Brace yourself.

Should you make a quick, sharp twist or coax it out gently to minimise damage, knowing that the latter method will be even more excruciating? That's the conundrum facing this poor soul as he grips his front tooth with the rusty pliers extricated from the bottom of an old toolbox at the back of his shed. Several shots of whiskey have not given him more courage so much as slightly diminished the lack of it, as the alcohol permeates the senses and his reflection in the bathroom mirror starts to blur. Just go for it. Make it too quick to think about. And the reflection is immediately curtained by a wet, crimson spray, blasted forward by a glass-shattering scream…

A scream heard a few doors down the street by one of the neighbours, herself mixing a paste to fill a cavity in her upper molar. Not the kind of paste one can purchase in a pharmacy. Tried that already. Several times. Didn't work. This time we're going for broke with some leftover tile grout that was hidden in the boiler cupboard. At least it'll be a white filling. And probably waterproof, too.

Dentists care a great deal [...] Alas, the frustration they feel at not being able to help doesn't stir the emotions of the reader quite as much as their alleged hive of villainy and greed.

This isn't an apocalypse. There are simply no dentists anywhere within reach. The closest one packed up from the next town along two years ago, nudged into retirement by a sudden pandemic, and the nearest one now is over 80 miles away and not admitting any new patients.

And it's apparently getting worse. A crisis of pandemic proportions in dental provision with a severe and growing shortage of dentists, especially under the NHS auspices. And, as ever, the complaint about this lack of provision pitches its fork firmly in a blame game, chastising the incumbent government for not doing more and the dentists for doing so much less. Politicians, of course, once again deflect from their own mismanagement by painting the dentists as the convenient villains of the story, as avaricious sociopaths slamming the phone down on desperate patients with cold, uncaring indifference. Heck, even barnyard animals receive better and more immediate dental care than the millions of patients without access to a dentist.

Well, if only that were actually true, it would be so much easier to win elections…

Dentists care a great deal about the lack of dental provision, as it is ostensibly in their interest to provide it. And they are greatly sympathetic to how debilitating toothache can be for a patient, an affliction whose severity in any dentulous organism has not changed since the continents were a single land mass. Alas, the frustration they feel at not being able to help doesn't stir the emotions of the reader quite as much as their alleged hive of villainy and greed.

Except that every solution or lip-service offered is yet another feeble plaster on this massive, open and chronically unhealing wound. It seems that, in the same way healthcare in this country is biased towards treating disease after the event, no thought is given to preventing this wound from opening in the first place. The news items reporting on the shortage of dentists do not seem to be asking why they are leaving the NHS in droves and abandoning their contracts, beyond the 14% approaching retirement.

For some time now, and only accelerating in the wake of the pandemic, perceptions about healthcare and its delivery have been changing. While many have argued that the past few years have exemplified the need for even more investment in the NHS, others have realised that socialised medicine and state paternalism cannot competently deliver on its promise. As almost every independent commentator expounds on the looming crisis of undiagnosed and untreated disease, many patients have understandably lost patience and decamped to private providers for speedier diagnosis and results.

But not everyone can afford to do that, of course, especially in the current period of rising living costs and budgetary tourniquets. Regardless of one's financial insulation, dental pain can be suffered with a universal intensity and people with thinner wallets will still need some access to dental care. Whether or not we are all equally entitled to it is a debate for a different article and for the subsequent wrath of cancel culture.

Throwing more money at contracts won't open a new surgery in a remote rural town tomorrow. The system itself is broken. Apart from the fact that any healthcare provision predicated on treating disease after it has occurred will never catch up and never have enough funding, politicians could perhaps try a little introspection and start from the ground up, creating a dental care infrastructure that prioritises access and emergency treatment, especially in rural areas. To do so would be far less costly in the long run and certainly absolve A&E departments of the burden of dealing with dental emergencies, invariably just symptomatic relief with painkillers and antibiotics.

And, of course, it's not just about dental care after the caries has cavitated or the apices of the roots engorge their granuloma. Dentists don't cause caries or periodontitis themselves. Much of dental disease is preventable with good oral hygiene and less sugar in the diet. Emphasis on this prevention coupled with personal responsibility have to play their part too, rather than relying on pointless sugar taxes or bans on junk food multibuys.

If recruiting more dentists to work for the NHS is akin to drafting soldiers to perish on the losing side of a war, then it is certainly true that something will have to make the prospect appealing to them. Not just with a system that appreciates the expense of providing good dental care, but one in which the provision of that care is genuinely patient-focused and preventative, rather than just a service to the statistics collated by bean-counters at the Treasury.

Yes, it will cost money. But a nation that is the fifth largest economy in the twenty-first century having its citizens quite literally pulling out their own teeth in desperation is already an expensive embarrassment.