Private dental work - no guarantee?

Ellie2758

I am confused, again. I had a composite (white) filling a year ago in lower tooth number 5 which is classed as a back tooth, therefore I paid for it to be done as "Private" work by an NHS dentist. Last week the filling came out whilst I was eating my breakfast (muesli, as it happens) so I rang the surgery and explained that it was a white filling. No problem, said the receptionist, it will be covered anyway and replacement will be FOC.

However, when the dentist looked at it she referred it to her boss who decided it WASNT a FOC replacement as it was private work. My question is, how long is the guarantee on private work? Is there a guarantee? I am also annoyed because the dentist who put the filling in has now left and the new dentist says I would be better of with an amalgam filling as the tooth has hardly any sides left to support it and she is also going to put a pin in it. Why didnt the previous dentist advise me of this? It had already fallen out when it was replaced last time so you would think she might have pointed out the advantages of having an NHS replacement amalgam filling with a pin. Wouldnt you????

Ellie

Toothsmith

There is a one year replacement clause on some NHS treatments.

On private work, it is down to the discretion of the dentist.

This post really throws up some of the points I have been trying to make about the differences between proper 'private dentistry' and an NHS dentist doing the odd thing 'privately'

To me, private dentistry is a whole philosophy.

A 'private' practice will be able to survive and pay the bills with a lot less patients than an NHS place. The patients of a private practice should get exemplary service, be seen very quickly if they have a problem, get appointments long enough to fully discuss their concerns and be able to have all the options for treatment explained to them. They should get good preventative care, and be taught how to best look after their teeth themselves in order to keep their treatment needs to a minimum.

The downside of being a private patient is that it costs more money, but if the place is good, at the end of the day, that patient should have healthier teeth and any restorations the patient does have should last a good long time.

Should anything go wrong, then it is likely that the same dentist that did it, should be able to offer a free replacement if he feels the fault was with the workmanship, or offer a discounted replacement if he feels the reason for failure was nobodies fault, or explain why the reason for failure was because the patient didn't look after the item well enough. But all of the above reasons for failure should have been discussed beforehand, and the patient be aware of just where they would stand if something did happen. In an ideal world, the costs, risks, benefits, necessary aftercare and guarentees should be available in writing. (I must admit, I don't go that far, but I do make good notes of all the things I've discussed with the patients.)

In an NHS practice, there are lots of patients to look after, because the fees are so low, having ots of patients is the only way to survive.

If a patient has something done 'privately' then really they are just paying more money to get something that the NHS won't pay for.

An NHS practice cannot afford to spend the time with it's private patients, because there will be a queue of NHS patients still sitting in the waiting room. They cannot really afford to block of the time to give full explainations but also they don't tend to charge as much as a 'proper' private practice would.

Another problem is staff turnover. Dentists tend to come and go far more in NHS practices, which interrupts continuity of care. Also, as it will be the dentist who did your filling who got paid for it, the practice owner may feel that it was his responsibility, and not the practices. Therefore, he doesn't want to loose money by actually doing the replacement for free, and if you go elsewhere, hey, there would be a queue round the block if he announced he had room for another NHS patient! NHS practices do not NEED good customer service these days!

(Apologies to Teerah if she's reading - there are some decent NHS places still out there - they are jsut getting fewer and further between)

I hope this helps to explain things a bit Ellie.

Just as an aside, I'm not a fan of pins at all. Studies have shown that half of all pins placed cause micro-cracks in teeth that can expose the nerve. I have managed to go 7 years without the need to place one, using bonding agents, or other types of restoration instead. I would ask about alternatives to pinning if I were you, even if the tooth is already dead and root filled. Maybe crowning it?

( I have never given any specific dental advice on this site up to now, because I can never know the full circumstances of anybodies particular situation, but I really don't like pins.)

j-baby-scotland

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Ellie2758

Toothsmith, thanks. You have managed to explain that perfectly. Now I have to worry about pins though. Arghhhhhhhhh. The tooth isnt dead, there just isnt a lot of it. I dont fancy an exposed nerve at the end of the day.

Oddly enough, here in the compost heap of the Garden of England we have dental practices advertising for NHS patients. This is my second NHS practice in the ten years we have lived here. Erm, bonding agents? Restoration? Is that different from a crown? I wouldnt have a clue about the alternatives if I did ask them. My latest dentist is very YOUNG, as was her predecessor. I'm wondering about going back to my old dentist now, but I didnt find him very communicative......

Ellie

Toothsmith

A restoration is just 'the thing that fixes the tooth' be it a filling or a crown. Bonding agents are things that make resorations stick better to teeth - glues if you will!

It does dissappoint me that they still teach dental students to use pins. It was one of the things I had to bash into my associate was the fact that I didn't have them on the premisis, and would never have them on the premesis!

If the dentist can't/ won't give an alternative, get something done temporarily and find a dentist who can.

Ellie2758

Ah, thanks. I'm a bit clearer now. However, I noticed today on another of your posts you mention that white fillings shrink and that if they are put into a hole which was originally intended for an amalgam filling it may cause probs. This is exactly what happened. Fume, rant.:mad: No wonder the dentist has left - why didnt she advise me?

I am going to go back to my old dentist if I can and see what he recommends.

Ellie

Toothsmith

She could well have felt that the adhesive properties of the white filling were a better bet than putting a pin in!

She was probably trying to do you a favour, but didn't have the time to explain it properly, or enough time to slow down and really do the white filling properly.

She's probably moved on to a practice where she can afford to slow down and explain things better, and do them right first time.

Ellie2758

I mentioned to my other half today that I was thinking of going back to my old dentist to get this tooth sorted out with a crown instead of this pin and filling job. Husband says that his crowns have pins in them anyway. I am even more confused now Toothsmith... Husband has ameliogenesis imperfecta so had very little tooth to "base" the crown on.

Also, will my old dentist be allowed to finish off what my new dentist has started i.e. replacement of the temporary filling with a crown? Both are NHS dentists - is there some code of practice that disallows switching dentists mid-treatment?

Ellie

Mr_Proctalgia

I found this site informative

http://www.animated-teeth.com/dental_crowns/t1_dental_crowns_what_are.htm

I like to know what is being done to my body when someone is altering it!

lots of other good stuff too!

Toothsmith

Ellie2758 wrote:

I mentioned to my other half today that I was thinking of going back to my old dentist to get this tooth sorted out with a crown instead of this pin and filling job. Husband says that his crowns have pins in them anyway. I am even more confused now Toothsmith... Husband has ameliogenesis imperfecta so had very little tooth to "base" the crown on.

Also, will my old dentist be allowed to finish off what my new dentist has started i.e. replacement of the temporary filling with a crown? Both are NHS dentists - is there some code of practice that disallows switching dentists mid-treatment?

Ellie

Your Hubby may be thinking of posts. Some crowns on root filled teeth need a post down into the root to help support the crown.

You can change dentists whenever you like, but I would go back to the dentist who was talking about the pins, and ask about alternatives. Changing dentists too often is never good, as you get so many different opinions. I rather fear I have added to this by telling you my predjudices about pins.

I won't do it again!

Ellie2758

Thanks Toothy. I'm not chopping and changing as such, just going back to my old dentist.

Ellie