General information on the regulatory rule, not clinical or legal advice. For a specific overcharge dispute, raise it with your dental practice first, then with NHSBSA on 0300 330 1343.

Updated May 2026

What Counts as a Course of NHS Dental Treatment

The course-of-treatment rule decides whether multi-appointment dental work attracts one band charge or several. It sits in regulation 3 of the National Health Service (Dental Charges) Regulations 2005. This page explains the rule, the two-month gap, the free repair rule, and the boundary cases that produce most overcharge complaints.

One sentence summary

You pay one charge per course of treatment, at the highest band required to cover all the work in that course. A new course of treatment only starts when there is a fresh clinical assessment after the previous course is complete or abandoned.

The definition in regulation 3

Regulation 3 of the NHS (Dental Charges) Regulations 2005 defines a course of treatment as "an examination of a patient, an assessment of his oral health, and the planning of any treatment to be provided to that patient as a result of that examination and assessment, and the provision of any planned treatment". The same regulation defines the three bands by reference to the treatments included in them, and regulation 4 sets the charge for each band.

Two key consequences follow from this wording. First, an examination always starts a course, even if you intend nothing further. The Band 1 charge of £27.90 (April 2026) covers an examination as a course in its own right. Second, the "planning of any treatment to be provided" sits inside the course, so any work that flows directly from the original assessment is part of the same course even if delivered weeks later across several appointments.

The regulations do not specify a maximum duration for a course. NHSBSA guidance treats two months as the working norm. A course running longer than two months without progress is presumed to have ended unless the practice records a clinical reason for the gap, such as waiting for a laboratory-fabricated crown to return or allowing healing time after extraction.

The "highest band" rule sits in regulations 4 and 5. If a course includes only Band 1 work, you pay £27.90. If it includes any Band 2 work, you pay £76.60 (which includes anything Band 1 would have covered). If it includes any Band 3 work, you pay £332.10 (which includes anything Band 1 or 2 would have covered). There is no double charging within a single course, and no upgrade fee on top of the higher band.

Worked examples

Example 1: check-up plus two fillings

Visits: Examination on 1 May, fillings on 15 May.

Course: One course of treatment.

Charge: one Band 2 (£76.60). Not £27.90 plus £76.60.

Example 2: filling then root canal in same course

Visits: Filling 8 May, dentist finds nerve pain, root canal completed 22 May.

Course: Same course; treatment plan revised, both stay in Band 2.

Charge: one Band 2 (£76.60).

Example 3: filling that escalates to a crown

Visits: Examination 1 June, filling 8 June fractures the tooth, crown placed 30 June.

Course: Same course (continuous treatment of the same problem); upgrades to Band 3.

Charge: one Band 3 (£332.10). You owe the difference if you already paid Band 2.

Example 4: examination in May, fillings in October

Visits: Examination 1 May, fillings 1 October (five-month gap).

Course: Two courses; the May course closed, October requires a fresh assessment.

Charge: Band 1 (£27.90) for May, plus Band 2 (£76.60) for October. Total £104.50.

Example 5: filling fails at 8 months

Visits: Filling June 2026, falls out February 2027 (8 months).

Course: Free repair rule applies; replacement done at no charge.

Charge: zero, same practice required to repair free within 12 months.

Example 6: emergency followed by routine

Visits: Urgent appointment with pain relief on 5 May, root canal completing the treatment on 19 May.

Course: Single course combining urgent and routine since both treat the same problem.

Charge: one Band 2 (£76.60) including the urgent element.

The two-month gap presumption

Regulation 3 does not state a numeric maximum interval but NHSBSA operational guidance, the British Dental Association advice notes, and the standard practice management software all use a two-month presumption. A two-month gap between appointments in the same plan raises the question of whether the course has ended. Practices typically record the clinical reason for any gap longer than two months: usually waiting on a laboratory crown, allowing extraction sites to heal, or scheduling a multi-stage root canal.

If a gap exceeds two months without a clinical reason recorded, NHSBSA may treat the second appointment as a new course on audit. This is largely a back-office matter that does not affect what the patient pays at the point of treatment, but it can become relevant if you dispute a charge or if NHSBSA opens an investigation into a practice's billing. From the patient's perspective, the practical rule is simple: if you have not been seen for several months, the next appointment is likely to count as a new course.

A common patient misunderstanding is that they can defer treatment from a Band 2 plan, return six months later, and pay only the difference because they "already had the assessment". In law and practice that is not how it works. The original Band 1 (or higher) charge covered the original course; the new appointment begins a new course with a new band charge.

The free repair rule (12 months)

The free repair rule does not sit in the Dental Charges Regulations 2005 themselves. It sits in the General Dental Services contract, which is the contract every NHS dental practice signs with NHS England. The contract requires the same practice to repair or replace NHS work that fails within 12 months of completion at no further charge to the patient.

In practice this covers: fillings that fall out or fracture; crowns and bridges that debond; root canal treatment that requires re-treatment; dentures that crack, lose teeth, or no longer fit due to manufacturing defect (it does not cover relines due to bone change, which is normal denture wear). The rule does not cover trauma damage (you broke the crown by chewing bone), wear from normal use after 12 months, or further problems on adjacent teeth.

The 12-month clock starts on the date the original course of treatment closed (the date the work was completed, not the date it was started). If you have any doubt about the start date, ask the practice for a copy of your FP17 form; it shows the course-end date in the "completion date" field.

If the original practice closes, goes out of NHS contract, or moves and you cannot access them, the free repair right is portable in principle: any NHS practice can deliver the repair under contract handover arrangements. In practice this is sometimes contested and you may need to escalate to NHS England regional dental commissioning team if the new practice refuses to honour the rule.

Where dentists get it wrong

A meaningful minority of NHS dental charges complaints, summarised in Healthwatch England local reports and BDA practice advice columns, involve a misapplication of the course-of-treatment rule. The pattern is usually one of:

Splitting one course into two charges. The most common error: charging Band 1 at the examination, then Band 2 when the fillings are placed two weeks later. This is incorrect; the whole sequence is one Band 2 course.
Charging Band 2 plus Band 3 instead of just Band 3. If the same course includes fillings and a crown, you pay one Band 3 charge that covers everything. Separate Band 2 + Band 3 charges for one course is incorrect.
Charging for a free-repair visit. If your filling falls out at 8 months and you return to the same practice, the replacement should be free. Some practices try to charge a Band 1 examination fee for the assessment; that is not consistent with the contract.
Charging Band 1 for urgent treatment then Band 2 again for the routine course. If the urgent treatment and the follow-on routine work address the same clinical problem in the same continuous episode, they should usually be combined into one Band 2 course.
Refusing to deal with a complaint internally first. The contract requires every practice to operate a complaints procedure with a 3-working-day acknowledgement and 40-working-day response. If a practice refuses, escalate to NHS England regional dental team and to NHSBSA in parallel.

If you suspect an overcharge, ask the practice for a copy of your FP17 form, which records the course start date, completion date, and band assigned. Compare what the FP17 shows with what you were charged. If the two do not align, raise it with the practice in writing, then with NHSBSA if unresolved. See our full disputes and appeals guide.

Frequently asked questions

What is a course of dental treatment in the NHS sense?

A course of treatment is everything your dentist plans to do following a single clinical assessment, until the assessment outcome is completed. It is defined in regulation 3 of the NHS (Dental Charges) Regulations 2005 as an examination and any treatment plan that flows from it, until the treatment plan is fully delivered or formally abandoned. Multiple appointments can sit inside a single course as long as they are all delivering the original treatment plan.

If my dentist finds problems mid-treatment, do I pay a second charge?

Not normally. If the dentist discovers additional work needed inside the existing course, that work is added to the treatment plan, the band may be upgraded if the new work moves the course into a higher band, and you pay the difference rather than two separate charges. The principle is one charge per course at the highest band reached. The exception is if your dentist formally closes the original course and starts a new course of treatment after a fresh assessment, which is unusual mid-treatment.

How long can I have between appointments inside one course?

There is no fixed maximum interval but the NHSBSA guidance suggests a course of treatment should normally be completed within two months. A gap of more than two months between appointments raises a presumption that the original course has ended and that any further work begins a new course. In practice many courses (especially Band 3 with crown laboratory work) run six to ten weeks legitimately. A six-month gap almost certainly resets the course.

What is the free repair rule?

If NHS work fails within 12 months of completion, the same NHS practice is required to repair or replace it free of charge. This sits in the General Dental Services contract. Examples: a filling that falls out at 8 months, a crown that debonds at 10 months, a denture that fractures at 11 months. The 12-month clock starts on the date the original course closed. If you switch practice, you may need to negotiate; the obligation sits with the original practice.

Can a dentist charge me Band 1 for the check-up and Band 2 for the fillings separately?

No. If the check-up and fillings are part of the same treatment plan following a single assessment, you pay one Band 2 charge of £76.60 (April 2026). The check-up cost is absorbed into the higher band. If you receive separate Band 1 and Band 2 charges for what appears to be a single visit, that is an overcharge and you should raise it with the practice or escalate to NHSBSA.

What about an emergency appointment followed by routine treatment?

An urgent course is charged at Band 1 (£27.90) for the immediate emergency treatment. If, at the urgent appointment, your dentist proposes a separate routine course of treatment to follow, that is normally a new course at the appropriate band. However, if the urgent appointment leads directly into completing the same clinical problem (for example, urgent pain relief followed by the root canal that addresses it) the urgent and routine elements may be combined into a single Band 2 course with the urgent charge included.

Does the course-of-treatment rule apply if I miss an appointment?

If you miss an appointment that was part of a course and do not rebook, the practice may eventually close the course. If you rebook within a reasonable time the course continues. If you abandon treatment entirely the practice closes the course without you paying any unpaid balance; if you have already paid in full there is no automatic refund unless the work was not delivered. Missed appointments themselves do not attract a separate charge under the NHS rules, though practices can charge a non-NHS no-show fee under their own policy.