Britain's dentists are inflicting at least £200 million of unnecessary and even harmful treatment on patients each year, according to one of the UK's most respected dental experts.
A damning report, to be presented to the Dental Practice Board conference in Eastbourne tomorrow, will say that dentists are boosting their incomes by insisting on too many check-ups, taking too many X-rays, doing unnecessary scaling and polishing, and replacing fillings too frequently.
Aubrey Sheiham, professor of public health at University College London, says: 'Numerous dental procedures are ineffective at best and harmful in many cases.'
The study is a dramatic demonstration of recent concern that dentists - who earn on average £50,000 a year - are being financially motivated to do treatments that are based on tradition rather than medical evidence. Last month the National Institute of Clinical Excellence ruled that dentists should stop taking wisdom teeth out as a precautionary measure. It said there was no evidence that there is any medical benefit from extracting wisdom teeth unless they are diseased.
Sheiham claims there is no medical evidence to support dentists' insistence that people need a check-up every six months. The twice-yearly check-up was first mentioned in The Toothache, a storybook for children published in 1849, that quickly entered dental mythology. 'Recall intervals can safely be extended to 18 months for most age groups. For those over 20 years old, longer intervals of three to five years are recommended,' says the study. Overall, adults endure between 6 million and 10 million unnecessary dental check-ups each year, wasting up to £120m.
More than 13 million scalings and polishings are done every year, at a cost to the NHS of more than £100m, and yet there is no evidence of any medical benefit. Within 72 hours they are as dirty as they were before the cleaning. There is also no benefit from having X-rays every year. Dental decay is so slow that X-rays are only required every five years. Replacing missing molars with false teeth may have a cosmetic benefit but there is no health gain. Modern foods are so tender they can easily be chewed without the full set of molars.
Studies show that dentists replace fillings far more than necessary, and that if they suffer a drop in income, they will replace their patients' fillings more frequently. The less someone visits a dentist, the longer their fillings last, because it gives their dentist fewer opportunities to replace them prematurely.
Fillings should last at least 15 years, and Sheiham claims that if a filling needs replacing within five years, it is professional incompetence and should be replaced free. The reason that women lose their teeth earlier than men, he says, is because they visit their dentist more often.
Compared with other doctors, dentists have almost total clinical freedom to do whatever they want, and are paid for each piece of work they do. A year after having his wisdom teeth out, Theo Howe was told by his dentist that he needed 13 fillings. He sought a second opinion from another dentist who told him he needed only one. 'It was clear the dentist was just trying to boost her work. I find it gutting that I went through all the pain and expense of having my wisdom teeth out when it was completely unnecessary,' he said. 'But there is little you can do but trust your dentist.'
Dentists are only likely to face discipline in extreme cases, but can then be barred from practising. Earlier this year Stuart Molloy, who claimed to be one of Britain's best dental surgeons, was struck off after giving 18 unnecessary root fillings to a man who had visited him with a cracked tooth and sore tongue. Another patient, Sheila Muggleston, visited Molloy's practice complaining of pain in her upper jaw, and ended up spending £2,000 on dental treatment that left her with broken facial bones. Molloy told another patient she needed all her top teeth taken out, although a second opinion revealed she only had one problem tooth. Molloy claimed he was trying to nip problems in the bud.
Another dentist, Melvyn Megitt, earned £600,000 in a single year by seeing 150 patients a day. Megitt was eventually found guilty on five charges of misconduct after deliberately snapping braces to ensure they needed further treatment.
Sheiham claims that the amount of unnecessary dental work will increase unless the number of dentists is cut back sharply. Improving dental health - the result of better diet and toothpaste not better dental treatment - means there is less and less work for dentists to do. He says that idle dentists will find new markets: 'A hungry dentist is a dangerous dentist. Dentists will look for new work to do. They'll tell patients to have their teeth whitened or straightened; they'll tell them to replace coloured fillings with white ones. They will start offering treatments to stop snoring, although there's no evidence that it works.'