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

jugglebug

Welshdent is spot on
The line from the DOH is that patients like the simpler charging structure of just 3 bands (despite the fact when you look at cases such as this it is obviously silly and confusing)
They also say that we dentists should like it because for every case where we are potentially underfunded (Such as the root treatment example) There is a case like yours that makes up for it.
We essentially have a swings and roundabouts system in the Dental NHS and if as a small business we only apply the "swings" and ignore the "roundabouts" the practice would close.
it isn't right, but it is what we have

boozercruiser

Well guys, I am really pleased to see that the debate on this subject is still ongoing and is really irking some people in all sorts of ways.

Dear Toothsmith, Welshdent and and other respected Dentists who come here to help us, I would appreciate if I can further 'Pick your brains':D so to speak.

Like I have said previously, until recent years I had only two lovely Dentists and the whatever treatment always ended with a clean up which comprised of a gentle scrape around, finishing off with what seemed like a rotating rubber wheel going carefully from tooth to tooth and a good swill and spit out! My teeth and mouth always felt better for it, and a Hygenist at an extra cost never did come into the equasion. Any further tooth care advice was always given by the Dentist himself.

Since moving to Wales six years ago, and coming under this ruddy Denticare organisation and up to now FIVE various Dentists the mention that I should see the Hygenist (£25....now £30) for a 'clean up' and advice has happened more often than not.

I have always insisted, as reported here in my original post on a NHS Scale and Polish inside the Band............................................... And here I am going through that ***p yet again.:mad:

However, even when the various assortment of EU Latvian/Polish Dentist have done it the Scale and Polish has just comprised of a scrap around, possibly not every tooth either.

In other words...a Scale and Polish, but not as I know it Jim!"

So then, could you honoured gentlemen describe exactly what a reasonable Scale and Polish should comprise of please?

Should it be roughly as I fondly remember it, or like most things run by the NHS, am I expecting too much?

Following my check up on 8th November 2010 My next appointment for the two fillings (on 6th JANUARY 2011):( and an extraction (on 18th JANUARY 2011):(

(The lady Polish Dentist said she didn't want to take the tooth out just before Christmas.....in case there where complications!).:eek:

BUT... I would like to know what procedure SHOULD be done for a normal Scale and Polish.

Thank you in anticipation.:D

welshdent

I'll get back to this later lol. In town at the mo :-) is the new age of smart phones a blessing or a curse??! ;-)

boozercruiser

welshdent wrote: »

I'll get back to this later lol. In town at the mo :-) is the new age of smart phones a blessing or a curse??! ;-)

Dunno Welshdent....I don't own one.

I have my little 'Pay as you go' and that does me.:D

However, me who knows nothing I would say....

Sometimes they are a curse.......:mad:

And sometimes they are a blessing!:D

coldstreamalways

To be honest boozer, I do S&P and not my hygienist (my patients don't pay though so it's slightly different), I never get him to do something as simple as a scrape as he is brilliant at the BPE 3s and 4s which I hate.

The scaler that I use is better at removing staining that the polishing cup or brush (in my hands anyway) so I very, very rarely use the polishing stuff. I find I'm more likely to cause a minor trauma to the gum than if I do it with the ultrasonic scaling tip.

So, in answer to your Q, the rotating rubber thing isn't necessary to achieve the result.

HTH

Toothsmith

An S&P should probably be how you remember it.

What it has become - on the NHS as you experience it, is what NHS dentistry has been 'encouraged' to become by those that make policy.

Easier to contract with big corporates rather than single dentists. Big corporates look to 'source' dental care in the most 'cost effective' way.

They 'train' their dentists who come to this country not knowing how the rules should work, and assume that the way the company tells them to do it is the way it should be done.

Of course, this represents value for money for the taxpayer, and a high quality care environment for the patient. Of course it does, because that's what it will say in the company's 'mission statement'.

brook2jack

boozercruiser wrote: »

De

Like I have said previously, until recent years I had only two lovely Dentists and the whatever treatment always ended with a clean up .:D

BC just out of interest look up you two "lovely dentists" and see if they are still doing NHS dentistry. I would say the odds are not but if they are I bet they are not taking on NHS patients.

The NHS you remember and I worked with for 20 years does not exist any more. The sort of care that was provided even up to 2006 does not exist anymore. You can complain to the LHB but this would appear to be standard practice.

You are getting cheap dentistry, I know you don't think so , but you are. In your area the problem is the LHB values cheap dentistry but not quality dentistry..... that costs and the overwhelming statutory duty of any health board is to stay in the black. All Welsh health boards are in the red and looking to save where they can. The dental corporates have ,in the past , launched legal battles to get more money , but failed.

The company will be losing money on folks such as yourself because three visits (check up, filling, extraction) will costs more than they get from the NHS.To have an extra visit for scaling and polishing or to visit the hygienist even more will lose them even more so this is why they do what they do.

Don't take it out on the individual dentist but the company and the LHB who collude in the deception that NHS dentistry exists to provide everything.

welshdent

Brook sums things up a lot better than I could.

BC just to summarise the differences - it isnt to do with perception it is to do with diagnosis. IF the diagnosis is staining or calculus build up with some mild gingivitis this means that effectively the supprting tissues and gum is more or less at the right level and there is no formation of "pockets". Whilst not PERFECT its not pratciularly bad so you can clean off the debris/build up and stain that is so called supra gingivgal. It is good to do because calculus CAN harbour more virulent bacteria which in a susceptible individual may lead to a more advanced problem called periodontitis. BPE scores here are usually 2 maybe 1 depending on the dentists views. Usually a score of 2 in a sextant on the bpe system indicates stain or calculus and thus the "little scrape and polish" though the physical act of polishing is usually in my experience not necessary as most comes off with the scaler.

If there exists a score of 3 or above this indicates that either everywhere or in an area of the mouth your supporting tissues have started to move away from your tooth and the plaque begins to form in the space left around the tooth. The gums become inflammed and swollen to form "pockets" These pockets harbour more plaque and calculus under the gum line which leads to more inflammation and more bone loss around the tooth and usually bigger pockets. This is the simplistic explanation as I dont think the detail is necessary LOL.

SO when someone gets a score of 3 or above anywhere then the diagnosis is different. Instead of being gingivitis and calculus or stain it is periodontal disease or at least "false pocketing". This is caused by the plaque under the gum all around the affected teeth. As a result as well as surface supra gingival deposits the "sub gingival" deposits need to be removed to manage and actively treat the disease as opposed to prevent problems occuring. It takes a number of forms, sub gingival debridement or root planing or both. It may be done by hand or by ultrasonic scaler or both.

the problem is that we use the same/similar instruments for both and the sensation to the individual is largely the same so your perception is that we are doing the same thing. In addition if only one area is affected then it may only take a short time to clean it adequately but it does not change the diagnosis.

They key is in conveying the diagnosis appropriately. I have an information form, consent forms and a set of pictures to explain the differences. I accept not everyone has all this but periodontal treatment is NOT a scrape and polish IMO

boozercruiser

Yet again, thank you for all this very informative input by you knowledgable guys.:T

You always mention the BPE scores with some generalisation as to what they mean. However, I wouldn't know what my BPE score was if I fell over it.:D

At the check up, I was seeing this particular Dentist for the first time and going around my mouth while relaying the info to her helper
the Dentist just said "That will be 2 Fillings and an extraction. Oh! and you have some gum disease so you should see our Hygenist".
(At extra cost of course!).

Absolutely no explaination was offered regarding the fillings or why the extraction was needed (I do no have any sign of pain).

Would any Dentist ever say...well your BPE rating is XYZ which means ZYX?

Even with my lovely past Dentists I don't remember the words BPE!:D

welshdent

BPE is a basic periodontal examination which is in effect a screening for the different levels of gum disease. The mouth is divided in to sextants i.e. top left 4th tooth to 7th, middle 3 to 3 then right 4th to 7th. This is repeated on the bottom. All the teeth present are scored with a standardised probe and the highest score in the area is what makes up the overall score in that area.

Code 0 No bleeding or pocketing detected 1 Bleeding on probing - no pocketing greater than 3.5mm. 2 Plaque retentive factors present - no pocketing greater than 3.5mm. 3 Pockets greater than 3.5mm but less than 5.5mm in depth. 4 Pockets greater than 5.5 mm in depth
A plaque retentive factor is calculus, an overhanging filling or maybe a defective crown margin. 2 also refers to staining. There is also a * score which referrs to recession over a certain level (7mm) or if the area where the roots split from the crown of the tooth (furcation) is abel to be probed and therefor exposed

Ideally from there we would switch to a 6 point pocket chart where every single tooth is recorded individually but I do not know many NHS or even fully private practitioners that do this routinely. I tend to reserve it for more advanced cases because most of what I find i need is covered with the BPE and x rays