Cost of living: 'I had to choose between heating or my teeth'

"I had to choose between heating our house or saving my tooth," says mum-of-two and carer Melanie Fudge-Horton.

She needed root canal and a crown, but didn't have an NHS dentist and was at the end of a long waiting list.

And after being told it would cost £1,000 to save the tooth, she paid the cheaper option of £50 to have it extracted instead.

The Welsh government said it had allocated an additional £2m to help NHS patients access treatment.

Melanie and husband Marc are full-time carers for their son Thomas, 24, who has Asperger's syndrome, and daughter Elphie, six, who has autism.

Melanie called more than 20 NHS dentists near her home in Abercynon, Rhondda Cynon Taf, before considering the £1,000 private treatment.

"With the cost of living rising there was no way I could afford it," she said.

"My family and I, we're on benefits, there's no way we have that kind of expendable income.

"So eventually I decided to have the tooth extracted for £50."

Melanie said it left her feeling "a little bit sad" and like a "victim of an unfair system".

"I feel if they have room to treat you as a paying customer they should have room to treat you as an NHS patient," she said.

"It definitely feels wrong and I do feel robbed, to be honest with you, because had I had access to an NHS dentist I wouldn't have had to make that choice.

"It came to a choice of saving the tooth or keeping the house lit and having a warm house, and, at the end of the day, the family comes first."

Melanie is one of thousands of people in Wales who are on waiting lists to get onto the books of an NHS dentist.

Three Welsh health boards established centralised lists last year and they have more than 11,000 people on them: 8,992 in Cardiff and Vale, 1,330 in Cwm Taf Morgannwg, and 1,255 in Powys.

The other four health boards do not know how many people are waiting because the lists are kept by individual practices.

The BBC has seen a document sent by the Welsh government to dentists earlier this year which acknowledges that NHS services will not be able to meet "all the demand" for dental access.

It says patients will have to be prioritised which could mean people with "healthy mouth and low risk" waiting for a check-up "much longer than they have been advised for many years".

On Monday, the patient watchdog for Swansea Bay published a report which found there are "unacceptable levels of dental access" in the area meaning many people are living with pain.

One person who responded to its survey had resorted to pulling out their own teeth.

Tara Pearce moved back to Pembrokeshire last July with her husband John and two daughters, Frankie, nine, and Taya, eight, after five years in Essex.

She tried to register with an NHS dentist, but there were no spaces available.

"I went miles further afield, and with no joy," she said.

"No NHS new patient spaces in any of the dental surgeries from here up to Llanelli."

Tara feels very "let down" and has what she calls "mum guilt" at not being able to get the girls seen.

She is still on a waiting list and will pay privately if and when she has to, although the potential costs are a worry.

"It does feel like a postcode lottery, or first come first served," she said.

"It's very unfair that some people have been lucky enough to get it and some people haven't when everyone's entitled to it.

"So it is unfair and it does need to change."

Hairdresser Katie-Louise Howells, from Milford Haven, does have an NHS dentist but they are unable to remove a wisdom tooth that is growing badly.

Katie-Louise has two children and, in a single-income family, said there is "no way" she can afford to go privately.

"My whole side of my face was swollen, I was unable to open my mouth to eat or drink, I had jaw lock, I had earache, it affected my balance," she said.

"It put me in bed for three days, I was unable to work, it affected me being a mother to my children because I'm on my own with them."

Katie-Louise has been referred to another NHS dentist for the operation to be done under general anaesthetic but it is a two-year wait or a big private bill.

She said she cannot afford it with "two children to feed as well as the living expenses of everyday life".

"I'd have to take out a loan or probably ask to borrow money just to get the problem sorted," she said.

"I'm worried because I don't like the thought of being in pain."

British Dental Association's (BDA) Russell Gidney said the Welsh government would need to make "a lot of extra investment" to meet the demand for NHS dentistry.

"We have a capped contract on the numbers of treatments that we can do and once we've hit that target there is no more money.

"So, for us to treat more (NHS) patients would literally just be us paying to treat patients."

He said the message he received from negotiations with the Welsh government was "there is no more money".

"We need an honest conversation. The conversation that we always have is about NHS dental system that can do all things for all people, which is just disingenuous.

"It physically can't do that until we can start talking about what we can do with the money that we've got for all patients, which might mean, restricting what we can do, or saying that we cannot see everybody."

The BDA estimates the annual budget for general dentistry in NHS primary care in Wales before the pandemic was £145m.

The Welsh government said the pandemic meant fewer people could be treated but now guidelines had been revised to prioritise at-risk groups and those with urgent problems.

It added: "We have asked health boards to encourage dental practices to recall people who are overdue their routine NHS dental examination and to provide appropriate NHS treatment for all.

"The return of services will continue to be gradual and will depend on capacity within individual practices.

"We are working with the British Dental Association and the wider dental community to reform the contracting arrangements for NHS dental provision.

"This will enable dentists to focus on prevention, providing care for existing patients and include a need to see new NHS patients."

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