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

boozercruiser

Billieblob wrote: »

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.

:T:ABillieblob. What you say above and opinion that you have already expressed in the short time that you have been posting is a Masterclass of everything that I have been trying to say as a Dental Patient Novice.

Certain of the Dentists here (certainly not Welshdent who has been very even handed with me) have done nothing but insult me and try to put me down.:(

They cannot put you down though because you know exactly what you are talking about.

Just don't expect to be popular here though...thats all.

I feel pretty well vindicated now.

Many Thanks.

Boozercruiser (Kenny Thain).

welshdent

Billie you and I do sing from the same hymn sheet believe me, i just felt that pretty much all covered by you is already touched on in the many pages. I do advocate floss btw ;-)

I do concur entirely about the state of the nations perio health. One thing to touch on is that the new contract is IMO partly designed to eliminate "un necessary" treatments of which I believe cosmetic scalings were included. Iirc I saw a study that showed scaling these low risk/need patients made no difference to perio levels. If anything it was insinuating we were doing more harm than good. The new contact is a different beast to the old one so I do think it's a little unfair to compare them directly. The old system was clearly very prescriptive about what was and wasn't available. This one unfairly leaves too many open ends IMHO. Administrators = lhbs, pcts, doh, hmg. The ones making the decisions. Fwiw I actually think out and out perio disease is easier to treat than on the old system. The hard bit is convincing the pain free individual they need £39/£42 worth of debridement and possibly more in 3 months time!! That's obviously the 3's and 4's. I have a lot of perio disease where I work and a lot responds well but I ams sure you would concur that patient motivation is a major factor with rates of healing.

The lack of bpe scores is a major concern for me and one that has been outlined as an issue in this thread, like you all examinations receive one and few if any are all the 0's. Hence why I do a lot of scaling. I can't afford to use my hygienist though as her charge is highly prohibitive off the back of a band 1. Usually people that request her or those where its cheaper privately than nhs see her. I.e. >60s with perio dis. Free exam then treatment with her.

welshdent

Booze my boss closed our books a few months ago sorry :-( we are to coin the phrase "at capacity". I tend not to see new patients as I am more than happy with my list size which allows me to complete treatments very quickly and my patients do not have to wait long to get in.

nineteenseventyseven

Billieblob wrote: »

Just to throw in my fourpenn'th.

It would be interesting to analyse how many dentists thought an S&P was clinically necessary before the new contract in 2006 (ie when they got paid an addtional fee for providing one) and how those same dentists have changed their opinion since.

As we all know (from reading through this thread) screening for gum disease in this country is by use of the BPE.

Visit the British Society for Periodontology Members and Policy page for further info (sorry as a new member I can't post links)

Any score higher than 0 results in clinically necessary treatment (oral hygiene instruction or prophylaxis (aka cleaning/scaling and polishing)).

I am a private dentist and I do a BPE on every adult patient at every routine visit. I have fewer than 1% dentate patients who consistently score 0 in all sextants.

Dentists have a duty of care to their patients, not to the NHS. If dentists are unable to provide the quality of care expected of them on the NHS they should terminate their contract. I did.

Discuss.

Just a bit more stirring.

I realise that changing patients' behaviour, particularly their toothbrushing and flossing technique is difficult. However, surely you're doing something wrong if only 1% of your dentate patient have consistent BPE scores of 0 in all sextants. Maybe it's time for you to catch up on some CPD on perio to enable you to give your fully private list of patients the standard of care they deserve.

boozercruiser

welshdent wrote: »

Booze my boss closed our books a few months ago sorry :-( we are to coin the phrase "at capacity". I tend not to see new patients as I am more than happy with my list size which allows me to complete treatments very quickly and my patients do not have to wait long to get in.

I understand:) It seems to me that you are the sort of Dentist which I had for 25 years in Northampton. I saw him just once a year, a lovely man who always talked to me about what he was doing during treatment, and he always finished whatever with a Scale and Polish.

I always felt good after that and my teeth certainly looked better as he did it properly. I still have all of my frontage teeth...but have lost some rear ones since moving here.

For seven ruddy years now here in Wales it's just been various mainly Polish Dentists imported by Denticare who obviously instruct them to do the minimum and always to direct patients to the Hygienist for £30 extra.

I mean, when one Polish Denist under Denticare here at Machynlleth said "I can't do Scale and Polish here as I don't have the equipment. You will have to go to the Hygienist in Aberystwyth at £25." (£30 now).

It says it all really does it not?

I tell you Welshdent it will come as a very big suprise to you...but that really 'issed me off!:rotfl:

And started me off to post here.:D

welshdent

Not have the equipment? Seriously?? I fully understand the sentiments!! I consider a scaler unit essential and I use it routinely, daily for everything from removing temporary fillings to locating root canal anatomy. Occasionally I clean teeth with it too ;-)

Billieblob

nineteenseventyseven wrote: »

Just a bit more stirring.

I realise that changing patients' behaviour, particularly their toothbrushing and flossing technique is difficult. However, surely you're doing something wrong if only 1% of your dentate patient have consistent BPE scores of 0 in all sextants. Maybe it's time for you to catch up on some CPD on perio to enable you to give your fully private list of patients the standard of care they deserve.

:rotfl:If all my patients acted upon my instructions as if they were the word of God I might just achieve that!

coldstreamalways

I use mine for cutting off GP after an RCT, tidier and less alarming/risky than heating up a plugger with a bunsen burner.

welshdent

Seconded! I never thought of doing that until I did an attachment. I can never understand why people would not have a scaler unit <<<puzzled face>>>

Fork86

While I may have posted earlier on in the thread, I thought it would be pertinent to those involved to know that the goal posts in perio are slowly changing again.

New evidence based dentistry is actually starting to show that removing calculus/tartar does not benefit the patient, and therefore BPE's of 2's can also be deemed clinically unnecessary (just look up Phill Orr).

If tar tar is kept clean, there will be no gingivitis.

Our new practice policy incorporates this new evidence into our current treatment planning, and our focus is on prevention rather than 'cure'

Before anyone flies off the handle. Anyone who presents with a BPE 3/4/* will have their perio treatment done on the NHS by our hygienists (so dentist's who even do fillings on the same treatment course will not even get payed for band 2's should perio treatment be needed).

Only patients who can bring their plaque scores down to 20% or less will get full mouth ultrasonic debridement on the 4th visits (the 2nd and 3rd being focused on pcoket depths, indicies and OHI).


So anyone thinking this new policy is for the benefit of the dentist is sadly mistaken, as we end up actually earning less through this change in treatment offered.