Private dentistry is continuing to expand and the mass exodus of surgeries from the NHS over the 1990s reflects both "knightly and knavish" motives on the part of dentists, according to a study out this week.
Speaking at the Social Policy Association's Annual Conference, Peter Taylor-Gooby, of the University of Kent, said that cutbacks in government support for dentistry began with changes to the contract between the profession and the health service in 1990.
General dental health of the population had improved greatly in the post-war years with fluoridation of water and more effective toothpastes having a major impact. One study showed that the number of decayed teeth per adult fell by about a half between 1968 and 1988.
But the government's push to make dentists concentrate on preventing dental problems rather than restoring damage caused dentists to move into the private sector, operating surgeries like small businesses.
Dentists argued that government cutbacks meant that within the NHS they could no longer provide the standard of care to their patients or afford the materials they were duty-bound to offer. They also wanted more pay than the NHS could provide.
Professor Taylor-Gooby believes that in the long term the dental profession cannot avoid a massive transformation: "Improvements in dental health of the population continue apace and will restrict the market for traditional dentistry in both public and private sectors."
He believes that unless the profession takes the matter into its own hands, a mixture of market and government pressures will force the issue: "Dentists do have a sense of grievance, they cannot really understand why things cannot go on as they have done in the past. In future dentists will deal with only major dental problems and there will be new tiers of therapists dealing with the less serious complaints. A good model for dentists to follow would be that of hospital consultants."