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

brook2jack

The nhs is there to secure dental health and nothing else.

The loss of one tooth is very unlikely to damage your oral health as you only "need" 20 teeth to secure health.

You may want to hang onto a tooth and it may be possible to for a limited time ( and a rootfilled crowned tooth with the sort of destruction you are talking about will only have a limited lifespan).

The average cost , per year , of dental treatment done on the nhs per person is around £36. The cost of specialist treatment with a microscope for this tooth plus a crown would be upwards of £800 plus to the health service. To put this in context the total budget for specialist restorative dentistry in my area is £35,000 a year. That will cover the rebuilding of the faces and jaws of two oral cancer patients and little else.

You are not entitled on the nhs to all the treatment you want, you are entitled to work that will secure your oral health, that doesn't mean going all out to repair damage by "heriodontics" trying to save teeth damaged so much you cannot expect a reasonable lifespan.

Now the other thing is the clinical context of the treatment...
It is not good practice to even consider doing such treatment unless the patient is in stable oral health
A is the decay under control has the person made the diet and lifestyle changes to achieve this

B are the gums healthy , does the patient floss etc

C will the work be maintained, does the patient see a dentist regularly

D general health is the patient taking medications, do they have health problems that may limit the ability of the person to maintain the crown.

welshdent

I can guarantee that if I were to refer yourcase to the local dental hospital of district general they would laugh at me with a letter basically saying extract it. Your dentist more than likely also knows this hence the offer of a private referral. Molar endodontics is far from simple. It's bloody hard without high end equipment such as microscopes. Even with them a case you describe can be a nightmare. I do undertake some herodontics from time to time but they are carefully selected instances. The nhs do not give a damn about endodontics. If they did they would actually place value on it and pay us for doing it! Believe me, they don't. They rely on stupid people like me that actually take some pride in what they do and acknowledge the contract isn't the patients fault to keep doing them. But even then a line needs to be drawn somewhere.

welshdent

Ps I have no idea what you are on about re the x ray transfer thing? There isn't one as far as I am aware. I can safely say few if any dentists would be swayed or influenced by another in the described manner. Dentists are some of the most critical people I know of their colleagues! Seriously! If you spend long enough on dental messageboards it becomes very apparent. As brook has said, we all have our own opinions! Lol. If your dentist were to refer you the the hospital then they may well send their original films along. If you visited another dentist then you would need to pay again for the assessment appointment becuase you would be entering a separate agreement with a new dentist - nhs dentistry is nothing like nhs medicine I.e. There is no unified body they are all independent private practices.

welshdent

George_Bray wrote: »

It's not what I wanted to hear but I guess you're probably right. The forum is so lucky having you as a member.

My filling might look like the photo shown here:

http://en.wikipedia.org/wiki/Root_canal

The filling in the middle of the photo towards the right of the tooth goes below gum level (on Wikipedia), so why is it such a problem for my tooth (from my amateur description)?

I'm not sure if the other dentists would agree with me but I don't think that image is the best one to use for what wikipedia are trying to explain! Is that resorption on the medial roots?? George I suspect that is an American tooth and it's all private so someone probably thought they would have a bash seeing as the patient is accepting the risks either directly or via their insurance company. It looks to have a nayyar core. I do them occasionally but they are very popular on the American dental site dentaltown

George_Bray

I'm grateful to the dentists here for giving me their opinions. It sounds like my dentist was right even though I don't really understand how it can be so difficult to somehow restore this tooth. Even after the decay is drilled out, it's so large I hoped there would be enough left as a base for any filler and possible crown. As for the apparent de-minimis standard of NHS dental care (you only need 20 teeth) it seems wrong that some people might get gender change work or an operation to reduce the size of a nose they think is too big, or hyper-expensive drugs on the NHS, but I can't even get a tooth restored.

I might still get a second opinion at another NHS dentist if I can get an appointment. Or do you think I'm wasting my time from what I say? (quarter of tooth above gum line fell away, presumably due to decay, and some decay extends down below gum line). If I go to the second NHS dentist, what will happen regarding the X-Rays? Am I likely to be booted out by the first NHS dentist?

coldstreamalways

George_Bray wrote:

it seems wrong that some people might get gender change work or an operation to reduce the size of a nose they think is too big, or hyper-expensive drugs on the NHS, but I can't even get a tooth restored.

You need to speak to your MP about that! It may seem wrong to you but if you had cancer and you were being denied a drug that may allow you to live longer, how would you feel about someone having one tooth fixed by a specialist at a cost of £800 even though that tooth isn't needed for health?

The situation with NHS dentistry is entirely unsatisfactory. I think you are on a hiding to nothing if the tooth is as unhealthy as you have described. Looking at pictures on wikipedia isn't enormously helpful as that article could have been written by an 8 year old, you don't have to have a degree to write a wiki page!

You can try your luck with another NHS dentist, you can write to your PCT complaining about the lack of an NHS specialist referral service, otherwise, you may just have to accept what seems like the inevitable.

LondonDiva

George_Bray wrote: »

I'm grateful to the dentists here for giving me their opinions. It sounds like my dentist was right even though I don't really understand how it can be so difficult to somehow restore this tooth. Even after the decay is drilled out, it's so large I hoped there would be enough left as a base for any filler and possible crown. As for the apparent de-minimis standard of NHS dental care (you only need 20 teeth) it seems wrong that some people might get gender change work or an operation to reduce the size of a nose they think is too big, or hyper-expensive drugs on the NHS, but I can't even get a tooth restored.

I might still get a second opinion at another NHS dentist if I can get an appointment. Or do you think I'm wasting my time from what I say? (quarter of tooth above gum line fell away, presumably due to decay, and some decay extends down below gum line). If I go to the second NHS dentist, what will happen regarding the X-Rays? Am I likely to be booted out by the first NHS dentist?

Contact your local PALS at the PCT.

The NHS does not say that you only need 20 teeth, but if your mouth is in such bad shape (possibly due to standard of care) it is unlikely that the dentist / dental hospital can / would apply for exceptional funding for your treatment.

Ask PALS to get the dental advisor to review your case and confirm that youa re getting the most appropriate treatment.

welshdent

You need a coronal seal following aneoot filling to have even a hope of the treatment being a success. That is to prevent inbreed of fluids and bacteria re entering the now clean root system. Also due to the tooth now being weaker you need to raise the axis of rotation along which the tooth can break. This is done by having tooth above the gum line. By being below the gum you in effect have the filling or crown (ideally crowns on back teeth) sitting in a sea of tissue fluid plaque and bacteria. It doesn't take long for the margins to fail and there to be a weakening and thus leakage in to the tooth. In some cases you can do a procedure called crown lengthening where you surgically remove bone and gum from all the way around the tooth to get the margins above the gum. I have never been trained how to do this. It's very difficult and painful. You would ve very unlikely to have someone volunteering to do this IMHO! Certainly not your average nhs practitioner. As an example of how each case is different. I am the go to guy at my practice for difficult root filling work as I bought myself a microscope. I was asked to see a lady for a root filling in a lower molar tooth. She had decay under an existing filling on the side of the tooth. There was no other decayed surfaces and I would say the tooth was 90% intact. When the decay was removed it was under the gum line and in to tho bone between the 2 roots. Hopeless prognosis and totally unrestorable should the root filling be carried out. She had this tooth out. She had never had a tooth out before. On the flip side I was recently able to remove a portion of an upper molar. Retain 2 of 3 roots and finish the root filling because most of the tooth was above the gum line. All situations are different and each case should be taken on their own
Merits. It doesn't sound as if you have been unfairly treated to me. I know that's not what you want to hear but I see and hear of far more unfair situations were people that actually have restorable teeth are not even given the option to save. You are getting offered a chance of a second opinion even if you don't like where it is

brook2jack

Why is it so hard to fill such a big hole?

Enamel is the hardest substance in the body , harder than bone, so hard you have to use a diamond drill to get through it.

Teeth are purpose designed to stand up to pressures greater than that of a elephants foot, with massive extremes of temperature and constantly bathed in a soup of bacteria and acid.

We have never created anything that is as strong as a tooth in this environment , any artificial replacement is NEVER as good as a tooth. Eg materials are used that were developed for holding heat shield tiles on the space shuttle ...... Work well in space and during re- entry , but in the mouth much less durable. If your own tooth rots, falls out due to gum disease etc unless you change the conditions in your mouth it's replacement will fail even quicker.

Now the conditions in your mouth are such that the tooth has decayed away taking the majority of its substance and therefore strength. You would be putting a crown on a weakened base and its likelihood of lasting any time will be zero.

Instead of concentrating on this one tooth it's far better to look at preserving what you have left to prevent yourself losing any more teeth.... Ie change your diet and cleaning habits otherwise in a few years or less you will be back to the same problems.

Don't wait for toothache for dental care but invest time in prevention.

George_Bray

welshdent wrote: »

You need a coronal seal following aneoot filling to have even a hope of the treatment being a success...In some cases you can do a procedure called crown lengthening where you surgically remove bone and gum from all the way around the tooth to get the margins above the gum. I have never been trained how to do this. It's very difficult and painful. You would ve very unlikely to have someone volunteering to do this IMHO! Certainly not your average nhs practitioner.

You are spot on with your advice by the sound of it. I only explained what little I know but you've come up with a comment almost the same as what the dentist said, i.e. about cutting away bone, so this gives me increased assurance, he was probably right all along. It's certainly not the news I wanted to hear but as everyone is basically telling me the same thing, I have to concede that fillings and a crown are probably not viable.