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

sweetcheeks33

My dentist does a scale and polish on me every visit or second visit on the NHS while checking my gums ( a new unpleasant technique odd poking them with a metal instrument not particulalry pleasant) However it only only takes two minutes almost and its done. I've never been referred to the hygenist for one.

I use an electric toothbrush so maybe its just a quick after check up or treatment to end it and have a good poke round??

jugglebug

sweetcheeks33 wrote: »

My dentist does a scale and polish on me every visit or second visit on the NHS while checking my gums ( a new unpleasant technique odd poking them with a metal instrument not particulalry pleasant) However it only only takes two minutes almost and its done. I've never been referred to the hygenist for one.

I use an electric toothbrush so maybe its just a quick after check up or treatment to end it and have a good poke round??

Sorry, that technique isn't new. It what was taught to me at dental school back in the 90's and certainly a damn sight earlier than that.
However there are Dentists unfortunately that wouldn't know how to find a BPE probe in their own surgeries with both hands and a compass which is why if you look at litigation towards dental professionals as whole it includes a healthy wedge of untreated gum disease cases.

welshdent

Something we enountered yesterday was utter disgust and almost a complaint that a patient had to pay £12 for the check up x rays and scaling that was advised. The patient thought it was disgusting they should have to pay anything at all despite attending with a problem ("gums are bleeding") had not been in for 4 years and had a shadow on their occlusal surface of LR6. They said if they had known they would have to pay for the scaling they wouldnt have bothered coming in. Cant please everyone eh. The fact they would have had to pay for the x rays (under 25) was lost on them (same cost for all with or without the S+P!!)

brighthair

welshdent wrote: »

Something we enountered yesterday was utter disgust and almost a complaint that a patient had to pay £12 for the check up x rays and scaling that was advised. The patient thought it was disgusting they should have to pay anything at all despite attending with a problem ("gums are bleeding") had not been in for 4 years and had a shadow on their occlusal surface of LR6. They said if they had known they would have to pay for the scaling they wouldnt have bothered coming in. Cant please everyone eh. The fact they would have had to pay for the x rays (under 25) was lost on them (same cost for all with or without the S+P!!)

:eek:
Just booked my appointment..... £33 for checkup, £39 for hygienist. So that'll be £72. I did tell him it was no wonder he was driving a Porsche, and I'm in a Fiat :rotfl:

welshdent

bright maybe that experience I had can highlight what we face. Many are damned if we do or damned if we dont. As I said, I have never ever witheld any necessary treatment from anyone. People may not have always agreed with my recommendations ... but This patient came in with a problem, they were treated absolutely by the book and the standard band 1 charge was levied. Depite this they were STILL unhappy.

brighthair

welshdent wrote: »

bright maybe that experience I had can highlight what we face. Many are damned if we do or damned if we dont. As I said, I have never ever witheld any necessary treatment from anyone. People may not have always agreed with my recommendations ... but This patient came in with a problem, they were treated absolutely by the book and the standard band 1 charge was levied. Depite this they were STILL unhappy.

I'm quite shocked by that. I can't really afford my dentist appointment this time, but I am still going, because I only get one set, and I'd like problems spotted early on so I can have them sorted out. I joke with him about how much I pay despite the fact I have really good teeth, but it's worth it

Billieblob

welshdent wrote: »

Discuss eh? Where did anyone say the 16.50 was what the dentist received? I certainly didn't. I actually receive less than that :-( but then I'm a lowly associate on a 40:60 split. IMO you are misleading about your representation of bpe scores. A score of 1 does not indicate scaling is needed and beyond that we have already agreed that 2 is scaling and 3 and 4 warrant sub gingival debridement et al. So my discussion points are that either you are stirring (your word) incorrectly a dead horse debate or b) you have not trawled through all the pages on here where all of the other dentists acknowledge that the dentists duty is to the patient. They have indicated where the dentist is in the wrong or the patient is incorrect. I have no idea what was done on the old contract as I was not out of Vt when it came in. I have never deprived anyone of clinically necessary treatment. The problem is it's dentists like me that are penalised with this system not the - shall we say less principled amongst us. We have largely agreed with you tbh but you do seem to have posted rather negatively

Sorry welshdent, perhaps the phrase 'the dental practice receives £16:50 from the patient' would be more accurate.

Would you also prefer the term 'devil's advocate' (as opposed to stirring) for presenting a view which differs subtly, but not greatly from yours?

When you state 'we have already agreed', to whom are you referring? I can see probably a maximum of 10 dental professionals have contributed to this thread. The assertation that a maximum BPE score of 1 in any sextant does not entitle the patient to prophylaxis is contradicted by the BSP policy document;

bsperio.org.uk
members
policy

(sorry, I still can't post links)

which clearly states that for a BPE score of 1 that prophylaxis IS required.

Oral prophylaxis is defined as (c&p'd from another website):

oral prophylaxis cleaning of the teeth by a dentist or dental hygienist, including removal of plaque, materia alba, calculus, and extrinsic stains; done as a preventive measure for control of gingivitis. Called also dental prophylaxis.
The BSP policy continues to state that a BPE score of 2 requires SUB-gingival scaling.

From that it is reasonable to infer that both removal of plaque and extrinsic stains are justifiable by prophylaxis and are clinically necessary?

I don't see this as being misleading about BPE scores, nor is it my opinion.

I am sorry you feel I have posted negatively (I'm not quite sure what you mean by that), and I am sorry you feel the new contract penalises you - from what I read in this thread however it is the patients who appear to be being penalised.

welshdent

Not all the patients billie. I am as annoyed as the next about how hard it is to gauge if the average member of the public has located an ethical dentist or not. I have seen some very shoddy work that I woudl be embarassed to let out of my surgery but that doesnt mean we are all rubbish does it??

I subscribe, in accordance to my training ... bpe 1 with soft deposts requires oral hygiene instruction. Whats the point in brushing off the soft stuff if it will be back in 2 days because the individual is incapable of keeping it off? Especially as a good brush at home will shift it all anyway. Today I have had 3 patients in that have all had 111/111 (not counting the others that had higher scores). All had time from me with a mirror and a general demo on technique for brushing and advice to get an electric tooth brush. Is that denial of prophylaxis?? ALL of them had soft depoits that were capable of being scraped off by a probe (part of my demo). There is more benefit IMHO in showing them how to remove if themselves than me having a poke about only for immediate recurrence.

I generally feel you are a little late to the party on this one because every single one of us on here have said that where deemed necessary it should be provided. We have all given explicit advice to people and have provided information as to what they are and are not entitled to, and how to point things out to their dentist politely but firmly. Now i am suspecting that your issue is the definition of clinically necessary? Well the guidance has usually come from higher up than us, the administrators have aknowledged they are happy with staining to NOT be classed as clinicaly necessary and as such acceptible for private scalings so perhaps you should take it up with them? We can infer what we like but we do not make up the NHS contract billie - from a dentist that does 99% of their own perio and usually DOES do scalings anyway. I do generally agree with you in the most part but I dont think a score of 1 indicates a need for an S+P thats all.
Now if one of my patients particularly want to see the hygienist then they are of course welcome to do so ...... privately. I provide it all as part of an NHS course if they wish though.

boozercruiser

welshdent wrote: »

Something we enountered yesterday was utter disgust and almost a complaint that a patient had to pay £12 for the check up x rays and scaling that was advised. The patient thought it was disgusting they should have to pay anything at all despite attending with a problem ("gums are bleeding") had not been in for 4 years and had a shadow on their occlusal surface of LR6. They said if they had known they would have to pay for the scaling they wouldnt have bothered coming in. Cant please everyone eh. The fact they would have had to pay for the x rays (under 25) was lost on them (same cost for all with or without the S+P!!)

Blimey Welshdent.....even I think that Wally had a cheek!:o

And even I would be pleased with what you did. Tell me exactly where you live and I will put my house on the market tomorrow and move there:D

Do you have any NHS spaces M8?:)

Billieblob

welshdent,

I agree I am 'late to the party', but hopefully that doesn't make my point any less valid. This thread came about because patients are being asked to pay privately for treatment that should be available on the NHS.

Obviously the worst cases are where patients with BPE scores of 3, 4 or * are having to pay privately for their treatment.

More ambiguous are BPE scores of 2. Please remember that this denotes 'plaque retentive factors', and staining along the gingival margin provides a rough surface. In theory then I suppose it is possible for a dentist to remove the extrinsic stain along the gingival margins and then offer to refer the patient privately to a hygienist for removal of the remaining unsightly stains. How that would be achieved is an unknown!

I have no idea who you are referring to when you mention 'the administrators', but I agree that removal of extrinsic staining remote from the gingival margin is not clinically necessary.

It appears the majority of posters here are being told they have to visit the hygienist and pay privately with either no discussion at all or even when they have BPE scores of 1 or more.

I agree that BPE score of 1 does not necessitate a scaling, however prophylaxis and oral hygiene instruction (as you do (please be aware that my comments are not directed at your own practice), but please tell me you also instruct them in flossing) are indicated, and clinically necessary (and therefore available on the NHS - as you do)

As I implied in an earlier post, in the old contract S&Ps (which included one visit OHI) were done on virtually every adult patient, and the rules of being clinically necessary and BPE scores haven't changed. Very few of my patients present with BPE scores of 0-0-0/0-0-0. It is therefore suspicious that there seems to be a much greater proportion of hygiene therapy that is now not clinically necessary (yes I know that was pre-VT for you).

The point is that this 'changing of the goal posts' does not reflect well on the profession. Periodontal health in the UK did not miraculously improve on the night of 31 March 2006.The reason for increased private referrals to the hygienist is due to the contract. IMO it is widespread practice to supplement a dentists income with private income from the hygienist that does actually qualify for treatment under the NHS (and NO I don't accuse you of that practice, welshdent!).

That conflicts with my view of duty of care to the patient and I would feel far more comfortable if a bit more integrity was shown.