It was after days and days of unbearable pain that James Crick snapped and tried to take out his tooth with a knife.
A tooth on the left side of his mouth has broken in half, two teeth have come out and his gums have become infected.
He has been trying to get an NHS dentist since he was 18, he’s now 27, and cannot afford to go private.
“I was just crying every day and not being able to go on with my life, not being able to work, not being able to do any of that,” he told Sky News.
“And then eventually I just got to the point where I snapped and I took a knife and tried to loosen the tooth.
“Sadly, I sort of slipped and cut the inside of my gums and then obviously there was blood and it’s quite a horrible thing,” he told Sky News.
Far from a one-off, this is becoming commonplace across the country.
Exclusive numbers given to Sky News show that pre-existing pressures on the dentistry industry intensified hugely when the pandemic hit.
COVID restrictions saw the number of NHS appointments plummet with an estimated 43 million lost, including over 13 million for children.
That has still not returned to anywhere near pre-pandemic levels.
Forty per cent fall in income
Financial pressures on dentists were building long before coronavirus.
Real terms pay in England has fallen year on year since 2009, meaning high street dentists have seen their taxable income fall by nearly 40% over the last decade.
With more and more dentists leaving the NHS to go private, desperate people who can’t afford to pay more are suffering.
Lydia’s had three fillings fall out, and her wisdom tooth is growing into her cheek, ripping into the side of her mouth.
She lives in Somerset – a so-called dentistry desert – where getting an NHS appointment is near impossible.
She said: “Eventually I caved and paid for a private check-up just to see exactly what needed to be done and to see if there was any way I could afford the treatment but once she gave me the treatment plan I burst into tears and ended up having a panic attack in the seat because it’s just so expensive.
“There’s no way I would’ve been able to pay for it, but at the same time it was also knowing that if I can’t pay for it, I’m just going to have to continue being in pain, and it’s probably going to get worse as well.”
Eventually, it became too much for her, overwhelmed by the pain and the cost of potential treatment.
She said: “I actually had an overdose of painkillers because the tooth pain was so bad that I didn’t want, I just didn’t want to be awake anymore, so I didn’t really care what happened if I took too many. It didn’t bother me.”
Now she says she’s hoping and praying that one day she’ll get an “amazing promotion” or that she’ll manage to secure an NHS dentist, but says she can’t trust that she won’t take another overdose.
She added: “My mental health wasn’t great to start with so I don’t trust that at all, not at all.”
‘The government’s not really interested’
Len D’Cruz, a practising dentist and an elected member of the General Dental Practice Committee, issued a stark warning for the future.
“The government’s not really interested in NHS dentistry,” he said.
“They seem not to care. I think NHS dentistry is dying. It’s dying a very slow death.
“I fear for NHS dentistry in this country if the government doesn’t wake up and start sorting out the NHS contract and reforming it putting some more money into dentistry, encouraging young dentists to want to work back in the NHS, we’re going to end up with a system that for years which is going to be a very, very difficult system to find, patients are going to struggle to find their dentist in this country.”
He said he is concerned that if this continues it is the next generation that will pay the price.
He said: “The most common reason why children end up in hospitals is for extractions for general anaesthetic extraction, so it’s horrendous.
“We’re the fifth richest nation in the world yet we have a system where people are taking their own teeth out, that is Victorian values.
“We should not have that sort of system in this country. And the government has just watched this happen. They’ve been asleep at the wheel, successive governments, government after government.”
A Department of Health and Social Care spokesperson said: “We are working closely with the NHS to reform the dental system and we are negotiating improvements to the contract with the British Dental Association to ensure that working in the NHS remains attractive to dentists, while increasing access for patients.
“The NHS commits around £3 billion to dentistry each year and last year we gave the NHS an additional £50 million to fund up to 350,000 extra dental appointments.”
‘I have to keep giving him Calpol regularly’
In Suffolk, a mother, who wants to remain anonymous, hopes that the situation will improve for her three young boys – none of whom have ever seen a dentist.
She said: “My little one did have problems for a little while. He actually got an abscess on one of these teeth and I couldn’t get him in anywhere.
“And he was only seven at the time. And for a seven-year-old to feel that pain is awful. He didn’t know how to cope with it. I had to keep giving him Calpol regularly to help him deal with the pain.”
She says she understands how someone could get to the place where they pull out their own, or their child’s, tooth to stop the pain.
She said: “If my children were in agony that much, and there was nothing I could do for them to get them out of that pain. I can see why parents and children, just desperate to get out of pain and pulling their own teeth out.”
She has been trying to see a dentist herself for several years too and says none of her remaining teeth are worth saving.
She takes strong painkillers every day and is only able to eat soup and liquid foods. Brushing her teeth now causes too much pain.
“I avoid talking to people I don’t know because I’m always covering my mouth. I’m self-conscious,” she said.
“I’m a single mum so I can’t afford to pay for my dentistry. And when I’ve asked people, just to get out of pain or to even register with an NHS dentist, you know, it’s been you know, ‘we can’t help but if you can privately, we can help you tomorrow’.
“I can’t afford 1000s and 1000s of pounds for my smile to come back.”
Her message to those in power?
“Please, I beg you, I’ve been waiting years just to get even registered to be seen and to be, you know, have a checkup. You know, that’s all I’m asking. And then, just to ease me out of the pain a bit and so I’m able to eat and fix the smile gradually, that’s all I’m asking for.”
UK on the verge of ‘two-tier’ healthcare system
Sir Peter Bottomley MP, a member of the dentistry APPG, said it is “unacceptable that people have nowhere to go”.
He said: “We’ve got to change it. It requires the government taking action, National Health Service England doing something.
“It requires getting the co-operation of dentists as high as possible, using the public and private sector to make sure we can catch up with the COVID backlog and then create a system which will work for the future.
“It hasn’t worked and it’s not going to work without drastic action.”
Wes Streeting, the shadow health secretary, said the country is being “marched into a two-tier healthcare system”.
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He said: “Patients are finding it impossible to see a dentist after 12 years of Tory mismanagement. Thousands of dentists are leaving the NHS, but going private in the middle of a cost of living crisis is simply not an option for most people.
“Labour will provide the NHS with the staff, equipment, and modern technology needed to get patients seen on time.”
‘Put patients above targets’
Toothless in England, a pressure group campaigning for more NHS dentists, said the situation highlighted “Dickensian levels of self-treatment and neglect throughout the country today”.
Campaign co-ordinator Mark Jones said: “14 years of hand-wringing by successive governments since the Health Select Committee declared the NHS dental contract ‘unfit for purpose’ back in 2008, has resulted in high levels of oral health inequalities.
“If only Westminster had the political will to actually do something about it, we wouldn’t be witness to Dickensian levels of self-treatment and neglect throughout the country today.
“Both the public and dentistry professionals alike deserve better. The NHS dental contract needs urgent and significant reform along with new and proper funding.”