When dentists were forced to display their prices for the first time in 2011, it was seen as a landmark moment for patients.
It followed sustained criticism about a lack of transparency as a series of price surveys compared dental costs in the Republic and Northern Ireland.
Some NHS-subsidised dentists in Belfast were attracting so much business they were offering transport as patients crossed the Border on the “pain train”.
An Irish Independent survey of dental prices shows widespread variation, with gaps emerging not just between town and city but among surgeries relatively close together, with a filling costing €70 in Dundrum, Dublin, and €170 in Blackrock, a few kilometres away.
So, is this evidence of competition? And why such wide variations?
Overheads such as property prices and rent are higher in the cities and must be added to the business cost.
But other hidden factors might be influencing prices. One is the recruitment and retention of dentists and dental hygienists. They are in short supply, so if a practice owner wants to hold on to them, they must be competitive when it comes to pay.
That cost could be passed on to the patient, but dentists argue this means the service is improved with more access to timely appointments by the patient.
The arrival of bigger, corporate-owned chains has also changed the landscape. These have economies of scale not open to the smaller, family-owned practices.
Covid-19 has also affected some practices more than others.
During the darkest days when so many people were afraid of infection, they avoided doctors and dentists. There was not only a fall-off in custom, but dentists had to reduce their number of patients by a third.
By July 2020, 16pc of dentists had resumed less than 50pc of their practice.
Yet most said they were working the same hours due to social distancing and infection control measures. Dentists have long highlighted the additional cost burden of PPE, which came to around €14 per appointment in a three-dentist practice.
A number of dentists have employed additional staff to manage cleaning and infection control between patients. Some have been able to absorb these costs more than others.
Most have said their day-to-day running costs have risen since the pandemic, while they saw income fall during its height.
Some clinics and surgeries also offer more advanced treatments than others, and the expectations of the public – particularly younger age groups – have increased.
In addition, at the last count, only 1,082 private dentists were contracted to the HSE to provide care to medical card holders, down from 1,482 in May 2020. Dentists insist it is economically unviable.
An extra €10m was announced this year by Health Minister Stephen Donnelly to reintroduce a scale and polish for medical card holders from May 1, and a wider review has been promised.
Dentists say the current medical scheme is so restrictive in what they can offer patients that it creates a two-tier system they find difficult to stand over ethically.
State payments provide a guaranteed cushion, so if there was a better medical card scheme it could have the knock-on effect of benefiting private patients.
Michael Kilcoyne, chairman of the Consumers Association of Ireland, who for years was the facilitator at the Dental Complaints Resolution Service, said some of the issues around cost related to the patient not being properly informed of any increased payment that arose after work got under way in their treatment.
Every patient should get a treatment plan in advance, setting out what they will pay, Mr Kilcoyne added.
The Dental Council regulates the profession, but, unlike the Medical Council overseeing doctors, it maintains an obscure profile that is not good for dentists or the public.
Although it has no role in prices, in cost-of-living crisis times it should be more consumer-driven about the obligations of dentists, which will make people more vigilant if price is a priority.
