Asked for Dental NHS Scale and Polish.Told "Go to Hygienist at £25 extra"

welshdent

Gum disease is essentially pain less. You only really get discomfort if your teeth start moving and irritate the gum or if you get an infection. I have also a number of patients with excellent cleaning techniques yet they still have advanced gum problems. I regularly use my private hygieneist for treating these problems mainly because it usually works out cheaper for my patients to see her than to have it done with me. Particularly the over 60s who have free check ups normally in wales. To be able to justify these charges the dentist should be carrying out what is called a basic periodontal exam (BPE) ... and if you have a particularly keen dentist or advanced condition .. a 6 point pocket chart. This would help to come to the necessary diagnosis.

In order to do this band 2 treatment you must do one of the following ... locally irrigate a pocket i.e. squirt corsodyl mouthwash in to the pocket of gum around a tooth caused by the gum disease, sub gingival debridement ... i.e. clean the part of the tooth under the gum that is exposed by loss of bone and creation of this gun pocket, or root planing ... scaping the whole side of the root ... essentially the same sort of thing in laymans terms. Often ... to the patient they do not feel much different. The best signs are that they may use hand instruments as well as the ultra sonic scaler. There is also likely to be a lot more blood!! They may also give some local anaesthetic although I routinely do not as I have found my patients tend not to need it much. BPE scores of 3 or 4 in any of 6 sextants can legitimately allow you to claim for this.

A "scale and polish" to me consists of having done the BPE and getting a score of 2 which means calculus or staining ... now personally I do all my staining scale and polishes on the NHS. I do not bother sending the average patient for a private clean. That said if someone demands one when I do not feel it is necessary I will but I explain the reasons for this. That however is just me. Staining alone is cosmetic and the dentist may well feel justified in making you see the hygieneist on a private basis. But they should explain this to you and give you the options. With me I do not send NHS patients to the hygieneist for a scale and polish because I do not get paid enough to allow it to happen! If I was to send a patient to her then she woud charge me more than the NHS pays me to do that AND the check up.

The bottom line however is that gum disease is painless so its often likely you will have no idea you have it. The dentist SHOULD be providing you what is necessary.
If they can reach a diagnosis of periodontal disease or feel that an extensive clean is needed then they can justifiably claim a band 2. Ideally IMHO they would normally place you on a 3 month recall interval to monitor the problem and assess any healing. I do this a LOT. I usually use the band 1 scaling option as a carrot to patients and explain I am aiming to get them from needing a band 2 clean to a band 1

Toothsmith

And to give you something to measure it against,

If you came to me for an examination and I did the cleaning, it would cost you £92.

If I did the check up and then you saw my hygienist, it would be £107. If she decided it needed more than one visit, then extra visits with her would be £67.

(In truth though, most of my patients wouldn't pay this directly, as 85% of them are on Denplan, which covers the costs.)

welshdent

another thing to give a measure against ... I had a lady in today who is over 60 SO they are allowed a free "exam" ... not a band 1 ... and exam. SO exam done and identified a need for a scale and polish. Offered and accepted ... carried out ... then an almight fuss created at the desk when she was charged the appropriate £12 NHS fee. Her arguement was she didnt think she should pay as she hasnt got that many teeth and I wasnt that long doing it ... doesnt matter how long I take it was still done and deemed to be satisfactory when she left.

The moral of the story? You cant keep anyone happy it would seem.

brook2jack

The whole idea was NHS is supposed to be swings and roundabouts, The very rare times when you a recieve a fee for a small amount of treatment is supposed to make up for the many times you recieve a small fee for a huge amount of treatment.

Unfortunately everyone wants to be the person who recieves a massive amount of treatment for a derisory fee.

I feel for you Welshdent ,I remember the days of practising in a high needs area on the nash, only I jumped ship in 2006 after 20 years.The last few years of NHS were soul,body and enthusiasm destroying.Good luck.

welshdent

thanks brook! I also completed today 2 upper molar endos (using a scope), sectioned an MB root off one! cored the pair of them, extracted UL1 and added this to an existing partial all for 3 UDAs!!!! Treatment started in may but I both I and the patient have been away.

The contract is terrible but coming on to sites like these often makes you think we are sometimes faced with an uphill battle

jugglebug

George_Bray wrote: »

Toothsmith - thank you for your helpful response. I've learned something in that hygienists can tackle quite serious gum problems. I question, though, whether my gum problems are very bad at all - i.e. bad enough to justify a level 2 charge.

Leaving aside, the dentist's dealings with the NHS and how they get paid, how can I ascertain whether the dentist is doing enough work to justify a level 2 charge when it specifically states that 'scale and polish' is included in level 1? Is it time-based, like anything over 20 minutes, or is there some named procedure which takes the gum work up to level 2?

To Address this point
I have often felt the information given to patients by the NHS is very poorly worded in this area. It is clear in it's wording that scaling and polishing is band 1.
However
The information to dentists (and this is part of the contract with the NHS so we cant ignore it) is that if in our judgement the scaling and polishing is to treat gum disease then that is Band 2.
And here lies the rub.
if we treat something as band 2 and charge appropriately the information from the NHS direct to the patient makes us look like cowboys.
Which brings us to the second part of my point. The contract leaves the dividing line entirely up to the prescribing dentist.
Dentist number one has his judgement, dentist number two has hers. You as a patient have no benchmark as guess what? The NHS has no benchmark either, so neither do we as clinicians.
You may have a google around and come up with some hits for what is known as the BPE or CPITN. Which is a quick way of categorising someones general level of gum health. Unfortunately it is a broad brush. Your mouth gets split into 6 areas and is assigned a score. But each area gets scored as per it's worst point, and that may be 1 single point in a group of 6 teeth! So potentially 2 people could have a code 4 but be a world apart in their actual treatment needs. So that's no help to you or us either.
Hence the stupid, confusing and frankly idiotic system we are all left with and the upshot is that your care is band 1 or 2 because we say so and none of us are happy with it.
The old pre 2006 contract had a big list of treatments with a list of provisos for each one. That was scrapped because it was simpler this way. Excuse me while I stop laughing at that one :rotfl:

George_Bray

I'm very interested to hear the dentists' (members) points of view on this. As for me, I'm now happy with the level 2 categorisation because I now need a filling as well. At the time of my first visit, the dentist never said I have perodontal level gum problems. He's now prescribed a short course of Amoxicillin 500mg capsules. The leaflet says these are for 'serious infections' whereas there's also a 250mg dose for normal infections. Blimey - this sounds like I'm in a bad way and yet my gums aren't bleeding when I brush and the gum colour looks normal (not inflamed) when I look in my mouth with a torch. Is there any way I can self-validate my condition?

Toothsmith

I can't think of the last time I gave 500mg of amoxicillin for anything! I certainly wouldn't give it for gum problems!

Metronidazole is a more effective ab for gum problems, but even so it seems strange.

2nd opinion?

brook2jack

George do you smoke? If you do not surprising if gums bleed as it stops both inflammatory response and peripheral circulation so gums don't bleed.

The other thing is many people with gum disease do not clean (floss interdental brushes) etc in the correct way so gums don't bleed because they never clean the inflammed areas .

Finally dentists train for years to be able to diagnose (amongst many other things ) gum disease. There are obvious and subtle signs somtimes tricky to see even with magnification , dental mirrors and a high powered light.

brook2jack

Ts metronidazole for me ... Gram -ve anaerobes. But I have been to lectures suggesting short high dose amoxil loading doses but makes no sense to me.

Also high initial loading dose with severe periapical infection followed by standard doses.