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

boozercruiser

coldstreamalways wrote: »

Boozer, as well informed as you are I honestly can't see how you would be able to tell if you had a BPE of 2 or 3. If the dentist says you have BPE 3 and need band 2 treatment, what will you say? I wouldn't give you band 1 treatment if you needed band 2 as it wouldn't be what is indicated for the condition. If the dentist says you have BPE 2 then tries to charge you for band 2 then ok, you have a grievance but otherwise you may be missing out on what is needed?

You flatter me when you say that I am well informed coldstreamways..but I will take that thank you.:)

However, the more info I try and gather, as below for instance from the British Society Of Periodontoligy the more complicated I see that the whole issue is.

However, to your point. I think that the scenario that you describe would be extremely unlikely, and in that event I would hurry back to you guys for your very informative and valuable help!

My appointment for my 2 fillings is not until 6th January 2010 with the extraction not until the 18th January 2010 so I will see what happens then.

In the meantime, although that Dentist seemed to do a BPE Check as I was seeing her for the first time....she didn't convey anything at all regarding BPE Score, except to say that I had some Gum Disease which required a trip to the Hygenist for £28 extra!

When I said..."No, I am requesting a Scale and Polish under the NHS price band", she did not answere me. So, I still have that to face.

When I do eventually see her though I will be asking what my BPE score is...then...armed with what I have learned here...I will tackle her, depending on what she has to say.

One thing is for sure.....that £28 is not going out of my pocket...I will be SKINT after Christmas anyway!

Below of course is not trying to teach you guys how to suck eggs! merely to give people like me some info. Of course there is lots more on the web site. http://www.bsperio.org.uk/members/referral.htm

Parameters of Care

• It is the responsibility of the dentist to monitor/screen patients for the presence of periodontal diseases including the use of relevant radiographs to make a diagnosis and institute a treatment plan with defined therapeutic goals.
• Like many other conditions the treatment of periodontal disease depends to a large extent on patient compliance.
• An assessment should be made of rate of disease progression and related to age in the overall context of oral health management. Consequences of no treatment should be explained.
• For reasons of poor general health, lack of effectiveness of plaque control or non-compliance with good oral hygiene regimes, the patient's own wishes or the operators' decision, appropriate treatment to control disease may be deferred or declined.
• In certain cases, because of the severity and extent of the disease, the age and health of the patient, treatment that is not intended to attain optimal results may be indicated. In these cases initial therapy may become the end point.
• All periodontal assessments should be written in the notes particularly with regard to probing depths, attachment levels, bleeding sites, plaque scores and mobility and outcome assessments must be carried out in relation to the balance of the health/disease axis and the comfort function and aesthetics of the patient.
• If the results of initial treatment resolves the periodontal condition, maintenance therapy should be scheduled at appropriate time intervals.

BPE - Basic Periodontal Examination

The Basic Periodontal Examination requires that the periodontal tissue should be examined with a standardised periodontal probe using light pressure to examine the tissue for bleeding, plaque retentive factors and pocket depth:
Code0No bleeding or pocketing detected1Bleeding on probing - no pocketing > 3.5mm2Plaque retentive factors present - no pocketing > 3.5mm3Pockets > 3.5mm but <5.5mm in depth4Pockets > 5.5 mm in depth

boozercruiser

welshdent wrote: »

But ... what if paying privately was cheaper?

Oh! Welshdent....I wish....I would just love to be able to go private. There is after all a very good (so I am told) Dentist here in Machynlleth.

I suspect that there well may be a few cases where the Private MAY be cheaper, but I bet in most cases not.

I mean, is the private Dentist going to do TWO FILLINGS,
AN EXTRACTION, PLUS that SCALE AND POLISH for £39?

I think not!:D

PLUS....let us not forget that there are lots of people out there on Benefits who pay NOTHING. Most justified, plus a lot of Scroungers.

mmmmm...But even they are being roped into this Trip To The Hygenist for around £30 lark.

welshdent

Dont get me started on exempts! I have lost track of the numbers going off on their second holiday while those genuinely struggling have to pay.
Just a quick come back on the lists of bandings ... the official information is again misleading although I am not surprised due to the lack of ability to organise the proverbial knees ups.

there is a situation where I could quite legitimately claim repeat bandings to manage the same thing. They dont mention that but we can actually stabilise your problems. An example would be multiple sites of decay. I am perfectly entitled to removed the decay and place interrim restorations for a band 2. Review you in a few months, replace all the interrim fillings for permanent fillings and claim a band 2. If you have a large area of bone loss for an infection on a tooth, I can remove the nerve and disinfect the space followed by dressing with calcium hydroxide and sealing for 3 months - Band 2. Review and do the filling up part - band 2 or crown (band 3) ... or review again after a filling and THEN crown as a band 3 ... so potentially 3 courses of treatment. All allowed according to what WE get told ... but they conveniently miss it out with patient information. This "phasing" of treatment is approved certainly by the chief dental officer in wales because I heard him say so.

boozercruiser

welshdent wrote: »

Dont get me started on exempts! I have lost track of the numbers going off on their second holiday while those genuinely struggling have to pay.
Just a quick come back on the lists of bandings ... the official information is again misleading although I am not surprised due to the lack of ability to organise the proverbial knees ups.

there is a situation where I could quite legitimately claim repeat bandings to manage the same thing. They dont mention that but we can actually stabilise your problems. An example would be multiple sites of decay. I am perfectly entitled to removed the decay and place interrim restorations for a band 2. Review you in a few months, replace all the interrim fillings for permanent fillings and claim a band 2. If you have a large area of bone loss for an infection on a tooth, I can remove the nerve and disinfect the space followed by dressing with calcium hydroxide and sealing for 3 months - Band 2. Review and do the filling up part - band 2 or crown (band 3) ... or review again after a filling and THEN crown as a band 3 ... so potentially 3 courses of treatment. All allowed according to what WE get told ... but they conveniently miss it out with patient information. This "phasing" of treatment is approved certainly by the chief dental officer in wales because I heard him say so.

Yes...a lot of the 'exemps' ish me off as well! Although now a Pensioner I cannot claim Pension Credit, Council Tax relief or whatever.
Why? well, becaue I worked all of my life thats why! My Wife and I have a few hundred pounds a month coming in from our past Company Pensions, and combined with Government Pension means that we can claim Jack Hit!

I would have done better if I had never worked. But at least I have my pride. But I will of course try and keep costs down, and that includes avoiding the Hygenist!

Regarding your other points, it's pretty obvious that the whole system is open to abuse, supported by the very people who are supposed to be looking after the public.

The last Government sure made a right royal mess of a system which needed improving. But what we got was incompetent trash which has left I guess you guys unhappy, along with a lot of your NHS Patients.

I suppose that all I and others can do is try and be aware and have as much information that one can. Listening to you guys is part of that.:A

Your examples are I guess extreme and very unlikely for most patients. But it is a concern. Thats for sure.

Best Regards

Boozercruiser.

akh43

I recently went for my check-up and was advised that I needed to see the hygienist due to gum disease, not the first time. Last time I was not particularly impressed with the treatment I got from the hygienist, partly because I was a few minutes late and partly due to my extremely sensitive teeth. I did not feel any difference in my teeth afterwards, not like you used to notice in the old days when your had a scale and polish, and only felt as if I got half the treatment I should have received. My dentist told me £25 to see hygienist or the NHS cost of £40+ (I am now thinking what he quoted me was the level 2 charge of £46.50). I also had to decide what I wanted to do regarding a tooth that had recently broken which was to add a filling to an existing filling or have a crown. I paid the £16.50 for the check-up and was told depending on which option I went for with the broken tooth the £16.50 would be deducted. An appointment was also booked for the hygienist for January, the dentist agreed to give me LA beforehand so it would not be as painful so I need an appointment with him then one with the hygienist. I then found this thread and have been reading with interest.

I went back on Friday having decided to go the crown option rather than the filling on filling and have 2 appointments booked for January and they moved the hygienist appointment to February after the crown treatment was finished.

I am now wondering whether I can now ask that this is included in my course of treatment rather than paying for the hygienist on top seeing as I am paying £198. I clearly have gum problems, despite my cleaning, flossing and using the interdental brushes, dentist says it has improved from when he last saw me but I still need scale and polish. My gums have receded due to the gum disease and my already senstive teeth are now extremely senstive and no toothpaste has any impact on the sensitivity.

I am unsure whether the scale and polish he could do would be comparable with the hygienist. I am also not sure on the best time to bring this up, whether to ring them first or to mention at my first appointment in January.

boozercruiser

akh43 wrote: »

I recently went for my check-up and was advised that I needed to see the hygienist due to gum disease, not the first time. Last time I was not particularly impressed with the treatment I got from the hygienist, partly because I was a few minutes late and partly due to my extremely sensitive teeth. I did not feel any difference in my teeth afterwards, not like you used to notice in the old days when your had a scale and polish, and only felt as if I got half the treatment I should have received. My dentist told me £25 to see hygienist or the NHS cost of £40+ (I am now thinking what he quoted me was the level 2 charge of £46.50). I also had to decide what I wanted to do regarding a tooth that had recently broken which was to add a filling to an existing filling or have a crown. I paid the £16.50 for the check-up and was told depending on which option I went for with the broken tooth the £16.50 would be deducted. An appointment was also booked for the hygienist for January, the dentist agreed to give me LA beforehand so it would not be as painful so I need an appointment with him then one with the hygienist. I then found this thread and have been reading with interest.

I went back on Friday having decided to go the crown option rather than the filling on filling and have 2 appointments booked for January and they moved the hygienist appointment to February after the crown treatment was finished.

I am now wondering whether I can now ask that this is included in my course of treatment rather than paying for the hygienist on top seeing as I am paying £198. I clearly have gum problems, despite my cleaning, flossing and using the interdental brushes, dentist says it has improved from when he last saw me but I still need scale and polish. My gums have receded due to the gum disease and my already senstive teeth are now extremely senstive and no toothpaste has any impact on the sensitivity.

I am unsure whether the scale and polish he could do would be comparable with the hygienist. I am also not sure on the best time to bring this up, whether to ring them first or to mention at my first appointment in January.

Thank you for joining the 'thread'.

Well then, I would think that you sound the classic of my whole point that your so called 'Hygenist' for £25 is a total 'Rip Off'.

There is absolutely no doubt in my mind that the Scale and Polish should have been included with the NHS fee band.

SCHEDULE 2 (Band 2).
Regulation 4(2)
Band 2 Charges - Treatment
(a) non-surgical periodontal treatment including root-planing, deep scaling, irrigation of periodontal pockets and subgingival curettage and all necessary scaling and polishing.

Please read the full regulations posted a little earlier.

Even Band 1 should have done it!
Band 1 course of treatment – £16.50
This covers an examination, diagnosis (e.g. X-rays), advice on how to prevent future problems, A SCALE AND POLISH, IF NEEDED!!!!!!, and application of fluoride varnish or fissure sealants. If you require urgent care, even if your urgent treatment needs more than one appointment to complete, you will only need to pay one Band 1 charge.

I will be very interested what the very respected Dentists who input here have to say though.

Not that, with great respect, I agree with them every time though you understand!:)

welshdent

Now booze you can NOT say that a band 1 would suffice because you can not see the poster to diagnose them
A lot of dentists call periodontal treatment a scale and polish because its easier to explain. I dont agree with that as it causes problems with understanding and ultimately trust.
I am not as concerned with your case because mainly, you were given a choice. They offered you the NHS band 2 which they are perfectly entitled to do so if as you say, they have diagnosed gum disease OR see the hygienist. A hygienist would be specifically trained to treat gum disease. Thats pretty much WHAT they are there for. Now the complicated aspect comes in with the needing the crown. Regardless of any other factors, the band 3 charge WILL cover treatment for gum disease. Its not like you are being offered a band 2 or see hygienist privately for less. Seeing as you have not as yet had the hygiene appointment my advice would be to contact the practice and ask that seeing as you will be having band 3 treatment anyway could you have the treatment with the dentist within that course rather than with the hygienist .... Its highly unlikely you will get to see the hygienist for NHS treatment as the dentist would have to pay for that AND the crown they are making out of the cash limited course of treatment they are providing. .... they wont. You MAY also find that the dentist is unable to numb you up for a full mouth clean up due to the resources being limited. I am not saying they will but I do know of some practices that would not do full mouth periodontal treatment with local anaesthetic on the NHS because they would view it as not strictly necessary. I very very rarely have anyone in that would need it for example. Seeing the hygienist privately would factor these additonal costs in already. I know I would not be able to offer for example multiple periodontal treatment visits with anaesthetic. Possibly a single vists but no more.

So your options are ... ask for it all to be done within the NHS agreement with the dentist ... or choose to see the hygienist in addition to the band 3. I would imagine you would get more time spent on you with the hygienist but thats purely a guess. Its up to you at the end of the day. Ask what the pros and cons would be and make a decision thats best for you.

But let me be clear. This to me is no scam because they are offering you a choice. Thats is perfectly acceptable to me and the NHS treatment plan form even has a box for private scale and polish or periodontal therapy.


Incidentally a common "complaint" from my patients that have been treated for gum disease is increased recession. Thats actually a good thing. When your gums are swollen and inflammed but the bone has been resorbed away this is bad. They are inflammed due to the plaque etc there. This is what causes the bone to break down (simplistically speaking!). This swelling however masks just how much supporting tissue you have lost for your tooth. As it heals up following good cleaning, it basically beds its self down against the new position of the bone. This is a sign its healing. The side effect is more of the tooth is now exposed and these bits should not have been exposed and as such you get sensitivity. There are STACKS of sensitive toothpaste out there and they all work differently. Try some out and see what works for you.

akh43

Thanks for the responses, I think when I go for my first appointment in January I will ask then, may print out the relevant bit for back up.

Thanks welshdent for explaining the recession aspect and how this is actually a good thing.

With regard to the sensitive toothpastes I have tried them all, each time a "new improved" or new brand comes out I am first in the queue to try, unfortunately I have found none that help that much. My fall back has always been sensodyne and at the moment the pronamel one (more because I prefer the taste). I also put toothpaste on the back few teeth (which are the worst ones and the ones he is going to use the LA on) after cleaning, as suggested by dentist. Although the sensitive toothpaste does not get rid of the pain if I stop using for more than a few days the pain does get worse so maybe it does slightly lessen it. When you see these rapid relief toothpaste adverts which show the pain goes almost straight away (I can think of 2 brands specifically and have tried both), does this actually work for some people as I went straight out and bought and found no difference to my usual toothpaste.

welshdent

I find they are all very individual. Ask your dentist if they have any seal and protect, I find that works well in sensitivity cases.

boozercruiser

akh43 wrote: »

Thanks for the responses, I think when I go for my first appointment in January I will ask then, may print out the relevant bit for back up.

Thanks welshdent for explaining the recession aspect and how this is actually a good thing.

With regard to the sensitive toothpastes I have tried them all, each time a "new improved" or new brand comes out I am first in the queue to try, unfortunately I have found none that help that much. My fall back has always been sensodyne and at the moment the pronamel one (more because I prefer the taste). I also put toothpaste on the back few teeth (which are the worst ones and the ones he is going to use the LA on) after cleaning, as suggested by dentist. Although the sensitive toothpaste does not get rid of the pain if I stop using for more than a few days the pain does get worse so maybe it does slightly lessen it. When you see these rapid relief toothpaste adverts which show the pain goes almost straight away (I can think of 2 brands specifically and have tried both), does this actually work for some people as I went straight out and bought and found no difference to my usual toothpaste.

Yes, and isn't it absolutely wonderfull that you have had a REAL LIVE Dentist take so much time to give advice and explain everything to you as best he can in this Forum? Which cannot be easy, as he doesn't have your mouth in front of him!:D

Thank you Welshdent:A Every time I read a post of your I learn and understand just a little bit more of what is an extremely complicated matter.

I am still not going to pay that £28 Hygenist fee at my next appointments in January though!:D