A Nagging Pain in Britain: How to Find a Dentist

By LIZETTE ALVAREZ

ARMARTHEN, Wales, Aug. 7 — Nelson Kernahan, a dentist in this small Welsh-speaking town, was in his car still rubbing the sleep out of his eyes, easing himself out of his two-week vacation, when he spotted a line so long he could not pinpoint the end.

"I said this couldn't be for us — no, this couldn't be for us," said Dr. Kernahan, a 25-year-old from Belfast. "And it was. It was like a bread line."

On a rainy Monday morning two weeks ago, 600 people turned up outside Brynteg Dental Surgery, a tiny white-stucco office, to secure one of the 300 advertised appointments to see a National Health Service dentist.

Wales is so lacking in government-subsidized dental treatment that some people pitched tents overnight rather than miss a chance for a slot. Others hopped buses from 90 miles away, only to arrive too late. A few even tried to bribe their way onto the list.

"I just assumed they were giving away mobile phones," said Steve Acworth, who rode a bus for 75 minutes to reach Carmarthen. "The first person I talked to I thought was joking. Then I realized that it was absolutely serious."

Not anticipating the dental mob, Mr. Acworth, 56, arrived too late, which he said was too bad, considering he does not really have any teeth to speak of.

"My crowns all fell off," he said. "I got some really bad dentistry and it ruined all my root work. I have no front teeth and one pair of molars, which meet on the right side of my mouth. I can't bite anything."

Ever fewer British dentists are willing to endure the grueling, assembly-line work required to take part in the National Health Service.

On average, National Health Service dentists see 30 to 40 patients a day, compared with the 12 a day that dentists see in the United States.

The dentists here are paid an amount set by the Health Service for each job they perform — a filling, a root canal. They make considerably less money than private dentists, but also leave themselves open to criticism that they do unnecessary work to line their pockets.

People who seek private care must pay for it, unless they have health insurance that covers it.

Last year the Audit Commission warned that 4 of 10 dentists in England and Wales would not accept Health Service patients, and called for structural changes to the system. Dentists now earn half their income through private practice, by some analysts' estimates, more than a 40 percent increase from the numbers 10 years ago.

"If you could earn more money for seeing less patients, what would you do?" asked Mr. Kernahan, who said he saw an average of 50 patients a day. "It's hard work. You are pushing it all the time."

The situation in Carmarthen, a rural, misty outpost where the sing-song cadence of Welsh is heard as often as English, typifies a trend that is plaguing increasingly large parts of Britain, particularly in out-of-the-way places.

There are fewer dental schools in Britain than there once were, and fewer dentists are being trained. Cardiff, Wales's capital, trains only 60 a year. To make matters worse, a high percentage of dentists are nearing retirement age or have already retired. Wales has 1,000 dentists for a population of 2.9 million, and one-third are expected to retire by 2008.

As a compromise, a majority of dentists go private and accept some government-subsidized patients on the side.

Stuart Geddes, the director of the British Dental Association, said that over the years the government had reduced National Health Service money for dentists, forcing them to take on heavy loads to make a living.

"The N.H.S. scheme down there is under pressure because it is under-funded," Mr. Geddes said. "Dentists do go private because they don't have to work at the same frenetic pace they do at the N.H.S., and there is a better quality of care for the dentists."

Dentists say that more and more people are waiting until the last possible minute to get their teeth fixed, and they are forgoing routine exams and cleaning.

To make up for some of the reduced financing, the Health Service makes grants to some dental surgeries. Brynteg Dental Surgery was able to take on 300 more patients after a grant from the Health Service allowed them to hire another part-time dentist. The surgery, wishing to be fair, placed an advertisement in the local newspaper two weeks before the enrollment date with information on the extra places.

Heather Davies, 25, the office manager who handed out numbers, deli style, on the morning of registration, said she was still getting nasty phone calls from some of the 300 people she had to turn away.

People hurled curses and rude gestures at her. One man threatened her, saying, "I know what time you get off work," Ms. Davies recounted. She felt compelled to telephone the police. In fact, the office now has a direct hot line to the police.

"Because they are paying national insurance, people feel they are entitled to service," Ms. Davies said.

One poor man — No. 301 — simply refused to leave. He dug in, hoping for a change of heart. "I felt sorry for him," Ms. Davies said.