DIY dentistry in the UK: what happens when NHS dental care is out of reach

Many people across the UK are finding it difficult to get the dental care they need to keep their teeth healthy. As NHS dentistry declines, dental hygiene poverty is becoming increasingly common.

Cuts to budgets are helping to create "dental deserts" nationwide - areas where NHS dental services are scarce or non-existent, and where private treatment is simply out of reach for many.

The pandemic lockdowns also blocked access to a wide range of healthcare, including NHS dentistry. Against that backdrop, it is unsurprising that recent years have brought stories of people taking drastic action to cope with dental problems.

A YouGov poll in March 2023 reported that one in ten Britons had "performed dentistry on themselves", including "using cement and superglue to fix crowns and dentures, killing an infection with urine, using "heated polybeads" to replace a missing tooth and applying chemical metal (an adhesive usually used for household or outdoor repairs) as a filling."

In 2022, researchers at the University of Plymouth’s Peninsula Dental School described cases in which one patient had "used a dart to remove gross deposits of calculus" and another tried to pull out 13 teeth with vodka and pliers.

Most instruments used in a dental surgery are, in effect, smaller or more specialised versions of tools you might recognise from a household toolkit.

Why dental tools aren’t the same as DIY tools

Dental instruments are engineered to make it harder for microbes to live on their surfaces, and they are sterilised after every patient. By contrast, the pliers you used to sort out a fitting behind the loo last month are very unlikely to be anything like as clean.

The dangers of self-extracting teeth

Trying to remove a tooth yourself can lead to an oroantral fistula - an abnormal tunnel between the mouth and the maxillary sinus (the air-filled space within the bones around the nose). If the opening is under two millimetres, it will often close naturally. Larger fistulas, however, carry a serious risk of infection.

With an open passage, oral microbes - along with liquids and food debris - can be pushed into the warm, damp maxillary sinus. Infection can then develop and worsen, potentially ending with the need for invasive surgery.

It is also important to note that pulling a tooth may do nothing if the infection lies at the junction between the tooth and the bone. Someone taking pliers to a painful tooth might, at best, see no improvement - and, at worst, be left in severe pain with an open wound vulnerable to a secondary infection.

There is an additional risk: part of the tooth can be left behind in the gum. Root fragments commonly remain because tooth roots taper to a fine point, and that tip often snaps during extraction.

This creates yet another infection hazard, because teeth have limited - or no - blood supply running through them, meaning immune cells cannot readily reach bacteria.

An average person pulling their own tooth is unlikely to be able to tell whether any root is still present. If that residue later causes problems, it may require oral surgery to remove - a procedure that can be expensive and extremely painful.

There is also the possibility that self-extraction permanently changes how the teeth meet when biting. That can make eating painful, interfere with other healthy teeth in the jaw, or injure the soft tissues inside the mouth.

It’s not all white

Although many people appear to turn to self-dentistry to try to relieve pain, some social media users take alarming risks in pursuit of a film-star smile.

There are reports of individuals using nail files to even out natural ridges and slight variations on their teeth - something that is highly dangerous.

Filing removes the hard enamel that protects teeth. It can also create micro-cracks that extend into deeper layers, raising the likelihood of infection and decay, and increasing the risk of the tooth dying - outcomes that can bring significant pain and suffering later.

Home tooth-whitening with hydrogen peroxide is another concern. Some people have put hydrogen peroxide solution directly onto their teeth, gambling on (possible) short-term results while risking lasting harm.

Regulated whitening kits are limited to a maximum of 0.1% hydrogen peroxide, yet users may expose their teeth to concentrations many times higher.

Hydrogen peroxide is a bleaching chemical that damages the tissues it touches. That means it can seriously injure gums - and, if swallowed, potentially harm the digestive tract.

These dangers underline why seeing a dentist should be treated as a priority in an oral emergency, or if you are determined to pursue cosmetic treatment (and why expanding affordable dental provision should be a priority for government).

Quick fixes and hacks typically end up costing more in the long run.

Adam Taylor, Professor and Director of the Clinical Anatomy Learning Centre, Lancaster University

This article is republished from The Conversation under a Creative Commons license. Read the original article.