How has dental care, including orthodontics changed?

Orthodontists are specialist dentists providing dental care, largely for children. New NHS contracts for dentists in England and Wales were introduced in April in a bid to improve the quality and availability of care and to plan that care more effectively at a local level.

All dentists and dental specialists must now have a contract with their local Primary Care Trust (PCT) to be able to provide an NHS service for their patients.

Now PCTs are responsible for deciding which NHS treatment should be available in their area and for funding it.

Before the new contracts, PCTs were not involved with the provision of dental care and dentists could see as many patients as they wanted.

Now the government is trying to target NHS resources to children with the greatest need.

So what's the problem?

n Orthodontists say the new contracts they have been given do not accurately reflect their true workload and their earnings should therefore have been set higher.

Failure to do so has forced many to seek private work instead to supplement their income and cover the cost of borrowing where new surgeries have been established.

The result, say orthodontists, has been the sacrifice of NHS patients. Many practices have since expanded their service at the request of their local Primary Care Trust, adding to the problem.

Secondly, new patient bandings have been set up under the new contracts to help practices prioritise who is most in need of NHS treatment. This can, in some practices, exclude cosmetic work from free NHS treatment altogether due to inadequate funding to treat all.

n In short, The British Orthodontic Society maintains that the government has failed to pass on the money the PCT needs to continue funding and expanding the service.

The society adds the new move is therefore rationing treatment, leading to longer waiting lists. This means some children who need treatment may go past the age where they are entitled to treatment.

n Finally, a recent survey of 650 dentists by the British Dental Association found 78 per cent had not been seeing any more patients since the new contracts came in - which was one of the key objectives. The government said the survey painted a "distorted picture".

What does the Department of Health say?

It acknowledges that some orthodontic practices have expanded since the new contracts were determined. However, it says it remains up to local Primary Care Trusts to decide whether to allocate money to all these cases. The new treatment bandings - five categories covering major work to cosmetic work - have been introduced to help orthodontists decide which cases should be treated on the NHS. Only categories four and five are guaranteed NHS treatment, ensuring only those patients who most need treatment will be eligible for NHS funding.

So what's the answer?

Orthodontists, many of whom signed their contracts in dispute, are frustrated about the longer waiting times for patients.

They say the government should simply change the contract values - increase the pot of money to cover more cases.

The British Orthodontic Society would like all children who need treatment to be able to access it at the optimum time in their development, which is at about the age of 12.

What does it mean for me if I want orthodontic care for my child?

It depends on how serious it is. Due to the treatment bandings and increased orthodontic caseloads, treatment you once received for free under the NHS may not now be available or you may have to wait longer for treatment.

This, for example, would include the fitting of braces or cosmetic work as opposed to more serious teeth realignment work that is needed to improve appearance and enable patients to eat comfortably or brush their teeth effectively.

What do I do if my local practice tells me my child's dental work is no longer available for free?

You will have to seek another orthodontic dentist whose workload enables them to have funding left for the more minor types of work.

Your family dentist will be able to refer you to other orthodontists in the area. If this search proves fruitless, you will have to seek private treatment. The British Orthodontic Society advises parents who are unsure about eligibility for NHS treatment to talk to their family dentist. Alternatively visit www.bos.org.uk for a list of orthodontists in your area who can be contacted directly for an NHS or private appointment.

How much will private treatment cost?

It depends on the treatment required but a brace fitting can cost around £2,500.

What if my child has already started treatment?

The Department of Health says any patients who believed they were entitled to NHS treatment prior to April 1 may still be able to receive it even if they don't qualify under the new rules.

This does not apply to patients who simply needed teeth removed to allow their adult teeth to grow. The British Orthodontic Society says patients who have already started treatment should talk to their PCT.