Four out of 10 dentists in England and Wales will not accept new NHS patients, according to a watchdog.

The Audit Commission is calling for urgent reform of dental care.

It warns the NHS spends at least �150m each year in England on unnecessary check-ups and treatments, and at least �8m in Wales.

A report from the commission says, while people can usually access emergency dental care through NHS Direct, continuing care for adults and children is far harder to find.

In some areas, no dentists will accept adult NHS patients onto their lists.

We don't need more reports, we need action

John Renshaw British Dental Association

The commission's report says the problems are rooted in the system rather than with the dentists themselves, who feel they are on an NHS "treadmill" - overworked and underpaid.

Some move into private practice, sometimes leaving communities with no NHS dental provision.

On average, dentists estimate 15% of their patients are private, but in the south east that figure can be as high as 50%.

And the Audit Commission warns the piecework system, under which dentists are paid per item of treatment provided, means there is a "perverse incentive" for unnecessary or cosmetic work.

For example, scaling and polishing teeth is a common procedure which accounts for 11% of NHS family dentist spending.

Temporary benefit

But for most people, it is of temporary cosmetic benefit and rarely prevents or cures gum disease, the commission warns.

The patient pays 80% of the cost of NHS treatment, with the health service footing the rest of the bill. In total, the NHS spends around �1.6bn each year on dental services.

The Audit Commission has said the check-up system, which requires people to come in every six months, also needs to be reformed.

Experts say because dental health has improved, in most cases a check-up every two to three years for adults and one to two years for children, is enough to pick up dental health problems.

Unnecessary check-ups

But dentists are not paid a fee for NHS patients who have not attended for 15 months, and they are dropped from the register.

Rosemary Lewis cannot accept new patients at her dental practice

Rosemary Lewis is the last remaining dentist in Cheddar, Somerset and the surrounding area prepared to take on NHS patients.

But her list is full, and she has had to officially close her practice to both NHS and private patients.

She told the BBC: "The only patients we are able to take are those who are closely related to people who already come here."

But despite the overall improvements in dental health, people in deprived areas are seeing significant problems, with children's tooth decay levels as high as they were 15 years ago.

The Audit Commission says many of the problems with NHS dental health services have been addressed by the government in its recent report "Options for Change".

The commission is calling for several measures to revamp the system, including better information for patients about how to maintain dental health and how to ensure they receive the right treatments.

Sir Andrew Foster, the Controller of the Audit Commission, said the current NHS dental care system did not provide the right incentives to ensure equal access for all.

He said: "It needs to be changed, to become more flexible, and more focused on the needs of individual people."

Postcode lottery

"We all need access to continuing, preventative dental care. Dentists and NHS bodies must work together to empower patients and encourage them to take an active role in maintaining their dental health."

We recognise that there is still more to do

Department of Health spokesman

The chairman of the British Dental Association's Executive Board, John Renshaw, backed the report's findings, but said: "We don't need more reports, we need action, through changes which are properly thought out and properly funded."

Sheila McKechnie, director of the Consumers' Association, which has looked at the problems in NHS dental care in the past, said finding the problems people in many areas had finding an NHS dentist was "another example of our health postcode lottery".

But a Department of Health spokesman said a lot of work was being done to improve NHS dental services and that there would be examinations of the check-up system and the benefits of water fluoridation.

Shadow health minister Simon Burns said: "Despite promises made by the Prime Minster in 1999 that everyone would be able to see a dentist within two years, this report shows just how shallow and meaningless the government commitments have been."