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

boozercruiser

#468
t0rt0ise
"I used to see a private dentist and for the cost of £40 I'd get a check up and a scale and polish. Then I moved to London and saw a dentist offering NHS treatment to new patients so I signed up and got a check up. He said that although I needed a scale and polish he didn't do it any more so I had to pay £49 to his hygeinist. So I'd gone from £40 private care to £65.50 for NHS care. I'm not best pleased with this."

Can some kind person please explain to me how this Dentist can get away with saying..."although I needed a scale and polish he didn't do it any more"!

Did I miss something, or did that Dentist say "You need a Scale and Polish....but I don't do it anymore"! I do not believe it!

That particular Dentist, and any more out there like him are the ones who "undermine peoples faith in their own dentists".

This Dentist should be carrying out a Scale, Polish and similar treatment as per NHS Contract......

(a) non-surgical periodontal treatment including root-planing, deep scaling, irrigation of periodontal pockets and subgingival curettage and all necessary scaling and polishing

It is part of his NHS Contract to carry out Scale and Polishes M8....particularly has he has said you should have it done. For goodness sake report him to the local Authority....and demand your money back!

Simple...isn't it?

NHS dental charges from 1 April 2010
[FONT=Times New Roman,Times][FONT=Times New Roman,Times]�[/FONT]
[/FONT][FONT=Frutiger 45 Light,Frutiger 45 Light][FONT=Frutiger 45 Light,Frutiger 45 Light]The charge you pay depends on the treatment you need to keep your mouth, teeth and gums healthy. You will only ever be asked to pay one charge for each complete course of treatment, even if you need to visit your dentist more than once to finish it – either Band 1, Band 2 or Band 3. If you have to be referred to another dentist for another course of treatment, you can expect a second charge. Some minor treatments are free, including having stitches removed and repair to dentures (if they can be mended). [/FONT]
[/FONT]If you are not exempt from charges, you should pay one of the following charges for each course of treatment you receive:[FONT=Times New Roman,Times][FONT=Times New Roman,Times]�[/FONT]
[/FONT]Band 1 course of treatment – £16.50
[FONT=Frutiger 45 Light,Frutiger 45 Light][FONT=Frutiger 45 Light,Frutiger 45 Light]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. [/FONT]
[/FONT]Band 2 course of treatment – £45.60
[FONT=Frutiger 45 Light,Frutiger 45 Light][FONT=Frutiger 45 Light,Frutiger 45 Light]This covers everything listed in Band 1 above, plus any further treatment such as fillings, root canal work or if your dentist needs to take out one or more of your teeth. [/FONT]
[/FONT]Band 3 course of treatment – £198.00
[FONT=Frutiger 45 Light,Frutiger 45 Light][FONT=Frutiger 45 Light,Frutiger 45 Light]This covers everything listed in Bands 1 and 2 above, plus crowns, dentures or bridges. [/FONT]
[/FONT]Free NHS dental treatment or help with health costs
[FONT=Frutiger 45 Light,Frutiger 45 Light][FONT=Frutiger 45 Light,Frutiger 45 Light]You may be eligible for help with all or part of the costs of your NHS dental treatment. To see if this applies to you, see the leaflet [/FONT][/FONT][FONT=Frutiger 45 Light,Frutiger 45 Light][FONT=Frutiger 45 Light,Frutiger 45 Light]NHS dental services in England[/FONT][/FONT][FONT=Frutiger 45 Light,Frutiger 45 Light][FONT=Frutiger 45 Light,Frutiger 45 Light], which is available from any NHS dental practice or at [/FONT][/FONT]www.dh.gov.uk/dentistry

boozercruiser

t0rt0ise wrote: »

Yes, in particular Immune Thrombocytopenia.. ITP.

Have you done a Google on the subject t0rt0ise?

There is quite a lot about it on the Internet.

welshdent

booze re anti biotic cover ... you do have a choice but also the dentist does. If you want it you would need to get it from your GP or cardiologist because I know I wouldnt prescribe it. You have have the following choices with me .... No abc and any necessary treatment on the NHS (unless cheaper with the hygienist and you were happy to see them when offered ) .... or pop along to your GP before hand and see if they will do the cover for you

boozercruiser

welshdent. "booze re anti biotic cover ... you do have a choice but also the dentist does. If you want it you would need to get it from your GP or cardiologist because I know I wouldnt prescribe it. You have have the following choices with me .... No abc and any necessary treatment on the NHS (unless cheaper with the hygienist and you were happy to see them when offered ) .... or pop along to your GP before hand and see if they will do the cover for you"

And thank you for your very constructive none 'kick him in the nuts' answer to me. I have noticed that even though we don't always see eye to eye over everything you always try to be helpfull, and if I may say are perhaps 'kinder' than some here who go for me at the jugular!

In reply, when the Dentist at Machynlleth around 2 years ago said that the new NICE guide lines advised that Amox........wasn't needed anymore I just accepted it. My next NHS Dentist up at Dolgellau said that he left the choice to the Patient. Then, when I saw my Cardiologist 2 months ago he advised me to have it, and that he would put a letter into my Doctor to this effect.
When I mentioned this to the Dentist in Newtown at my last check up...which led to this post starting up again she wrote out a prescription for me to use both before and after my 2 Fillings and 1 Extraction.

Now then, for me....I think I would feel better for me to have that Amox......for a bit more protection.

I have my original card issued 8 years ago to which I have always followed....the card reads....

ENDOCARDITIS DENTAL WARNING CARD
Show this card to your Dentist at each visit....

Before extractions or perlodontal surgery under local or no anaesthesia, the following is recommended

Adult...single dose amoxycillin 3g by mouth 1 hour before procedure. (Though I am certain that you know about tho'se particular guidlines)

After all, when the drilling is going on......swill....drill....swill...drill.......scrape....scrape...I cannot help but feel that an awfull lot of germs are going to be swallowed.......and.....I do have that valve to think of....as from what I have read....tho'se germs can under some circumstances attack that valve.

Then I am in the ***t and am no more able to post here.

Then...I am missed.....did someone say....."Yes...like Toothache"!

welshdent

Germ wise you are probably no worse than what happens during a normal days usage of your mouth IMO. You would have only needed them before for periodontal treatments/examinations and surgical procedures of which extractions are included. Swallowing actually isnt the problem anyway as digestive juices would make mincemeat of anything before it formed any nasty plaques in your heart that go on to damage valves. Believe me I am up there with the practice safely hand book, but I really would not have a leg to stand on if there was a problem. I also do not believe that dental treatment in itself is a problem given the risk of bacteraemia possible in normal tasks such as toothbrushing, eating, biting lips accidentally/deliberately etc.
Thanks for your comments by the way

t0rt0ise

brook2jack wrote: »

I think you posted on another forum about this? If so there have been a couple of answers posted there.

I did post on one and the answer there bore out my fear that some dentists don't know anything about it. He said that he knew that a count of under 50 would be treated with platelet transfusions. Transfusions are contra indicated in ITP except for very serious bleeding during surgery or something, and a count of 50 would have me partying. My current treatment aim is to get a stable count of 30 or so. It's scary when you know more than the professional you are seeing but I have to say that is also the case often with GPs and A&E doctors too.

And to keep being told that bleeding gums is a sign of a problem drives me nuts.. when I have a count of 5 or so my gums just bleed spontaneously, and slightly above that they will bleed with a bit of pressure. Nothing to do with hygiene and the dentist always admits after examination that actually my oral health is fine.

</rant>

brook2jack

The general advice is that all people with bleeding disorders can be treated in practice for most proceedures with a few exceptions.

All treatment is safe providing platelet levels/clotting times/inr levels etc are in normal ranges and for high risk proceedures I ask for blood work to be done the day before.

High risk proceedures are scale and polish, any surgical work eg extractions and block injections. However there are many levels and types of thrombocytopaenia and most patients are easily treatable in practice.

If your platelet levels are regularly so low you are getting spontaneous gingival bleeding you should ask for referral to the hospital service. It is likely that you would need eg tranxeamic acid mouthwashes to control bleeding and these are not available in general practice.It is vital,as you know , that your oral health remains excellent. You should ask your present dentist for a referral.

If you live in London the referral will be to one of the dental teaching hospitals.

brook2jack

The final word for anyone else worried about antibiotic cover

1 research shows you are far more likely to die from a reaction to the large dose of antibiotics than from bacterial endocarditis which they were supposed to prevent.

2 research shows that everyday eating and toothbrushing produces a similar or higher level of bacteria in the blood than any dental proceedure if you have inflammed gums.

3 research shows that although mouth bacteria have been implicated in some cases of endocarditis in the vast majority of cases this cannot be traced to recent dental treatment , in other words eating and brushing did it.

4 any one at any age can develop an allergy even if they have had the substance before, indeed the body needs to be primed to become allergic.

5 any dentist has to justify prescribing any medication. Since the overwhelming scientific proof is against prophylactic prescribing it would be indefensible if something should go wrong to prescribe.

6 if your doctor prescribes anyway the standard proceedure advised for many years is to take the antibiotics in the surgery and wait there as anaphylaxsis (allergy) can be quick and deadly if not treated immediately.

jugglebug

boozercruiser wrote: »

No disrespect to you of course, but if I have a choice of following my Cardiologists advice or my Dentists advice or that useless organisation called NICE (the organisation that refuses Cancer, Senile Dementia and other medication from sufferers) advice ....then I will follow my Cardiologist advice every time thank you very much.

Aye you do have that choice, but I don't feel I do.
Should anything ever happen we are judged by the body of evidence available at the time and for me to ignore the study that came before NICE, which then NICE was asked to adjudicate on after the barny that blew up afterwards would be asking for trouble.
As I said earlier the guidance has and does vary all over the world.
Your card says 3g.
An Americans card of the same vintage would have said 2g. Are American Bacteria weaker than ours? Or are the Yanks tougher?
I suspect neither

You also say that you have always followed this advice. However science changes. I do not do root fillings the same way now as I was taught at university, I don't even follow all the principles of a bog standard filling that was drummed into me there, materials and methods and basic understanding of what is going on are improved all the time.
There was a time we thought tooth decay was caused by the tooth worm, we don't now.
We used to think putting ground up mouse bones in tooth powders was a good idea, we don't now.
We are advised by many interested bodies, not just NICE, that Antibiotic cover may indeed be harming our patients just because it hasn't happened to you yet (or indeed will ever) doesn't change that.
I have had to attend to one case of anaphylaxis in my surgery and I don't want to do it again. On the other hand I have treated many folks who have had undiagnosed cardiac problems for years and never taken antibiotics pre diagnosis and have come to no harm, I also have taken over from other dentists who didn't apply the guidance properly and let patients take the Amoxicillin at home unsupervised, several of these patients didn't bother and were most upset when I started making them take it at the surgery. They also said, "but I have always done it before, and not come to any harm"

The academic discussion about giving Antibiotics has been going on since long before I qualified.
However, like the other dentists here, when the guidance said give it, I always gave it. Supervised and in surgery. Despite the protests.
Now the guidance says it is unnecessary I wont.

boozercruiser

jugglbug..."The academic discussion about giving Antibiotics has been going on since long before I qualified".

I think that says it all really jugglebug. It seems that there are some differing opinions about it. On the one hand there are well respected Dentists (thank you for your input...including B2J) here who think that in the main Antbiotics are not needed while having Dental treatment, even if one does have a replacement bovine heart valve. Also, the not so respected (as far as I am concerned anyway) latest NICE guidlines say that as well.

On the other hand I have my Consultant Cardiologist who arecently dvised me to take Anoxycillin. No doubt a different Cardiologist may advise as you guys do. But then opinions do differ in every aspect of medicine.

For instance.....I take the Statin 20mg Crestor every day, along with 75mg Asprin and 2 1000 mg Omacor. lots of medical opinion will rubbish the practice, (maybe even you guys too?) for various reasons of taking one or more of them. BUT.....my cholesterol was over 6, and is now below 4....and I generally speaking feel very well (apart from worrying about the Dentist!).

No wonder I am a little bemused about the subject! However, I won't worry too much in future if I don't take the Antbiotic.

Like I say....thank you all for your very valuable input. I hope that visitors here will find that at least some parts of what is going on in this post interesting, educational and helpfull.

I certainly do.

Even if I get wound up occasionally!