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

boozercruiser

brook2jack wrote: »

CLINICAL NEED!!!!!!!!

Person a may need it person b may want it but not need it. Person c dentist may have a quick flick around the lower teeth with a scaler... that is not a scale and polish.

Peoples clinical needs are different and everyone shouldn't get a scale and polish because they would like it. If it doesn't have a health benefit it shouldn't be done.

CLINICAL NEED...Dentist to me..."You have gum disease"

...CLINICAL NEED...

SCHEDULE 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
(b) surgical periodontal treatment, including gingivectomy, gingivoplasty or removal of an operculum
(c) surgical periodontal treatment, including raising and replacement of a mucoperiostal flap, curettage, root planning and bone resection

Gum Disease qualifies in amongst that lot I guess?!!:)

http://www.nhs.uk/Conditions/Gum-disease/Pages/Treatment.aspx

Scale and polish

To remove plaque and tartar (hardened plaque) that can build up on your teeth, your dentist may suggest that you have your teeth scaled and polished. A scale and polish is a type of ‘professional clean’ that is usually carried out at your dental surgery by a dental hygienist.
A scale and polish involves having the plaque and tartar scraped away from your teeth with a special instrument, before your teeth are polished to remove any marks or stains. If a lot of plaque or tartar has built up on your teeth, you may need to have more than one scale and polish.
The price of scale and polish treatments can vary depending on what exactly is being carried out, so ask your dental hygienist how much the treatment will cost beforehand. Treatment on the NHS should cost £16.50 for basic treatment, or £45.60 for more advanced treatment. For more information, see NHS dental services.

One of the best ways to treat all kinds of gum disease (gingivitis), including periodontitis and acute necrotising ulcerative gingivitis (ANUG), is to practise good oral hygiene.
Gum disease and periodontitis

Good oral hygiene



Good oral hygiene involves:

• brushing your teeth for 2-3 minutes twice a day (in the morning and last thing at night)
• using an electric toothbrush if possible (unless you have ANUG, see below)
• using a toothpaste that contains fluoride if your water supply is low in fluoride (fluoride is a natural mineral that helps to protect against tooth decay)
• flossing your teeth at least three times a week
• not smoking
• seeing your dentist regularly (at least once every one to two years, but more frequently if necessary)

For more information about good oral hygiene, see the teeth-cleaning guide.
Mouthwash

Antiseptic mouthwashes that contain chlorhexidine or hexetidine are available over-the-counter (OTC) from pharmacies. There is some debate about whether these are necessary for people with healthy gums.
Your dentist may recommend that you use a mouthwash if it helps control the build-up of plaque (the soft, sticky substance that forms when bacteria collect on the surface of your teeth). Your dentist will tell you which type of mouthwash is most suitable and how to use it.
Chlorhexidine mouthwash is not suitable for women who are pregnant or breastfeeding. It can also stain your teeth brown if used regularly. Rinse your mouth thoroughly in between brushing your teeth and using a chlorhexidine mouthwash because some ingredients in toothpaste can prevent the mouthwash from working.
Acute necrotising ulcerative gingivitis (ANUG)

Acute necrotising ulcerative gingivitis (ANUG) should always be treated by a dentist. However, if you see your GP before visiting a dentist, they may provide you with some treatment while you wait to see your dentist. Possible treatments are described below.
Antibiotics

Metronidazole or amoxicillin are the most commonly prescribed antibiotics for ANUG. You will usually have to take these antibiotics for three days.
Amoxicillin is not suitable for people who are allergic to penicillin. Amoxicillin can also cause the contraceptive pill to fail, so women taking the contraceptive pill should use an additional form of contraception while taking amoxicillin and for seven days afterwards.
Metronidazole can react with alcohol, causing you to feel very unwell. Therefore, it is a good idea not to drink any alcohol while you are taking metronidazole and for 48 hours afterwards.


Metronidazole and amoxicillin may also cause the following side effects:

• nausea (feeling sick)
• vomiting
• diarrhoea

Painkillers

Paracetamol and ibuprofen are the most commonly prescribed painkillers. They are also available over-the-counter (OTC). They may help reduce the pain and discomfort that is caused by your ulcers.
Paractemol and ibuprofen are not suitable for everyone, so read the manufacturer’s instructions before taking them. Aspirin should not be given to children who are under 16 years of age.
Mouthwash

A mouthwash that contains chlorhexidine or hydrogen peroxide may be prescribed. Some chlorhexidine mouthwashes are also available OTC, although they may not be as effective as a hydrogen peroxide mouthwash.
Always read the instructions before using mouthwash because some types may need to be diluted in water before they are taken. They are usually used two or three times a day.
Chlorhexidine mouthwash is not suitable for women who are pregnant or breastfeeding. It can also stain your teeth brown if used regularly. Rinse your mouth well between brushing your teeth and using a chlorhexidine mouthwash because some ingredients in toothpaste can prevent the mouthwash from working.
Good oral hygiene

As with gum disease and periodontitis, if you have ANUG, continue to practise good oral hygiene as described above. However, because ANUG can cause painful ulcers, brush your teeth with a very soft toothbrush and avoid using an electric brush.
Dental treatments



If your GP refers you to a dentist, they may recommend the following treatments:

• scale and polish
• root planing
• antibiotics
• surgery

These are described in more detail below and can be used for gum disease, periodontitis and ANUG.
Scale and polish

To remove plaque and tartar (hardened plaque) that can build up on your teeth, your dentist may suggest that you have your teeth scaled and polished. A scale and polish is a type of ‘professional clean’ that is usually carried out at your dental surgery by a dental hygienist.
A scale and polish involves having the plaque and tartar scraped away from your teeth with a special instrument, before your teeth are polished to remove any marks or stains. If a lot of plaque or tartar has built up on your teeth, you may need to have more than one scale and polish.
The price of scale and polish treatments can vary depending on what exactly is being carried out, so ask your dental hygienist how much the treatment will cost beforehand. Treatment on the NHS should cost £16.50 for basic treatment, or £45.60 for more advanced treatment. For more information, see NHS dental services.
Root planing

In some cases of gum disease or periodontitis, root planing may be required. Root planing is a cleaning procedure to clean bacteria from the roots of your teeth. Before having the treatment, you may need to have an anaesthetic (painkilling medication) to numb the area. You may feel some pain for up to 48 hours after having root planing.
Further treatment

If you have severe gum disease, periodontitis or ANUG, you may need further treatment, such as surgery, to remove the affected tooth. Your dentist can tell you about the procedure that is required and how it is carried out.
If you are having surgery or root planing, you may be given antibiotics (medication to treat infections). Your dentist will tell you whether these are necessary.

• show glossary terms

Glossary
Gum disease (gingivitis)
Inflammation of the gums, normally due to a build-up of dental plaque.
Periodontitis
This is when the inflammation of the gums also affects the bone surrounding the tooth and can cause your teeth to become loose and fall out.
Plaque
Plaque is a sticky substance that is made up of bacteria. It can build up on your teeth if you do not brush them.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some are good for you.
Ulcers
An ulcer is a sore break in the skin or on the inside lining of the body.



Last reviewed: 09/03/2010
Next review due: 09/03/2012

The_One_Who

I'm not a dentist, just someone who has followed this thread.

Please, dentists, correct me if I'm wrong. My understanding is that "gum disease" is not a catch-all term, but more like a scale. So there is a difference between someone who has a little bit of inflammation (not a clinical problem?) and someone who needs to see a hygienist for a professional clean. The first person might get a quick whizz round in the dentist's chair, but the second will need to pay more because it moves up a treatment band. Is that correct?

BC, you seem to want the earth but not have to pay for it. Granted, I'm in Scotland and the prices and structure are a bit different here. I am more than happy to pay for the preventative treatment if it means I don't need to shell out later on for fillings, root canals, extractions etc.

boozercruiser

The_One_Who wrote: »

I'm not a dentist, just someone who has followed this thread.

Please, dentists, correct me if I'm wrong. My understanding is that "gum disease" is not a catch-all term, but more like a scale. So there is a difference between someone who has a little bit of inflammation (not a clinical problem?) and someone who needs to see a hygienist for a professional clean. The first person might get a quick whizz round in the dentist's chair, but the second will need to pay more because it moves up a treatment band. Is that correct?

BC, you seem to want the earth but not have to pay for it. Granted, I'm in Scotland and the prices and structure are a bit different here. I am more than happy to pay for the preventative treatment if it means I don't need to shell out later on for fillings, root canals, extractions etc.

Well then...I don't know about wanting the Earth. I just want no more and no less than what I am ENTITLED TO. (This Forum falls under that catagory...I think!) under the NHS Dentists Contract for Dental Care.

Particularly being a Pensioner I am obviously not going to pay a penny more than I have to.

As it is what was a charge here in Wales of around £13 for for a filling and an included Scale and Polish is now £39. Then when you factor in being scooted off to the Hygenist, which is a recent years fob off anyway for an extra £28, which makes a grand total of £67...

Do you think I have money to burn or am senile or something M8?

In any case, with great respect to you and all up North, I think it's a bit rich for you to say "You seem to want the Earth but not have to pay for it". After all is this the very same Scotland where Student Fees, Prescriptions and lots of other goodies are FREE and subsidised by my English Taxes?

I will do my best not to feel insulted by your remarks, if you don't feel insulted by mine. After all...no offence is meant....M8y:D

English anger at subsidies for Scotland hits new high


By Daily Mail Reporter
Last updated at 9:30 AM on 2nd March 2010

• Comments (8)
• Add to My Stories

English resentment towards Scotland's subsidies has nearly doubled in just seven years.
Some 40 per cent of people in England believe the system which gives Scots more public funding per head is unfair.
Just 22 per cent thought so in 2003, research shows.
Scots receive £1,644 more in public spending per capita than English residents.

Rivalry: A growing number of English people resent the Scots receiving more public funding per head

Public spending in England is £7,535 per person, while in Scotland it is £9,179.
Since the Scottish Parliament was created in 1999, public spending has outstripped tax generated there by 45 per cent.
While Scots get free care for the elderly and deferred tuition fees, the English have to pay.
In addition, Scotland's two flagship banks, Halifax Bank Of Scotland and the Royal Bank of Scotland, were among the most in need of taxpayer bailouts.
Anger over the disparity has fuelled English nationalism, with a record 29 per cent of English respondents saying they now want an English Parliament.
However, the Scottish National Party insists £50million in North Sea oil revenues poured into the UK Treasury last year.
The report is published today by the Institute of Public Policy Research think tank.
Funding for the UK's nations and regions is decided by the Barnett Formula, which was designed as a temporary measure in 1978.





Read more: http://www.dailymail.co.uk/news/article-1254772/English-anger-subsidies-Scotland-hits-new-high.html#ixzz18efLzZxe

brook2jack

Errrr BC you live in Wales home of free prescriptions for all and dental check ups for under 25s and over 60s. You are also on a pension so presumably are not paying any taxes at all.

Also if you were in England you would pay £16 ish ,£46 ish and £194 ish in bands so more than Wales and the maximum charge in Wales is £177 in Scotland it's around £340, alot more than Wales.

Student fees in Wales are also subsidised.

Pot/kettle?

The_One_Who

boozercruiser wrote: »

Well then...I don't know about wanting the Earth. I just want no more and no less than what I am ENTITLED TO. (This Forum falls under that catagory...I think!) under the NHS Dentists Contract for Dental Care.

Particularly being a Pensioner I am obviously not going to pay a penny more than I have to.

As it is what was a charge here in Wales of around £13 for for a filling and an included Scale and Polish is now £39. Then when you factor in being scooted off to the Hygenist, which is a recent years fob off anyway for an extra £28, which makes a grand total of £67...

Do you think I have money to burn or am senile or something M8?

In any case, with great respect to you and all up North, I think it's a bit rich for you to say "You seem to want the Earth but not have to pay for it". After all is this the very same Scotland where Student Fees, Prescriptions and lots of other goodies are FREE and subsidised by my English Taxes?

I will do my best not to feel insulted by your remarks, if you don't feel insulted by mine. After all...no offence is meant....M8y:D

What you think you are entitled to and what a dentist thinks, may well be different. You aren't qualified to know what is needed and what course of treatment is best for you. Or am I putting too much faith in the dentist?

It's not all rosy up here. The maximum charge here is almost £400, which I believe to be double the charge south of the border. I'm pretty sure a lot of dentists are struggling to survive up here, perhaps more so than elsewhere because of the pricing structure. I don't know though, that's just my own conjecture. Also, after London, Scotland puts the most money into the pot, but do not get that much back. I believe it to be Northern Ireland and some parts of the north of England to get out a lot more than they put it. Although that mat have changed in the past few years, I'm not sure. However, that's a different topic for a different day.

As for the budget comments, well, I'm sure you know that Scotland gets a block grant of money to spend as they will. Priorities are different. I'll be the first to say that a lot of the spending habits are unsustainable and would be more than happy to pay for the services I use.

boozercruiser

brook2jack wrote: »

Errrr BC you live in Wales home of free prescriptions for all and dental check ups for under 25s and over 60s. You are also on a pension so presumably are not paying any taxes at all.

Also if you were in England you would pay £16 ish ,£46 ish and £194 ish in bands so more than Wales and the maximum charge in Wales is £177 in Scotland it's around £340, alot more than Wales.

Student fees in Wales are also subsidised.

Pot/kettle?

I will try not to be insulted by you either Brook2Jack;)

Actually, for your further information, our income from the Government Pension and Company Pensions for which I worked ALL my life for means that my Wife and I DO pay tax on our weekly income.

This income also means that we cannot claim Pension Credit, any Council Tax relief, (£1,298 a year) or any other benefits I could have claimed had I not worked all my life. (Including FREE Dental Care)

AND of course we have to pay whatever the Dental Band is for treatment.

O.K.....there are subsidies in Wales as well from England. BUT then...it isn't me who is accusing someone of wanting the Earth for nothing!

Anyway, Brook2jack....I do not intend replying to any more of your posts. I am getting the distinct feeling that you are just on a Wind Up now.

:beer: Bye to you.:D

Savvy_Sue

boozercruiser wrote: »

Particularly being a Pensioner I am obviously not going to pay a penny more than I have to.

that is, of course your choice, but I make no assumptions about the disposable income available to a pensioner. as pensioners, my parents had a far higher disposable income than they ever did while we were growing up. and like you, my mother refused to seek private dental treatment at a time when it was difficult to get NHS care, even though she could well have afforded to pay for it. I don't know if she regrets that decision now she has had most of her teeth removed in two risky operations because of her other health problems.

I am sure that the outcome would have been less unsightly. oh, and she's a Daily Mail reader too.

I am now paying for private dental care, and for hygienist visits, after persevering for years with benign neglect from the NHS. If I averaged out what I used to pay to the NHS with what I pay now, it's not significantly different, as far as I can see. the difference is, I think I'm getting good value, from the same person at successive appointments, with ease of making appointments at times which suit me.

In any event, DH was sent to the hygienist from the NHS dentist years ago, before it was 'the norm', and the advice he got from her about how to brush his teeth was invaluable: his technique was damaging them.

I'm teaching the boys that if you care about your teeth, you pay to see the dentist. you add it to your budget. it takes a lot if nagging now they are on the point of leaving home, but with only 2 childhood fillings between the 3 of them, it really shouldn't cost more to be private patients in a sensibly priced practice than to pretend the NHS is looking after them.

BTW, Martin talks not just about price but about value for money. for some things, cheap is best. for others, including IMO teeth, it's not.

The_One_Who

boozercruiser wrote: »

O.K.....there are subsidies in Wales as well from England. BUT then...it isn't me who is accusing someone of wanting the Earth for nothing!

I'm sorry if you have taken offence to my comment. I'm just saying how I see it.

It's a bit like when people complain about the price of stamps, I mean, think of everything that 40p gets you.

boozercruiser

The_One_Who wrote: »

I'm sorry if you have taken offence to my comment. I'm just saying how I see it.

It's a bit like when people complain about the price of stamps, I mean, think of everything that 40p gets you.

No, I have not taken offence:) I just don't care for the inference, thats all.:D

Not everyone is going to agree with me of course.:eek:

And in fact constructive points of view and criticism is to be welcomed.....and there has been a lot of that here.....particularly from the respected Dentists giving help and advice through this particular thread.

Just don't accuse me of being a free loader (not that you did of course).....that's all as well!:rotfl:

welshdent

for the one who ... "gum disease" is indeed a scale but it IS IMO a catch all term. It is a broad term that refers to 2 conditions and most dentists find its easier to tell a patient "you have gum disease" because the ACTUAL diagnosis would take a lot of time to covey seeing as most people do not really understand the terms. The 2 simple conditions are Gingivitis and Periodontitis. These are further subdivided for example acute ulcerative necrotising gingivitis and aggressive periodontitis. These are complex enough for the professionals . Gingivitis is simple inflammation of the gingiva (soft tissue aka gum) and it is caused by plaque accumulation. The plaque contains many different types of bacteria which all induce an immune response to the host. This manifests as often swollen, deep red coloured gums than are prone to bleeding. If the plaque is removed then it goes and the damage is reversible. The previously mentioned BPE gives it a score of 1 and treatment here is oral hygiene instruction. "scaling" is not indicated as the patient is capable of removing the plaque with a brush. If we removed it then it would only be back again in a day or so. If this plaque is not removed, it can form calculus which is a plaque retentive factor. It can host more bacteria and plaque and is given a BPE score of 2. Treatment indicated is scale it off. HOWEVER having calculus does not mean you have gingivitis. Its been shown that people that have calculus but keep it clean of plaque can have perfectly healthy gums despite the presence of calculus.

In the event of this plaque not being removed, in some people (approx 30% of people are naturally susceptible but modifying factors such as diabetes and SMOKING!!! can and do increase this number) .... go on to develop periodontitis. This is inflammation of the periodontum which is the supporting tissues of the tooth and relates to the periodontal ligament holding the tooth and the bone the tooth is within. What happens is the plaque forms causing inflammation, the bacteria and importantly the HOST produce toxins and inflammatory mediators that attack the bone supporting the tooth. In simple terms you get swollen gums that become hard to clean and the plaque then forms sub gingival calculus/plaque that is almost impossible to remove with cleaning alone. The swollen gums for a pocket and you get "apical migration" of this pocket floor as the bone is broken down. If you do not address this inflammation by plaque removal, in time the pocket keeps getting deeper due to swollen gums and loss of bone. With periodontitis you have to have gingivitis present as this is the initial inflammation that causes the disease process. The bpe scores here are 3 or 4. Treatment involves stressing oral hygiene instruction but also "deep scaling" and "subgingival debridement to remove the plaque and calculus that are under the gum line and that which is firmly adhered to the side of the tooth out of sight. This would the proceed to surgical treatment where the pockets are so deep that its impossible to adequately clean them going down the side of the tooth as normal. I try not to do this as its is really a specialists job. Only band 2 falls in to the scale and polish bracket and thus band 1 IMO. Often some people have so much calculus though that although they would only score 2, the do infact qualify for more advanced cleaning and thus band 2 treatments.

As some examples ... band 1 qualifying i.e. mild gingivitis with some calculus deposits supragingivally




No scaling indicated here but there is gingivitis. Note the red gums between the teeth and general puffyness.



I think this would be a band 3 score. Note the probe - it is graduated at mm intervals and at then some 2 mm intervals. This patient does not have the calculus deposits and they do not LOOK that bad. However they clearly have pocketing and this attachment loss and the bleeding around the gums indicates inflammation. They need band 2 treatment



This is advanced periodontal disease before treatment and would need the deep scaling I mentioned. Some may wish to do surgical treatments.



The X rays show the bone loss around the teeth (about 50%).

This is just unpleasant in general. Apparently this is in a poorly controlled diabetic


I hope this clarifies any points.