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Wisdom teeth

Can't find an NHS dentist? Don't despair, it may soon be easier than you think. Private dentists, it

patient: How much to have this tooth pulled?

dentist: £180.

patient: £180 for just a few minutes' work?

dentist: I can extract it very slowly if you like.

Jokes about going to the dentist used to be about the pain of tooth extraction, but in 21st-century Britain they're more likely to be about the pain to our wallets. An estimated one in five people in Britain is deterred from going to the dentist because of the cost; eight million of us have refused a course of treatment because it was too expensive. The seemingly inexorable decline of affordable National Health Service dentistry, and the growth of private practice (the most expensive in Europe), have certainly hurt our pockets.

But could it be that, after years of decline, the tide is turning? You wouldn't think so, judging by newspaper headlines reacting to newly published figures showing that more than one million patients in England have lost access to free dentistry since the introduction of the government's new NHS dental contract in April 2006.

The figures, according to Susie Sanderson, chair of the British Dental Association's executive board, were "further evidence of the persisting problems with the 2006 NHS dental reforms". But look a little closer. There were 655 more dentists doing NHS work in 2007-2008 than there were in the previous year, an increase of 3.2 per cent. NHS dental treatments also rose last year by nearly one million, to 36 million. And while Sanderson and her organisation attack the government for introducing a "crude, target-driven system", there is growing evidence that the BDA's members don't share this disdain.

The government's chief dental officer, Dr Barry Cockcroft, cites the example of Cornwall Primary Care Trust, which, when asking for tenders for four new NHS practices, received more than 80 applicants. "When primary care trusts ask for tenders for new services, dentists are falling over themselves to bid for them," he says.

It seems that some dentists are deciding that the NHS contracts, which provide dentists with a guaranteed salary of roughly £80,000 a year for three years and a 5 per cent reduction in their workload, are not such a bad deal after all. The economic slowdown could also be helping the return of dentists to the fold. Dr Mark Harris was among 2,000 to resign from the NHS prior to the introduction of the new contracts. Now he has applied to Devon Primary Care Trust to provide NHS care for adults at his Totnes practice. "I think when there isn't much money about, the best arrangement is a mixture of NHS and private work," he admits.

The dramatic decline of NHS dentistry can be traced to the decision of John Major's government to cut the fees payable to NHS dentists in the early 1990s - something to remember during the current wave of nostalgia for the former Conservative prime minister. The decision led to an exodus of dentists from the NHS into private practice. In 1990, before the cuts, only 5 per cent of dentists' earnings came from the private sector; today it accounts for more than half. And as private practice has grown, so the overriding commitment of the dental profession and its governing body to the NHS has weakened.

Throughout the 1990s, one could not question the fervency of the BDA's support for the NHS, but today the emphasis appears to have changed. In her speech to the BDA's May conference in Manchester, Sanderson enthused over the merits of private dentistry. "For many [here], private dentistry has given you the opportunity to work the way you want to, without any sense of compromise," she said. "It has given you freedom." She went on to express scepticism as to whether the NHS could ever meet the "expectations of patients and users".

It is hard not to detect a certain air of defeatism - Sanderson claimed last year that the future of NHS dentistry was "increasingly fragile" - and the BDA's disenchantment with NHS reforms has been seized upon by those opposed to the very idea of NHS care. In its own words, Nurses for Reform, a pro-privatisation pressure group, wants "to see NHS dentistry totally collapse".

"We want customers to be angry at how little they are getting for their taxation, and we want them to defect to a burgeoning private dental sector," writes the group's director, Dr Helen Evans, whose anti-NHS polemic Who Cares for the NHS? was published by the Institute of Economic Affairs earlier this year. "Already, in many [politicians'] minds, the NHS is dead," Evans claimed, having previously described the service as a "Stalinist embarrassment".

Open wide (your wallet)

The favoured gambit of the private dentistry lobby is to make NHS dentistry seem like a lost cause and the complete privatisation of dental care inevitable. If this all sounds familiar, then cast your mind back to the early 1990s when the same "the system's so broke it can't be mended" arguments were made by free-market think tanks lobbying for British Rail's denationalisation.

But nothing is inevitable until it happens - and there is nothing inevitable about the demise of NHS dentistry. The return of dentists to the NHS fold is a fact that fits neither Nurses for Reform nor the BDA's doom-laden prognosis. The increased number of places for training NHS dentists also gives grounds for optimism, as does the government's decision to increase funding for NHS dentistry by 11 per cent next year. And all three main parties remain formally committed to increasing provision.

In the final analysis, the future of NHS dentistry will be guaranteed only if voters raise their voices to urge that more resources be spent on improving access to the service. And the importance of expanding NHS dentistry cannot be overestimated if we care about both our teeth and our wallets: the decline in NHS provision over the past two decades has led to a major deterioration in the nation's oral health. In some parts of the country, tooth decay rose by 50 per cent between 1993 and 2003; mouth cancer has risen by around 25 per cent, with more than 4,700 new cases being diagnosed in the UK each year. The replacement of NHS dentistry with a wholly private system, as free-market pressure groups desire, would prove as catastrophic as the privatisation of the railways has been.

If we want to know what a Britain without any NHS dentistry would be like, we need only look to the United States, where more than 100 million people are without dental insurance and 27 per cent of children and 29 per cent of adults have cavities that go untreated. Last year, a child in Mississippi and another in Maryland died from infections caused by decayed teeth.

When the NHS was formed, exactly 60 years ago this summer, it promised to provide "all medical, dental and nursing care". Free NHS dental care may only have lasted until 1951 - the first year that NHS charges were introduced - but for more than 40 years the NHS provided Britons with access to good-quality and affordable dental treatment. The question that needs to be asked of the free-market ideologues who are already gleefully writing its epitaph is a simple one: if Britain could afford - and operate - a comprehensive NHS dental system in the austerity years of the 1940s and the recession-hit 1970s, why on earth can't we do the same today?

We'll know for sure that we've stopped the rot when dentist jokes are once again about extracting teeth, and not extracting money.

The roots of modern

dentistry

    The ancient Sumerians believed that tooth decay was caused by the "tooth worm". As did Homer and Guy de Chauliac, 14th-century inventor of the "dental pelican", which pulled teeth out sideways

    In Elizabethan times, teeth were cleaned with powdered pumice stone, brick and coral, removing the enamel in the process. Placing turnip parings behind the ear was said to cure bad breath. A bad tooth could be replaced with one from the mouth of a pauper, a dog, a sheep, a baboon . . . or a dead soldier

    Before the 18th century, dentistry was the preserve of barbers, blacksmiths - and others even less capable. Unsurprisingly, extraction could be fatal, as practitioners dislocated teeth from their sockets and pulled out the roots

    As well as hippopotamus bones, one of the first materials used for false teeth was celluloid - which proved extremely flammable

    In Britain in 1968, 79 per cent of the elderly had no natural teeth, partly explained by the trend, in the early years of the NHS, of replacing all your teeth with a nice new set of dentures

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The French millennials marching behind Marine Le Pen

A Front National rally attracts former socialists with manicured beards, and a lesbian couple. 

“In 85 days, Marine will be President of the French Republic!” The 150-strong crowd cheered at the sound of the words. On stage, the speaker, the vice-president of the far-right Front National (FN), Florian Philippot, continued: “We will be told that it’s the apocalypse, by the same banks, media, politicians, who were telling the British that Brexit would be an immediate catastrophe.

"Well, they voted, and it’s not! The British are much better off than we are!” The applause grew louder and louder. 

I was in the medieval city of Metz, in a municipal hall near the banks of the Moselle River, a tributary of the Rhine from which the region takes its name. The German border lies 49km east; Luxembourg City is less than an hour’s drive away. This is the "Country of the Three Borders", equidistant from Strasbourg and Frankfurt, and French, German and French again after various wars. Yet for all that local history is deeply rooted in the wider European history, votes for the Front National rank among the highest nationally, and continue to rise at every poll. 

In rural Moselle, “Marine”, as the Front National leader Marine Le Pen is known, has an envoy. In 2014, the well-spoken, elite-educated Philippot, 35, ran for mayor in Forbach, a former miner’s town near the border. He lost to the Socialist candidate but has visited regularly since. Enough for the locals to call him “Florian".

I grew up in a small town, Saint-Avold, halfway between Metz and Forbach. When my grandfather was working in the then-prosperous coal mines, the Moselle region attracted many foreign workers. Many of my fellow schoolmates bore Italian and Polish surnames. But the last mine closed in 2004, and now, some of the immigrants’ grandchildren are voting for the National Front.

Returning, I can't help but wonder: How did my generation, born with the Maastricht treaty, end up turning to the Eurosceptic, hard right FN?

“We’ve seen what the other political parties do – it’s always the same. We must try something else," said Candice Bertrand, 23, She might not be part of the group asking Philippot for selfies, but she had voted FN at every election, and her family agreed. “My mum was a Communist, then voted for [Nicolas] Sarkozy, and now she votes FN. She’s come a long way.”  The way, it seemed, was political distrust.

Minutes earlier, Philippot had pleaded with the audience to talk to their relatives and neighbours. Bertrand had brought her girlfriend, Lola, whom she was trying to convince to vote FN.  Lola wouldn’t give her surname – her strongly left-wing family would “certainly not” like to know she was there. She herself had never voted.

This infuriated Bertrand. “Women have fought for the right to vote!” she declared. Daily chats with Bertrand and her family had warmed up Lola to voting Le Pen in the first round, although not yet in the second. “I’m scared of a major change,” she confided, looking lost. “It’s a bit too extreme.” Both were too young to remember 2002, when a presidential victory for the then-Front National leader Jean-Marie Le Pen, was only a few percentage points away.

Since then, under the leadership of his daughter, Marine, the FN has broken every record. But in this region, the FN’s success isn’t new. In 2002, when liberal France was shocked to see Le Pen reach the second round of the presidential election, the FN was already sailing in Moselle. Le Pen grabbed 23.7 per cent of the Moselle vote in the first round and 21.9 per cent in the second, compared to 16.9 per cent and 17.8 per cent nationally. 

The far-right vote in Moselle remained higher than the national average before skyrocketing in 2012. By then, the younger, softer-looking Marine had taken over the party. In that year, the FN won an astonishing 24.7 per cent of the Moselle vote, and 17.8 per cent nationwide.

For some people of my generation, the FN has already provided opportunities. With his manicured beard and chic suit, Emilien Noé still looks like the Young Socialist he was between 16 and 18 years old. But looks can be deceiving. “I have been disgusted by the internal politics at the Socialist Party, the lack of respect for the low-ranked campaigners," he told me. So instead, he stood as the FN’s youngest national candidate to become mayor in his village, Gosselming, in 2014. “I entered directly into action," he said. (He lost). Now, at just 21, Noé is the FN’s youth coordinator for Eastern France.

Metz, Creative Commons licence credit Morgaine

Next to him stood Kevin Pfeiffer, 27. He told me he used to believe in the Socialist ideal, too - in 2007, as a 17-year-old, he backed Ségolène Royal against Sarkozy. But he is now a FN local councillor and acts as the party's general co-ordinator in the region. Both Noé and Pfeiffer radiated a quiet self-confidence, the sort that such swift rises induces. They shared a deep respect for the young-achiever-in-chief: Philippot. “We’re young and we know we can have perspectives in this party without being a graduate of l’ENA,” said another activist, Olivier Musci, 24. (The elite school Ecole Nationale d’Administration, or ENA, is considered something of a mandatory finishing school for politicians. It counts Francois Hollande and Jacques Chirac among its alumni. Ironically, Philippot is one, too.)

“Florian” likes to say that the FN scores the highest among the young. “Today’s youth have not grown up in a left-right divide”, he told me when I asked why. “The big topics, for them, were Maastricht, 9/11, the Chinese competition, and now Brexit. They have grown up in a political world structured around two poles: globalism versus patriotism.” Notably, half his speech was dedicated to ridiculing the FN's most probably rival, the maverick centrist Emmanuel Macron. “It is a time of the nations. Macron is the opposite of that," Philippot declared. 

At the rally, the blue, red and white flame, the FN’s historic logo, was nowhere to be seen. Even the words “Front National” had deserted the posters, which were instead plastered with “in the name of the people” slogans beneath Marine’s name and large smile. But everyone wears a blue rose at the buttonhole. “It’s the synthesis between the left’s rose and the right’s blue colour”, Pfeiffer said. “The symbol of the impossible becoming possible.” So, neither left nor right? I ask, echoing Macron’s campaign appeal. “Or both left and right”, Pfeiffer answered with a grin.

This nationwide rebranding follows years of efforts to polish the party’s jackass image, forged by decades of xenophobic, racist and anti-Semitic declarations by Le Pen Sr. His daughter evicted him from the party in 2015.

Still, Le Pen’s main pledges revolve around the same issue her father obsessed over - immigration. The resources spent on "dealing with migrants" will, Le Pen promises, be redirected to address the concerns of "the French people". Unemployment, which has been hovering at 10 per cent for years, is very much one of them. Moselle's damaged job market is a booster for the FN - between 10 and 12 per cent of young people are unemployed.

Yet the two phenomena cannot always rationally be linked. The female FN supporters I met candidly admitted they drove from France to Luxembourg every day for work and, like many locals, often went shopping in Germany. Yet they hoped to see the candidate of “Frexit” enter the Elysee palace in May. “We've never had problems to work in Luxembourg. Why would that change?” asked Bertrand. (Le Pen's “144 campaign pledges” promise frontier workers “special measures” to cross the border once out of the Schengen area, which sounds very much like the concept of the Schengen area itself.)

Grégoire Laloux, 21, studied history at the University of Metz. He didn't believe in the European Union. “Countries have their own interests. There are people, but no European people,” he said. “Marine is different because she defends patriotism, sovereignty, French greatness and French history.” He compared Le Pen to Richelieu, the cardinal who made Louis XIV's absolute monarchy possible:  “She, too, wants to build a modern state.”

French populists are quick to link the country's current problems to immigration, and these FN supporters were no exception. “With 7m poor and unemployed, we can't accept all the world's misery,” Olivier Musci, 24, a grandchild of Polish and Italian immigrants, told me. “Those we welcome must serve the country and be proud to be here.”

Lola echoed this call for more assimilation. “At our shopping centre, everyone speaks Arabic now," she said. "People have spat on us, thrown pebbles at us because we're lesbians. But I'm in my country and I have the right to do what I want.” When I asked if the people who attacked them were migrants, she was not so sure. “Let's say, they weren't white.”

Trump promised to “Make America Great Again”. To where would Le Pen's France return? Would it be sovereign again? White again? French again? Ruled by absolutism again? She has blurred enough lines to seduce voters her father never could – the young, the gay, the left-wingers. At the end of his speech, under the rebranded banners, Philippot invited the audience to sing La Marseillaise with him. And in one voice they did: “To arms citizens! Form your battalions! March, march, let impure blood, water our furrows...” The song is the same as the one I knew growing up. But it seemed to me, this time, a more sinister tune.