Dentists: given a drilling

Until I moved to south London six years ago I was a regular patient of a nice dental surgeon in Islington. My teeth rarely gave me much trouble and I lapsed in my check-ups - I hadn't seen a dentist for more than three years.

So I visited a selection of dentists to see what their recommendations would be. One wanted to give me eight fillings, and another just one. And prices ranged from £50 to £2,860. I also asked a consultant at the Dental Institute at King's College Hospital to see what work I really needed.

The expert's view on my teeth: After examining my teeth, the good news from Martin Kelleher, consultant in restorative dentistry, was that I am resistant to decay and gum disease. He advised that I'd need to have a filling in my lower-right molar within the next six months. He found a cavity on the upper-left premolar which would probably present no trouble for a year but would need to be monitored with the help of x-rays. He added that, as I don't attend regularly, some dentists might decide to give me a filling straightaway.

My existing fillings were intact and the fissures which some dentists wanted to fill) were not decayed and should just be watched.

One thing that did concern him - and I had no idea about - was how worn my teeth are due to grinding, presumably while I sleep. This, too, needed monitoring.

Boots, 127a Kensington High Street, W8

The practice: The smart DentalCare department is modern and the dentist showed me digital pictures of my teeth on screen and explained everything very clearly.

The advice: I required an urgent filling to the lower-right premolar and an additional filling on the upperleft side. He recommended a session with the hygienist to sort out three spots of mild gingivitis (gum disease) and also, as a precautionary measure, sealing the two molars with the deepest fissures. He also wanted to replace my one remaining amalgam filling with a composite filling and told me to make sure I returned in six months for a check-up and another session with the hygienist.

The expert assessment: "He's picked up on the same issues as I have. The filling to the lower-right premolar is definitely justified and you could argue that sealing the fissures is reasonable as a preventative measure. The upper-left premolar has an early lesion and could be simply monitored instead of filled. The third filling is just changing the amalgam, which is a cosmetic issue as the filling is stable. I think the hygienist is over-prescribed for your problems."

TOTAL (over five visits) ......... £407.50

Whitecross, 14 Broadway Chambers, W6

practice: I visited the Hammersmith Whitecross, one of a chain of 24 in London. It's described as "state of the art" in its brochure, but it could do with a little TLC.

The advice: This was the only surgery that offered me a choice between NHS and private treatment, so I decided to go with the NHS. The female dentist cleaned the tartar off my teeth (cutting my gums in one place, which was rather painful and she didn't apologise) and told me I needed a filling in the right molar that I was having problems with - a bargain £20 on the NHS.

If I wanted white fillings, I could pay for these privately and she recommended that for the upper-left molar where there was the beginning of a cavity and replacing my remaining amalgam filling, if I wanted. Hygienists are not covered by the NHS and she recommended I paid for this privately.

The expert assessment: "Getting NHS treatment in the South-East isn't easy. The recommended filling is based on the x-ray so that's fine. The upper-left molar, though, is intact so I disagree with the need for a filling there."

Total (two visits) £50

Private Cost consultation (30 mins) - £30

Total (over three visits) £223

Dentics, 1 Kensington Church Street, W8

The practice: Dentics is a chain with four branches in London. The surgery was clean and high-tech.

The advice: I was told I needed only one filling and a visit to the hygienist. There was also evidence of grinding my teeth, which the dentist said he would monitor for the time being.

The expert assessment: "£120 is quite expensive for a filling. The fact that only one filling has been recommended is giving the patient the bottom line and reflects different dentists' styles. A lot of other things would have been noted on the chart and would be monitored."

TOTAL (over two visits) £200

LUND OSLER, 56 Knightsbridge, SW1

The practice: Opposite Harvey Nichols, this really is the creme de la creme of cosmetic dental surgeries - with prices to match.

The advice: The dentist suggested putting in eight new fillings and replacing my existing five. He had concerns about my diet (was I eating a lot of sugary or acidic foods that could be eroding my tooth enamel?) and the wear to my teeth. The recommendations - in a ninepage report complete with 16 photographs of my teeth - were to replace all my old fillings and fill any new cavities, sandblast the stained and fissured areas, restore my chipped teeth and fit me for a mouth guard (to prevent me grinding my teeth at night). Once these procedures were done, we could then discuss tooth whitening and possible orthodontics to correct misaligned teeth.

The expert assessment: "Lund Osler has put in the most work with the elegant treatment plan. The two most urgent cavities that require filling have been pinpointed but aren't due to be treated until appointment five, which is surprising.

"There are some cavities that do not require filling yet and the existing fillings could be changed but it isn't necessary. One could resurface the existing composites rather than replace them. I'd agree with the sandblasting to etch and tidy up the teeth but at £240 it's expensive. Porcelain veneers would be a highrisk option considering your grinding and clenching habits. Rebuilding of the tips of the teeth is pretty minimal and would only be for aesthetic reasons.

"I would agree with making models of your teeth and making a soft splint for a mouth guard. There is no need to correct the smile unless one had a huge desire to change the appearance of their teeth and it is relatively risky. Finally, I disagree that you need an hour with the hygienist. They just need to give you some little inter-dental brushes and leave you to get on with it."

TOTAL (over nine visits) £2,860