indifferent oral hygiene; he is careful to brush once a day, he said. Instead, it is due in large part to the deficiencies in Britain's state-financed dental service, which, stretched beyond its limit, no longer serves everyone and no longer even pretends to try.
Mr. Kelly, interviewed in a health clinic here as he waited for his son to see a doctor, last visited a dentist six years ago, in Sussex.
Since moving to Rochdale, a working-class suburb of Manchester, he has been unable to find a National Health Service dentist willing to take him on.
Every time he has tried to sign up, lining up with hundreds of others from the ranks of the desperate and the hurting — "I've seen people with bleeding gums where they've ripped their teeth out," he said grimly — he has arrived too late and missed the cutoff.
"You could argue that Britain has not seen lines like this since World War II," said Mark Pritchard, a member of Parliament who represents part of Shropshire, where the situation is just as grim. "Churchill once said that the British are great queuers, but I don't think he meant that in connection to dental care."
Britain has too few public dentists for too many people. At the beginning of the year, just 49 percent of the adults and 63 percent of the children in England and Wales were registered with public dentists.
And now, discouraged by what they say is the assembly-line nature of the job and by a new contract that pays them to perform a set number of "units of dental activity" per year, even more dentists are abandoning the health service and going into private practice — some 2,000 in April alone, the British Dental Association says.
How does this affect the teeth of the nation?
"People are not registered with dentists, they can't afford to go private and therefore their teeth are going rotten," said Paul Rowen, the member of Parliament for Rochdale. Rotting teeth and no one to treat them are among his constituents' biggest complaints, up there with gas prices and shrinking pensions. Just 33 percent of the Rochdale population is signed up with a state dentist, down from 58 percent in 1997.
Nor is the level of care what it might be. The system, critics say, encourages state dentists to see too many patients in too short a time and to cut corners by, for instance, extracting teeth rather than performing root canals.
Claire Dacey, a nurse for a private dentist, said that when she worked in the National Health Service one dentist in the practice performed cleanings in five minutes flat.
Moreover, she said, by the time patients got in to see a dentist, many were in terrible shape.
"I had a lady who was in so much pain and had to wait so long that she got herself drunk and had her friend take out her tooth with a pair of pliers," Ms. Dacey said.
Some people simply seek treatment abroad.
"I saw it on the Internet," said Josie Johnson, 42, of London, describing how she heard about a company called Vital Europe, which offers dental-and-vacation packages to Hungary. "It's a quite small country, and I thought, they specialize in dentistry — so that's what I might do."
The dentists she consulted in London told her the four implants she needs would cost 8,000 to 10,000 pounds ($14,900 to $18,600); similar treatment in Budapest costs 3,200 to 4,400 pounds ($5,900 to $8,200), according to VitalEurope.
Beyond that, she said, "I can make a holiday of it."
In Rochdale, people who have no dentist but who are in dire straits can visit an emergency clinic that very day — provided they can get an appointment. The phones open at 8 a.m.; the books are closed by about 8:10.
"We see toothaches through trauma, toothaches through neglect, dental caries, dental abscesses, gum disease," said Dr. Khalid Anis, the clinical leader for the emergency facility, the Dental Access Center. "What we see is shocking."
Dr. Anis enumerated some positive dental developments in Rochdale: a second, soon-to-be-opened clinic; an aggressive community-health program; a political push, finally, to fluoridate the water. But, he said, "sometimes I feel as if I'm hitting my head against a brick wall."
The waiting room at the center was a testament to his concerns. Sitting by the window was George Glasper, 81. One of Mr. Glasper's teeth had broken off a week earlier, but when he called his dentist, he was told the practice had become a private one. Efforts to sign up with four other dentists failed, he said.
Nearby sat Shahana Begum, 27, a Bangladeshi immigrant with a bad toothache and no dentist. Her stepdaughter, Sanya Karim, 16, said her family had been trying to find a health service dentist for six years, since moving to Rochdale from Birmingham.
Occasionally, Miss Karim says, she feels a twinge or an ache, but she tries to ignore it. "It normally goes away in a couple of days," she said.
In extremis, Britons can always buy dental emergency supplies made by a company called Passion for Health DenTek. These include materials that allow people to replace lost fillings, treat gum pain or reattach cracked crowns "until they can actually get in and see a dentist," said Jennifer Stone, the company's sales and marketing director. Sales in Britain have increased by 40 percent in the last year, Ms. Stone said.
A recent Guardian newspaper article about the company titled "D.I.Y. Dentistry" (meaning Do It Yourself) said that the previous week British drugstores had sold 6,000 jars of the filling replacement, and 6,000 of the crown-and-cap replacement.
Ms. Stone, an American, says she is struck by the profound differences in attitudes about dental care in Britain and the United States.
"Prevention and having nice white shiny teeth is a huge priority for us from the moment we're born," she said. "That doesn't seem to be the culture here. You've got a lot of tea drinkers; you've got a lot of staining. In the U.S., we go through a spool of dental floss in six weeks, on average. Here it's a year and a half."
Back in Rochdale clinic, Dr. Anis laughed hollowly when the word came up in connection with his patients, who come from some of the area's most deprived neighborhoods. "Floss?" he said. "That's a good one."
...The aforementioned Mr. Kelly.
WAR nationalized health care. You, too, can have choppers like this man. Or even like this man...
Shane MacGowan
