Drillings and fillings, picks and swabs - it’s “open wide” and the tools go in. A visit to the dentist is rarely fun. But we all know it’s necessary.

Though it was nice to have a breather during the Covid lockdowns, it’s now getting to the stage of feeling abandoned. When four years have passed without a single check-up; when you’ve lost a second filling and the jagged edges have softened like sea glass - you might venture to pick up the phone and get those teeth sorted.

You could be in for a disappointment, however, or at least a wait of many months, as South West Wales’ dental services appear to be crumbling at a faster rate than your pearly-whites - especially for anyone looking to join an NHS dentist.

I think a lot of people would be shocked if they realised quite how bad the situation has got.

Simon Hart MP

MP for Carmarthen West and South Pembrokeshire Simon Hart is acutely aware of the problem. Talking to the Observer recently, he said: 

“As far as I am aware, if you call the Hywel Dda helpline you will be told that the waiting list to join an NHS dentist is closed. 

“People in agony are having to phone around every dentist in the area, only to find out that none of them is taking new NHS patients. The nearest practice we have heard that is taking new NHS patients is in Llanelli.”

And it’s not just about NHS dentistry either: “I am getting an increasing number of emails from residents who are unable to access ANY dentistry care – let alone NHS dentistry, added Mr Hart. “I think a lot of people would be shocked if they realised quite how bad the situation has got.”

A dozen years ago or more, there was a crisis locally as many dental practices that had started out providing NHS treatment moved completely into the private sector. It was into this context that {my}dentist came on the scene, and it was with much enthusiasm that several members of staff at the Observer added their names to the list for the Whitland branch.

They were not disappointed: the standard of service and care available at these local practices has been excellent - it’s just getting harder to access.

Malcolm, an 88-year-old {my}dentist patient living in the Kilgetty area, had not seen a dentist for three years when he called the Haverfordwest surgery in October 2022 to make an appointment. He needed new dentures but was told the first appointment available would be February 2023.

He had to take the initiative as regular check-ups had become a thing of the past. “My advice would be just ring up and make an appointment,” he said. “Andrea, my dentist, is very efficient, it’s just that the waiting list is so long.”

When the impressions were made in February, Malcolm was given a follow-up appointment many months ahead: “But they told me not to worry, as I would probably be called in sooner, and I was.” He finally had his new dentures fitted in early June, but he must be one of the last Haverfordwest patients to receive NHS treatment.

Apparently the {my}dentist group currently has 19 NHS clinicians at their practices in West Wales, but the last dental surgeon to offer NHS treatment in the Quay Street practice in Haverfordwest has just gone private, we learned this week. And are there any dentists at Whitland currently offering NHS treatment? The website implies that there are; locals say otherwise.

A spokesperson for {my}dentist said: “There is an acute shortage of NHS dentists not only in Wales, but throughout the UK. While we continue to actively recruit new clinicians to join our team, some of our practices are operating with a reduced number of NHS dentists. 

“Our practice teams are working hard to see as many patients as they can, but where there is unprecedented demand, a priority is being placed on emergency care over routine check-ups. 

“We’d like to apologise for any inconvenience this may cause. However, to ensure more people can get access to the care they need, we are able to offer affordable private dental appointments as well as an affordable monthly plan to help spread the cost over a longer period of time and provide peace of mind for patients.”

In Wales, dentistry is devolved to Welsh Government in Cardiff who set the payment terms for dentists doing NHS work.

In March 2022, Senedd Member Paul Davies raised dental services with the First Minister and asked the Welsh Government to support the sector and ensure it can deliver vital services across Pembrokeshire. 

At the time, Mr Davies said: “Access to local dental services is already a problem for some people in Pembrokeshire and so it’s vital that everything possible is done to protect the local services we do have and ensure patients can receive the treatment and care that they need. 

He added: “Dentists are warning that they will walk away from the profession unless a solution is found and the Welsh Government must step up and find a way to support the industry.”

It was about this time that the Welsh Liberal Democrat Leader Jane Dodds highlighted at a party conference in Swansea “Labour’s failings in the Welsh Government, particularly focusing on NHS waiting lists” and “the inability of large sections of Wales to access a dentist.”

Now, ahead of the June 21 Senedd debate on the Health and Social Care Committee’s report into NHS dentistry, Jane Dodds has said: “The NHS dental service has all but collapsed for many people in Wales.

“There are endless stories of people with dental emergencies either paying thousands of pounds, travelling long distances, or worse still doing DIY dental work.

“Children in particular are missing out on the dental care and support they need,” she adds.

A Welsh Government spokesperson told the Observer: “We have increased funding for dentistry by more than £27m compared to 2018-19, including an extra £2m a year since last year for health boards to address local access issues.”

Surprisingly, “Nearly 174,000 patients who have historically not been able to get a dental appointment received one last year.”

The spokesperson added that Health Education and Improvement Wales has launched a new recruitment initiative offering an enhanced support package for trainees who complete dental foundation training in specific rural dental practices including ones in West Wales.

Yet very recently Acting Leader of Plaid Cymru, Llyr Gruffydd MS, saw the need to stress that “while Welsh Government has often asserted that NHS Wales workforce is ‘at record levels’, figures obtained by Plaid show a trend in which levels of administrative and clerical staff has risen to compensate for decreases in levels of medical and dental staff.”

Earlier in the year, local Senedd Member Samuel Kurtz told the Chamber that he had spoken to a dentist who is a member of the Dyfed-Powys local dental committee. The dentist told Mr Kurtz that NHS dentists are facing large financial penalties if they fail to meet unevidenced and unachievable contract reform targets, which he described as a cliff-edge for NHS dentistry in Wales.

Preseli Pembrokeshire MP Stephen Crabb met with the My Smile dental practice in Milford Haven on May 26 to discuss the challenges facing the sector and to better understand how the new Welsh Government contract for dentists is working.

Stephen Crabb MP at MySmile Dentist in Milford Haven
Stephen Crabb MP visiting the My Smile Practice in Milford Haven (Pic. supplied)

After his visit, Mr Crabb said: “Many local families are struggling to get a dental appointment, even for private work. There are real problems across Wales with recruitment and retention of dentists, both in the NHS and privately.

“It is clear that there is a lot of work to be done to get NHS dentistry back on a sustainable footing.”

Speaking to the Observer, the MP added: “Since the pandemic, there has been a sharp increase in the number of constituents contacting me about the difficulty in getting dental appointments. Some have told me how their dentists have been willing to offer them private appointments but will not see them as NHS patients.  For many families, private treatment is unaffordable. The result is that oral health is deteriorating.

“But I have also heard from a number of local dentists about the realities facing the profession right now and, specifically, the impact of new NHS contracts issued by Welsh Government.

“I recently visited My Smile dental practice and was encouraged to hear about their commitment to deliver NHS dentistry services to the people of Milford Haven. But it was useful to hear about the significant challenges that delivering NHS services pose, with the new Welsh Government contracts coming into force.

“While there are problems with the recruitment and retention of dentists right across the UK, which we do discuss at Westminster, there are specific challenges here in Wales that need to be addressed urgently. 

“Back in December 2021, I wrote to Minister for Health Eluned Morgan MS regarding the provision of dental services in Pembrokeshire as I just don’t see the evidence for an increase in NHS availability. It’s definitely not what local people are telling me. 

“In December last year, First Minister Mark Drakeford appeared in front of my committee in the House of Commons, and I made the point that ‘NHS dentistry is disappearing at a rate of knots in West Wales’. He disagreed and claimed that the new NHS contract is creating ‘thousands more appointments in the NHS for dental patients, including in the Hywel Dda area’. 

“In fact, the current situation is the worst I have ever known it to be. It seems to me that the Welsh Government have a big decision to make - whether they want NHS dentistry to survive or whether they are content to see dental treatment to become essentially a private service in Wales.  

“I don’t believe dentists want to turn their backs on the NHS so I hope Welsh Government and the dental professions in Wales can resolve these issues as a matter of urgency.”

What is a dental emergency?

The following are classed as emergencies, and you are advised to see your regular dentist or contact NHS Wales 111:

  • Swelling of the lips, tongue, or cheeks that is causing difficulty breathing. This usually requires an urgent referral to an A&E department
  • Dental pain that is not relieved by simple painkillers
  • Teeth that have been knocked out or severely broken
  • Serious cuts to the lips or gums
  • Bleeding from tooth sockets after an extraction that cannot be stopped.

Tom Riall, Chief Executive of {my}dentist summed it up in January 2022 following a report that revealed that three in ten Britons can’t access an NHS dentist:

We need action now to support NHS dentists and to fix the dental workforce crisis once and for all. Without this, the problem will only get worse - more patients will be left in unnecessary pain and discomfort, dental decay will go untreated, and vital oral cancer diagnoses will be missed.

Tom Riall, Chief Executive, {my}dentist