People in Wales are struggling to access dental care, with many waiting years for appointments.
The system is said to be "hanging by a thread" as record levels of dentists quit NHS work in exchange for private practice. In 2021, six per cent of Welsh NHS dental posts were lost, with 83 fewer dentists working across health boards than the year before.
The situation has become so dire that some people have resorted to operating on their own mouths to treat problems that could have been easily avoided with an early check-up. You can read more on health here.
Read more: People being told to wait three years for a dentist appointment
Carlton Hill, 28, is a project coordinator from Gorseinon, Swansea. His nightmare with finding an NHS dentist started with a simple chipped molar that wasn't treated properly.
He said: "At the start of the pandemic I chipped a molar, so I called through to NHS direct for emergency help. A dentist drilled into the tooth and filled it with an antibiotic topped with a loose packing which came out after a day. I was advised to locate a dentist to arrange a permanent fix, but this was the most difficult task.
"I've been in contact with numerous dentists around Swansea, but none of them are accepting newcomers due to patient size and Covid. Within a couple of months, the crown of that molar shattered completely, leaving just the root behind."
Unable to access dental care, Carlton resorted to ripping up the bits of tooth from his gums using pliers.
He said: "I had to rip bits of tooth off my gums using pliers, but the nerves died off after that so the pain wasn't too bad. When I called NHS direct again seeking urgent help, I was told that the pain wasn't severe enough for a referral to an emergency dentist, because all they could do for me was ease the pain rather than extract the roots."
After ripping out the bits of his tooth with pliers, Carlton learned to drain abscesses that started to form in his mouth.
He said: "Since then, I have had multiple abscesses in that area which I have learnt to drain myself. Last week on the opposite side of my mouth, another molar cracked, this time leaving a sharp jagged edge cutting up my tongue. I called through to NHS direct seeking urgent help to again be told that all the dentist will do is ease the pain not fix the issue and I need to seek a dentist despite being turned away everywhere.
"I resorted to using a wireless dremel to shave down the sharp end of my tooth to avoid cutting open my tongue."
Carlton said that he "sees no end" to his time without professional dental care.
He added: "I am so scared now of how much this will cost me to have fixed when it could have been avoided in the first place. I'm a full-time professional in my field, and my speech and mouth health is detrimental to my life yet I can't get help anywhere to avoid it being destroyed."
Some patients said they have been unable to access dental care for up to five years.
Rachel Williams recently moved to Swansea from Ammanford.
She said: "My husband and I have both been unable to secure NHS dental places for the past five years, neither in Ammanford or Swansea.
"My husband has had serious problems with his teeth due to poorly controlled diabetes, and has lost several teeth as a result. This has knocked his confidence and made him embarrassed to see people. It's had a huge effect on his mental and physical health, as he also has a heart condition - tooth decay and gum disease can be detrimental to people with heart issues."
Rachel and her husband eventually paid for a private consultation, but they were quoted with an impossible price of up to £28,000 for dental implants.
She said: "We were forced to go private, and paid for an initial consultation at a cost of £75. During the consultation the dentist explained that he has two options. Option one - complete and full extraction, then the fitting of dentures, or option two - the fitting of a full-mouth of implants. Option one came in at £3,800, option two at £28,000. How is that even a choice for most working families?"
Rachel added: "Like many families we do not currently have the money for either option - my husband was furloughed for much of last year, so money has been tight. Due to the cost, we've had to hold-off on any treatment, until such times we can raise the funds for option one - there's absolutely no way we could ever afford option two."
The couple even considered taking out a loan to cover the treatment, or going abroad for the treatment.
She said: "We considered taking out a loan to pay for the treatment, but feel so aggrieved at having to do that, and why should we have to, when it should be available as part of the NHS? To add insult to injury, on looking into the matter further I discovered that if we could only find an NHS dentist, his treatment would barely be in the hundreds of pounds, rather than tens of thousands."
Rachel called 20 dentists within a 40+ mile radius, but none were taking on adult NHS patients.
She added: "Strangely enough, they all have space for private patients. I find it absolutely disgusting and so disappointing that we both work, pay our taxes and contribute (via full NI contributions) to be able to take advantage of the system that we fund, a system that has sadly failed us."
Newport local Michael Enea said that the situation was equally as severe in Newport and the surrounding areas.
He said: "I researched into this back in November after receiving feedback from residents in Newport. We rang around every single dentist in the city and they were all full. We even tried a few dentists further afield in Cardiff East, Caerphilly and Cwmbran. Again, all the dentists were full."
Reflecting on the quote for £28,000, Rachel added: "I think dentists are partly to blame, and are clearly profiteering. They have no caps put on what they can charge and clearly have a captive market, which allows them to put profit above people.
"As a nation, Wales has one of the worst dental hygiene records in Europe, we have terrible teeth. Poor dental hygiene and no access to affordable treatment is so detrimental to people's health, and it needs to be addressed. The government also needs to overhaul the current system, as it's clearly not fit-for-purpose."
She added: "I'm now completely stuck, I don't know where to turn and what to do for the best. My husband is suffering and it looks like if I want to help him, I'm going to have to get into debt to do it - how is that fair? I feel like I've been backed into a corner by a corrupt system and a useless government. It's a complete shambles!"
Pregnant women are also finding it impossible to access an NHS dentist
Pregnant women are entitled to free dental care in Wales, but even then, the chances of landing an appointment appears to be slim in many cases.
One woman from Swansea who preferred not to be named said she endured agony throughout her pregnancy because of poor dental care. Even after giving birth, she still requires extensive treatment that's only getting worse with each day.
She said: "I had my son in November 2020 and could not get to see a dentist due to Covid, and because I'd have to pay privately. There is free NHS dental care available during pregnancy and the following 12 months, but there are no NHS dentists. It's well known that women suffer dental issues from pregnancy.
"I currently require around four fillings, a crown replacing and hygiene appointments but the cost for private treatment is so expensive that I can't afford it with a young baby and returning to work part time. I recently had to have my wisdom tooth removed because I couldn't see a dentist during my pregnancy and I couldn't afford private treatment, so I lost the tooth instead and endured agony during my pregnancy until it was removed.
"It's a disgrace really. I will have to find the money for my son to see a private dentist and neglect my own needs to afford this."
Another pregnant woman, Katie Williams, aged 32, said she was kicked out of the dentist surgery she was registered with for missing an appointment due to sickness, and she's now faced with constant "agony".
She said: "I'm currently 25 weeks pregnant. I was previously registered in a private dentist in Whitland for NHS treatment and got kicked out for missing one appointment, as I was ill. No leeway whatsoever. I've needed a root canal for over six months now and can't get into a dentist."
Like many others, Katie said that she was only offered pain relief rather than treatment which was useless to her, given she's pregnant.
She said: "I've visited out of hours emergency dental care four times for temporary work but they will not do the root canal. I'm in agony and I don't like to take painkillers while pregnant, so I have to bare it. I've phoned numerous dentists and done online searches but nothing available. And no help in finding one. It's affecting my mental health, always being in pain."
Even if you're a cancer patient - you'll probably still have to wait
Joanna Prosser, from Swansea, has recently undergone radical cancer surgery, chemotherapy and radiotherapy after her having a cancer recurrence. She's been unable to access care, and is worried about what this might mean for her if she has to undergo further cancer treatment.
She said: "I'm suffering because I am on a long waiting list - I'm actually going to lose a front tooth and likely two rear teeth because of the wait.
"I had a crown on my front tooth in 2016 and my old dentist botched it. It eventually came away 18 months or so ago but I just can't get seen so the remainder of the tooth has got to the point of being unsalvageable.
"I caught Covid while undergoing chemo and radiotherapy and was very ill in hospital and neglected my oral health during that whole period last year, and so I have two rear teeth that are starting to ache. Because I can't nip it in the bud and get them filled, they're going to carry on rotting until I qualify for an emergency appointment - at which point they'll have to be extracted.
"I also have the fear of the very real possibility of needing further chemotherapy at any point and worry that if I was to develop an infection or access I would be in a lot of trouble."
She added: "I can't even smile - not that there's much to smile about. I'm desperate and something needs to be done."
The factors driving dentists away from NHS dentistry
One factor that's thought to have driven dentists away from NHS work is the UDA system (Units of Dental Activity), which was abolished last year by the Welsh Government. It's still in place in England.
The UDA system counts how many courses of treatment each practice performs, such as check-ups or fillings.
Dental practices are set targets of UDAs to achieve, but if the practice falls short of the target, they can be forced to pay back money, known as 'claw back'.
Critics have claimed the UDA system does not incentivise preventative work, and is a key reason for dentists leaving the health service.
Unhappiness with the NHS dental contract is also thought to be key factor in the exodus of NHS dentists.
Shawn Charlwood, chair of the British Dental Assocation's General Dental Practice Committee, said: "NHS dentistry is hanging by a thread, because without NHS dentists, there will be no NHS dentistry.
"It's a really serious situation and every dentist that is lost or every vacancy for NHS dentistry that remains unfilled affects thousands of patients in terms of care and their ability to access care. Every practice struggling to fill vacancies translates into thousands of patients unable to access care."
He added: "Years of failed contracts and underfunding have meant a growing number of dentists no longer see the NHS as a place to build a career. The pandemic has upped the ante, and we are now facing down an exodus.
"Ministers have failed to grasp that we can't have NHS dentistry without NHS dentists. Rather than punishing colleagues, we need a service that recognises and rewards commitment."
What does the Welsh Government say?
A Welsh Government spokesperson said: "We are committed to meeting the needs of NHS dentistry patients in Wales through preventive care and increased access, supported by contract reform.
"While the pandemic has paused some of this work, we will continue to support practices during the recovery period as focus is placed on increasing access to those most at risk.
"As Covid-19 is still in circulation, public health measures such as physical distancing, enhanced PPE, and infection control requirements, mean fewer patients can be seen in person and practices have been asked to treat people according to need.
"We are providing health boards with £3m in 2021-22 to boost access to NHS dental services, and £2m recurrently from 2022-23 to support increased provision.”
You can view the full data set of the figures mentioned above here.
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