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

boozercruiser

Xaccers wrote: »

So what you're saying is, not only did the dentist scam me by charging for a scale and polish that should have been included in the band 1 payment, but she also hasn't a clue when it comes to hospital extraction procedures by telling me the wrong information regarding the molar if it needs to be extracted?
Not only that, but she'll also fill a tooth which is giving me no trouble twice, but the tooth which is giving me trouble she'll leave open for months until it's extracted?

Erm....well M8.....it sure is a rather complicated crappy situation that you have there Xaccers....HOWEVER, It looks to me like your intertpretation of this is not too far from the truth. Particularly in respect of your Scale and Polish!

welshdent

Xaccers wrote: »

Thankfully PEMs are qualified enough to comment on what a dentist should explain to a patient, and what is included in the fees.

I mean this in good faith but you are over estimating what these guys know. You say qualified enough ... thats the problem. They arent qualified at all. The closest many have got to a dental qualification is a sticker for being a good patient as a child. They have zero knowledge of real dentistry outside of what their hand book informs them. Sure they can read you a list of items but that doesnt tell the story. They can not tell you what you should be having done because they can not see you or your notes. Even if they could they do not have the training to understand everything. They pass out "advice" but its usually incorrect because they do not understand the clinical situation.
An example ... patient a comes to see the dentist who says your tooth needs to come out. patient a says I want a root filling and dentist says no it cant be done. Basically they already rushed dentist is unable to explain fully and just mumbles an excuse so as to move on to patient 53!

Patient a phones the PEM and says ... are root fillings available on the NHS? My dentist says I cant have one.
PEM: absolutely they are available and your dentist is wrong in telling you that

patient a thinks dentist is trying it on and PEM thinks they have given fantastic advice.

The problem is this tooth which has been painless actually has a cyst on it that has been totally assymptomatic because the nerve died years ago causing a long standing chronic infection but remained painless because of the sinus that acts as a pressure relief valve. It is a top left back molar tooth that is unopposed in the bite and is in effect useless and hopeless with prognosis. i.e. unsaveable and not doing anything anyway.

No one bothers to ask the dentist. No one was able to see the notes to see the justification and diagnosis. Not offering a root filling was in fact the correct course of action in most peoples books.
I know situations like these happen.
what SHOULD have happened is the PEM should say something like "The NHS is able to offer necessary treatment to obtain oral health. Unfortunately I am not in a position to advise as to your own individual needs so I suggest you contact your dentist for a fuller explanation of the diagnosis and treatment plan. If you are still unhappy contact us again and we can discuss your case through the appropriate channels"

Dialogue and sensible advice. Saves a lot of sleepless nights.

Xaccers wrote: »

In saying the gaps between my teeth have increased, I wasn't saying that was a bad thing, I was saying it to show that they did indeed remove calculus, I'm not disputing that I needed a scale and polish, infact quite the opposite, I definitely needed a scale and polish hence why I should not have been charged extra.

I dont think you quite understood what I was commenting on. You were in with the hygienist for 20 minutes. Thats a fair amount of time. Given my old practice books 15 minutes for a hygienist appointment for its bi annual scale and polish for fully private patients you do appear to have had a fair amount done. That then to me indicates it wasnt a scale and polish but a more advanced treatment. Read back a page or 2 and you will see references to a BPE and comments on more advanced gum treatments. If you did indeed have a BPE score that indicated a need for more advanced treatments then you could well have ended up paying more than that on the NHS anyway. It is POSSIBLE ... and I am not saying this is the case as I can not see you or your notes. .. but it is possible that your practice was actually trying to save you money. When we do more advanced treatments as a matter of course the calculus is removed. Thats the first thing to happen in my book. What goes on beyond that is something you will have little or no appreciation of because it FEELS the same to the person experiencing it. We have given more information on this in the previous posts so I wont go in to it all again. My point is that even if you had that treatment on the nhs it still would have been more than £16. If it was band 2 it would have been £42. Without seeing your notes there is ZERO change the PEM could know what treatment you had. They are relying entirely on what you tell them. You will notice none of the dentists here will give specific advice to anyone. We give a broad range on applicable information however I have lost track of the number of times "your dentist is best placed to advise as they have seen you and examined you" has been said. You Can NOT give information on clinical cases without seeing the patient. End of.

Thats not to say your practice have not done anything wrong. Quite clearly they did not ask you if you wished to see the hygienist privately. They were clearly vague in explanation of diagnosis and you do not indicate that you signed any treatment plans so I am assuming you didnt.

My advice to you is to ask to speak to the practice manager. Ask for a diagnosis and information to support that diagnosis (see BPE information). Ask why it was not possible to have treated this within the NHS and ask why it was not mentioned at the time. Explain that you are aware non surgical management of periodontal disease is a band 2 treatment so the default "isnt available on the NHS" wont cut it. However if they say it worked out cheaper doing it this way then I would certainly be more sympathetic. Ask why you were not given a written treatment plan. FP17DC is the form (IIRC) - I print my own out which is an acceptible alternative as I feel these forms do not go anywhere near enough for my liking! But none the less if you were having band 2 or mixed nhs/private care then a form like this needs to be provided.
IF then you are unhappy by all means go down your intended route but all I am saying is get all the facts first. Give the dentist the opportunity to explain their diagnosis and treatment plan ... and do not assume the PCTs have the foggiest idea what is happening!

brook2jack

Xaccers wrote: »

So what you're saying is, she hasn't a clue when it comes to hospital extraction procedures by telling me the wrong information regarding the molar if it needs to be extracted?
Not only that, but she'll also fill a tooth which is giving me no trouble twice, but the tooth which is giving me trouble she'll leave open for months until it's extracted?

Please reread my previous posts.

1 The dentist is right in suggesting filling the tooth now in this respect she has acted absolutely correctly.

2 If the wisdom tooth is very rotten then leaving it open will cause you less pain then filling it. The tooth can drain when open ,if a filling is put in its like putting the top on a bottle of shaken up fizzy pop... the pressure builds up and pain gets worse.

3 The only way for the hospital to know if the other tooth needs extracting is for the dentist to investigate it ie fill it first. Oral surgery operating theatres are not set up to drill and fill teeth.

brook2jack

The vast majority of dentists are honest and deal in the patients best interest. This is why when the minority do deceive it rankles badly with us because it makes the work of honest dentists so much more difficult because in the end the vast majority of what we do has to be taken on trust.

The vast majority of us who are honest will however have had complaints about us because the activities of a small minority makes people cynical and suspicious and on the NHS side very very ready to go to the PCT/LHB.

The NHS contract is very poorly understood by PCTs and LHBs and dentistry is understood even less well. In my experience the majority of the time people are given the wrong information because the regulations very much depend on the clinical situation.

So yes there are definately some dentists trying to make the NHS contract work by only doing eg hygiene work privately but there are just as many legitimate reasons not to offer "cosmetic" scaling to remove stain on the NHS and as this forum is widely read we try to present the situation which most people will encounter.

Finally I would make one plea... in those cases where people have been incorrectly charged for hygiene visits privately, who do you think is to blame? he dentist ,often foreign trained , or the company/people who own/operate the practice and train the dentist in NHS regulations? The NHS contract is so flawed it is difficult to interpret and each surgery will train dentists in NHS regulations. a newly qualified or foreign qualified dentist relies on their practice owner to explain regulations and if it is company policy to only offer scale and polish privately the dentist has no choice and often knows no better than to offer hygiene appointments only privately.

It would be very easy for the practice to point the finger when a complaint comes in to the "naughty dentist" who may well have moved on dismayed by the realities of practicing on the NHS ,so different from the adverts, whilst still training the next generation of cannon fodder to do the same.

boozercruiser

welshdent wrote: »

I mean this in good faith but you are over estimating what these guys know. You say qualified enough ... thats the problem. They arent qualified at all. The closest many have got to a dental qualification is a sticker for being a good patient as a child. They have zero knowledge of real dentistry outside of what their hand book informs them. Sure they can read you a list of items but that doesnt tell the story. They can not tell you what you should be having done because they can not see you or your notes. Even if they could they do not have the training to understand everything. They pass out "advice" but its usually incorrect because they do not understand the clinical situation.
An example ... patient a comes to see the dentist who says your tooth needs to come out. patient a says I want a root filling and dentist says no it cant be done. Basically they already rushed dentist is unable to explain fully and just mumbles an excuse so as to move on to patient 53!

Patient a phones the PEM and says ... are root fillings available on the NHS? My dentist says I cant have one.
PEM: absolutely they are available and your dentist is wrong in telling you that

patient a thinks dentist is trying it on and PEM thinks they have given fantastic advice.

The problem is this tooth which has been painless actually has a cyst on it that has been totally assymptomatic because the nerve died years ago causing a long standing chronic infection but remained painless because of the sinus that acts as a pressure relief valve. It is a top left back molar tooth that is unopposed in the bite and is in effect useless and hopeless with prognosis. i.e. unsaveable and not doing anything anyway.

No one bothers to ask the dentist. No one was able to see the notes to see the justification and diagnosis. Not offering a root filling was in fact the correct course of action in most peoples books.
I know situations like these happen.
what SHOULD have happened is the PEM should say something like "The NHS is able to offer necessary treatment to obtain oral health. Unfortunately I am not in a position to advise as to your own individual needs so I suggest you contact your dentist for a fuller explanation of the diagnosis and treatment plan. If you are still unhappy contact us again and we can discuss your case through the appropriate channels"

Dialogue and sensible advice. Saves a lot of sleepless nights.



I dont think you quite understood what I was commenting on. You were in with the hygienist for 20 minutes. Thats a fair amount of time. Given my old practice books 15 minutes for a hygienist appointment for its bi annual scale and polish for fully private patients you do appear to have had a fair amount done. That then to me indicates it wasnt a scale and polish but a more advanced treatment. Read back a page or 2 and you will see references to a BPE and comments on more advanced gum treatments. If you did indeed have a BPE score that indicated a need for more advanced treatments then you could well have ended up paying more than that on the NHS anyway. It is POSSIBLE ... and I am not saying this is the case as I can not see you or your notes. .. but it is possible that your practice was actually trying to save you money. When we do more advanced treatments as a matter of course the calculus is removed. Thats the first thing to happen in my book. What goes on beyond that is something you will have little or no appreciation of because it FEELS the same to the person experiencing it. We have given more information on this in the previous posts so I wont go in to it all again. My point is that even if you had that treatment on the nhs it still would have been more than £16. If it was band 2 it would have been £42. Without seeing your notes there is ZERO change the PEM could know what treatment you had. They are relying entirely on what you tell them. You will notice none of the dentists here will give specific advice to anyone. We give a broad range on applicable information however I have lost track of the number of times "your dentist is best placed to advise as they have seen you and examined you" has been said. You Can NOT give information on clinical cases without seeing the patient. End of.

Thats not to say your practice have not done anything wrong. Quite clearly they did not ask you if you wished to see the hygienist privately. They were clearly vague in explanation of diagnosis and you do not indicate that you signed any treatment plans so I am assuming you didnt.

My advice to you is to ask to speak to the practice manager. Ask for a diagnosis and information to support that diagnosis (see BPE information). Ask why it was not possible to have treated this within the NHS and ask why it was not mentioned at the time. Explain that you are aware non surgical management of periodontal disease is a band 2 treatment so the default "isnt available on the NHS" wont cut it. However if they say it worked out cheaper doing it this way then I would certainly be more sympathetic. Ask why you were not given a written treatment plan. FP17DC is the form (IIRC) - I print my own out which is an acceptible alternative as I feel these forms do not go anywhere near enough for my liking! But none the less if you were having band 2 or mixed nhs/private care then a form like this needs to be provided.
IF then you are unhappy by all means go down your intended route but all I am saying is get all the facts first. Give the dentist the opportunity to explain their diagnosis and treatment plan ... and do not assume the PCTs have the foggiest idea what is happening!

WOW Welshdent.....what a lot of very interesting and valuable opinion that you give there.:A

No matter what a particular opinion is here, You, Toothsmith and others in the 'Real Know' provide the insight needed to try and sort out what sometimes can obviously be a very complicated situation for the patient.

I cannot thank you guys enough for all of the very valuable input that you give. :beer:

Xaccers

welshdent wrote: »

Brook isnt saying that at all. What brook is saying is that the hospital will only do what they are asked to do i.e extract the tooth that is deemed necessary for extraction. They will not do any exploration of the other tooth at all. What brook is saying is that if you have decay in a tooth then yes it is best to at least remove it before going to the hospital. This serves 2 purposes. 1 allows the dentist to see how extensive the decay is ... and also STOP the decay progressing to possibly avert the need for an extraction in that tooth. An x ray shows historic decay. A "carious lesion" actually has an advancing front which may be as much as 2 mm. THis will not show on an x ray because an x ray will only show what has already been demineralised and decayed. As a result I always know that whatever an x ray shows me, the reality will be bigger. Should the filling break during the extraction then its hardly your own dentists fault. Its a complication that MAY occur and you are rightly being warned about it.

She said:
If the hospital finds the molar needs to come out they'll extract it too, but it won't affect your chewing because you will still have one left. If it doesn't I'll need you in to redo the filling. But there isn't much decay so you aren't likley to lose it.

You're all saying:
The hospital will only extract the wisdom tooth and you'll have to have a second extraction at a seperate time if they find the molar has to come out.

So either the Dentist is wrong, or all of you are. My money's on you guys not being wrong

As for the hygienist's charge, I'd paid £16.50 already, which includes a scale and polish, can someone provide the guidelines where it says how long that should take? I've found nothing which says "if there is significant build up or treatment takes longer than X it is a band 2 treatment or not covered by the NHS"
Even so, my understanding is if you go in for band 1 treatment and within 2 months it is decided band 2 treatment is required, you don't pay band 1 and band 2 prices, but only band 2, ie they only charge you a total of £45.60, so if the scale and polish some how was a band 2 treatment, then I should have just been charged an extra £29.10
As I'm due the filling anyway, it would be included in that price, so before xmas I should be paying a total of £45.60, where as because they ignored that I had already paid for a scale and polish, I'd be paying a total of £78.10
The only way it would have been cheaper would be if for some bizarre reason they deemed the scale and polish (which was probably actually only 10 minutes of actual work) would be a band 3 treatment, and frankly if that were the case I'd expect it to be a hell of a lot longer and my mouth to be so full of calculus you wouldn't see any of my teeth's features!
And you think this shouldn't be reported to the PCT????

As I said, a PEM is qualified to tell me what should be included in each treatment band, and unless someone is also running a disreputable practice with the same upsale tactics of making NHS patients pay privately for a service they have already paid for, I cannot see why a dentist would not want such patient abuse to be reported officially and stopped.

Don't forget, I tried to complain to the practice about being charged for the hygienist, they weren't interested and said I could complain to the PCT.

welshdent

Xaccers wrote: »

Even so, my understanding is if you go in for band 1 treatment and within 2 months it is decided band 2 treatment is required, you don't pay band 1 and band 2 prices, but only band 2, ie they only charge you a total of £45.60, so if the scale and polish some how was a band 2 treatment, then I should have just been charged an extra £29.10

This isnt correct unfortunately. You are referring to a continuation of treatment. What that means is You are entitled to the same course or lower as a non chargable course provided it is within 30 days. That means if you have a band 3 then all other courses a to 4 are covered for 30 days. Band 2 means band 1, 2 and 4 are covered but band 1 only corresponds to bands 1 and 4. There is not facility to top up the charge if you have a band 1 then add on to a band 2 if the course is closed off. This is because its a tax that the PCTs gather to pay for dentistry as a whole and not payment to the dentist.

An example of where is may be cheaper is if you needed nothing but periodontal treatment and you were in my practice, see me and the hygenist for 32 or see just me for 39 ... if that makes sense? Sometimes practices do this. Its difficult to follow fully your case as so much is going on by the look of things! LOL.

Xaccers wrote: »

would be a band 3 treatment, and frankly if that were the case I'd expect it to be a hell of a lot longer and my mouth to be so full of calculus you wouldn't see any of my teeth's features!

LOL indeed! However please do read my posts on how we determine need regarding BPE scores and treatment required. I really dont think my poor fingers could take typing it all again

Xaccers wrote: »

And you think this shouldn't be reported to the PCT????

I didnt say that I said to try and establish all the information first to make sure in effect there was no misunderstandings.

Xaccers wrote: »

As I said, a PEM is qualified to tell me what should be included in each treatment band,

I still disagree on their qualification

I am maybe a tad battle hardened but in my experience there are few that actually understand the contract. Many dentists struggle and we are the ones that actually impliment it. Regularly we phone up for advice and one person says one things and on a different day someone else completel contraditcs them. I know of someone who was once a GP that was given a job handling GP practices for an LHB. Their dental lead left and the GP was asked if they would take it over. When their response was I dont know anything about dentistry they were told it didnt matter as they were sure they would pick things up as they went along! (GP contracts and dental contracts alone are totally different let alone the jobs themselves).

jugglebug

If you read back through the thread you will see that on more than 1 occasion we have pointed out that there is no guidance as to what constitutes a band 1 or 2 scaling Except that the contract says Band 2 is for the treatment of periodontal disease. It then goes on to give *absolutely no guidance as to what they define as periodontal disease*

your PEM going on about "follow up" is wrong. Nothing about that in the regs
Length of time taken? Nope nothing about that either.
Severity of disease? Nope not that either.
So we are left to make a judgement call as to what we individually judge to be a scaling for treatment, scaling for prevention and a scaling for purely cosmetic purposes.

Yes your practice should have given you an estimate up front.
Yes your practice should have made it clear they were intending to treat you privately.
Yes your treatment should have been offered on the NHS, possibly as a band 2
Is your PEM qualified in the way you describe.
Sorry no I doubt it. They have been left to interpret a bunch of woolly poorly thought out statements in their own way and in this case has made at least one statement that is incorrect.

To save you seeking out the patient charge regulations (you can google em though) here is a link
http://www.gov.im/lib/docs/dhss/health/sd10006doc.pdf

the section you want is page 9 schedule 2 a,b and c
This is the legal document in law and supercedes anything anyone else says.
You can see the description of periodontal treatment constitutes a massive 6 lines of text.

brook2jack

Xaccers wrote: »

She said:
If the hospital finds the molar needs to come out they'll extract it too,

You're all saying:
The hospital will only extract the wisdom tooth and you'll have to have a second extraction at a seperate time if they find the molar has to come out.

So either the Dentist is wrong, or all of you are. .

No , please reread the posts. The hospital will extract both the teeth if your dentist finds out when she fills the tooth that it is unstable.

The hospital would ask the dentist to investigate this tooth before they take out the wisdom tooth because they will NOT do two ga extractions.

All the dentists here agree with what your dentist is saying about filling the tooth in front of the wisdom tooth before the wisdom tooth is taken out.

In this respect your dentist is right.

coldstreamalways

Unless I am mistaken, it's not permitted for anyone who isn't a dentist (registered with the GDC and indemnified appropriately) to give advice on dental matters. I would go so far as to say the PEM is doing this and is as such, in breach of the dentists act. (I'm currently doing a masters in medical law and ethics so am quite interested in this point). I wonder if she/he is aware of this?


Xaccers, before I send someone for wisdom tooth removal due to decay in the next tooth, I remove the decay as best I can then put a temporary filling in and reassess when the healing from extraction is complete. If you don't want this perhaps you should just ask for them both to be extracted as that is where you will probably be headed if you continue to disagree with this perfectly reasonable treatment plan.
Whatever you get done and achive from you complaint, I hope that you get the tooth removed and the tooth restored appropriately.