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

Savvy_Sue

Haven't we had that article before? possibly with different examples, but it read as same old, same old to me ...

In the process of nagging DS1 to get himself to the dentist before he moves away. I've suggested he comes back to the dentist near us for a last checkup and whatever treatment he may need, since he hasn't got round to finding a dentist the other side of the city! Then when he's moved back to his Uni city, I can give him a short period of grace before nagging him again to find one there ...

boozercruiser

boozercruiser wrote: »

As sent to Denticare by E. Mail and normal post on 20th April 2011.

The spacings have not transferred with 'copy and past' exactly how I wrote it...but never mind.

Dear Sir or Madam,
Before moving to Machynlleth around seven years ago my Wife and I had one very good dentist in Northampton for 25 years. That particular
dentist always finished off treatment with a really thorough scale and
polish and I left England with around 85% of my teeth intact and
aso in relatively good condition.

However since moving to Machynlleth I have been a patient of your
Denticare Dentists, Dr. Botha...Dr. Gala....Dr. Ispas...Dr.
Tudor...Dr. Tsoumanis (Dolgellau) and am at present a patient of Dr.
Alina Jehac in Newtown because yet another dentist left Machynlleth.
Your customer policy statement says that denticare will "listen to
your dental needs, concerns and expectations"...........please allow
me to express mine.

With the exception of Dr. Tsoumanis all of your dentists (including
recently Dr. Alina) have said to me "You have some gum disease and you need to see see the hygienist".
(My teeth were then and are now quite sensitive and can be sore).
This though at an extra cost now of £28. However, my understanding of Wales 2006 NHS Dental regulations are that gum disease, needs and possibly warrants further treatment as per.........

SCHEDULE 1
Regulation 4(1) Charges – Diagnosis, treatment planning and
maintenance (i) scaling, polishing and marginal correction of
fillings.
SCHE DULE 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. (Further regulations apply of
course.)

My very recent and most visits to your dentists over the years have
nearly always been treated under Band 2 mainly because of fillings
needed and I have never been offered without asking a scale and
polish or other treatment for gingivitis/gum disease. I have only ever
been advised to see your hygienist.

In fact when I first saw Machynlleth Dentist Dr. Ispas he said "You
need to see the hygienist because you have gum disease". I asked him if he could do a scale and polish? and he replied (I remember it
well) "I do not have the equipment here to do that, you will have to go to Aberystwyth and see the hygienist".

After always requesting and insisting on a scale and polish from your
denticare dentist(s) my teeth do get a sort of half hearted far from
thorough bit of a go over. Sometimes this may just involve a
scrape/clean of either lower or upper teeth but not both.

However, I do not want the continued embarrassment of having to ask
the dentist to please carry out a scale and polish (and possibly
further treatment as required in the regulations) in respect of my gum
problems.
Also, I would hope to be able to note that the procedure had been
carried out fully and correctly. To my mind at the present time,
unfortunately I cannot say that.

Perhaps what your dentists SHOULD be doing is sending me to the
hygienist under the NHS if they either do not have the time or
possibly the equipment to do it ?
Surely gum problems should be sorted out on the NHS for an NHS patient?

Either way, I just want my gum disease to be treated properly by
either the dentist or the hygienist if that is how the dentist sees
it, but at no extra cost of course.

This situation has been bothering me to the extent that now I wish to
know exactly what your companies exact policy is on this subject?
Is it to follow obligations under the Wales 2006 NHS regulations and
contract..........
http://www.gov.im/lib/docs/dhss/health/sd10006doc.pdf ? I would
hope and expect so.
I do of course appreciate that a scale and polish and/or further
treatment is only carried out if necessary.

Please understand that this correspondence is not meant as a complaint against your dentists, including Dr. Alina (who I praised in a recent E. Mail to your Newtown office) as I feel that they are only carrying out your companies policy.

I am thinking about taking my concerns to the relevant authority's,
but I wish to know denticares thoughts on the matter before I decide
that.

Best Regards

Reply Received 4th May 2011. I thought particularly my Dentist friends may be interested in Denticares reply.......

And provided the below answer is followed then all is fine as far as I am concerned......it is after all what most of you guys have been saying anyway. I learned a lot from that thank you.

This should also be good general advice for anyone who is with any NHS Dentist who is being advised to see a Hygienist at extra cost even though they have gum disorders which warrent treatment as per Denticares official policy posted below.

'''''''''''''''''''''''''''''''''''

Dear..............

Thank you for your recent email which has been forwarded to me as Clinical Director of Denticare.
Denticare policy is that all NHS treatment should be carried out in
accordance with NHS regulations.

Our dentists are independent contractors who have personal responsibility for the care they provide and are registered with the Local Health Board Performers List, for NHS treatment, and with Health Inspectorate Wales, for private treatment.

As independent contractors all Denticare dentists have full clinical freedom in making clinical decisions. The decision as to when periodontal treatment is necessary must be made by the treating dentist. (Periodontal treatment includes Scaling and Polishing.)

As part of its Clinical Governance procedures Denticare undertakes quality assurance by regularly monitoring and auditing the performance of individual dentists to ensure the quality of treatment provided.

If there is anyquestion as to whether treatment is being provided in accordance with NHS regulations, Denticare takes action to remind dentists of their obligations.

I have enclosed a copy of guidance which was sent to all Denticare dentists, last August, to clarify the situation with regard to periodontal treatment.

(A copy of the guidance was also forwarded to the Local Health Board.)

You may wish to take a copy of the guidance to your next visit at the dentist, and if you are concerned regarding your treatment the dentist
should be happy to discuss it with you.

I thank you for taking the time to write to us, as feedback from patients is always welcome to assist us in our monitoring process.
I hope that this explains Denticare policy and that you are happy with the treatment you receive in the future. However if you have any further concerns please let me know.

Best Wishes
Paul Crockford
Clinical Director
Denticare Limited
1 Goldington Road, Bedford, MK40 3JY


''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

Periodontal Treatment

Denticare policy is that, for NHS patients, Performers should provide all ‘proper and necessary dental care and treatment’, as detailed in the NHS GDS regulations. This includes periodontal treatment.The regulations do not define ‘necessary’ so individual dentists need to make a clinical decision on whether they consider the treatment to be necessary.
If periodontal treatment is considered necessary it must be offered on the NHS. In many practices the service of a hygienist is available. If the hygienist only provides treatment privately:

when periodontal treatment is considered necessary, the patient may be offered treatment with the hygienist as an alternative to treatment on the NHS. the dentist must offer to provide the treatment on the NHS. The patient is free to chose which they prefer.

On some occasions, and in some practices, the hygienist may provide treatment both privately and on the NHS. In these circumstances:the dentist may give the patient the alternative option of seeing the hygienist privately for treatment. however they are not obliged to give the patient the option of seeing the hygienist on the NHS, as they may offer to provide that treatment themselves on the NHS.

Where periodontal treatment is not considered ‘necessary’ by the dentist: if the patient wishes to have periodontal treatment, such as scaling and polishing for cosmetic or other purposes, it should be provided privately.

NHS resources should not be utilised for unnecessary treatment.
If you have any queries or comments I would be happy to hear from you.

Best Wishes

Paul

Paul Crockford
Clinical [EMAIL="Director07826929633paul.crockford@denticarelimited.co.uk"]Director[/EMAIL]

My Reply........

5th April 2011

Mr. Paul Crockford
Denticare Clinical Director

Dear Mr. Crockford,
I am very pleased, appreciative and wish to thank you for taking the time to reply to my concerns with your very informative letter, which also included Denticare guidance notes.

The problem for me of course is that at least in my experience dental care has not been conducted along the lines you say is company policy.

(As outlined in my letter to you.)

So at my next check up appointment in Newtown with Dr. Alina Jehac in some months time I will follow your suggestion to take a copy of company guidance along and produce it (if necessary) to discuss any concerns with her. Though of course I should not need to feel so apprehensive about seeing the Dentist in the first place, as visiting any dentist is a rather nerve racking experience anyway!

So Thank You again Mr. Crockford and Best Regards,

[EMAIL="Director07826929633paul.crockford@denticarelimited.co.uk"]
[/EMAIL]

GotToChange

Could I ask (Toothsmith, welshdent etc....), if there is a set scale of charges for private treatment, i.e. perio?
Reading above, it would seem that this kind of treatment may or may not be available as a NHS, if one were able to access a NHS dentist; however, even just speaking to a private dentist costs money, so it isn't really an option to "shop around".
Is there a definitive price that is charged - or a range within depending upon severity/ extent of treatment required?
(i.e., I was told a figure for perio treatment, and he implied that this was worst case scenario. It seems, after a perio survey, that I have a mild case and yet the estimate amount is for the "top" amount that he initally mentioned...)

brook2jack

No there is no set scale of fees for private treatment.
On the whole you are charged for time involved plus costs such as medications etc.

For periodontal treatment time is the factor and that depends on the severity of disease and what exactly needs doing. Eg it may take longer to treat someone who has moderate gum disease but on alot of teeth than someone who has severe gum disease on a few teeth.

private surgery costs vary from area to area and obviously a city centre surgery will, on the whole, be more expensive than suburbs and a specialist surgery more expensive again.

As a very rough guide a private surgery will charge around £90 an hour for hygienists time and £120 to £200 for dentists time.With periodontal treatment it is mostly hygienists time that is used.

As each individual is different and needs different treatment it is impossible for a surgery to give you a quote without seeing you and your xrays etc.

You should also factor in that you will probably need maintainance visits with a hygienist for life afterwards as "gum disease" is never cured just controlled.

boozercruiser

brook2jack wrote: »

No there is no set scale of fees for private treatment.
On the whole you are charged for time involved plus costs such as medications etc.

For periodontal treatment time is the factor and that depends on the severity of disease and what exactly needs doing.

private surgery costs vary from area to area and obviously a city centre surgery will, on the whole, be more expensive than suburbs and a specialist surgery more expensive again.

As a very rough guide a private surgery will charge around £90 an hour for hygienists time and £120 to £200 for dentists time.With periodontal treatment it is mostly hygienists time that is used.

As each individual is different and needs different treatment it is impossible for a surgery to give you a quote without seeing you and your xrays etc.

You should also factor in that you will probably need maintainance visits with a hygienist for life afterwards as "gum disease" is never cured just controlled.

Blimey....private care is pretty expensive then! O.K. O.K. O.K. I can understand that, and a lot of people are happy to pay extra for private care for lots of reasons. I don't blame them.

I must take a hell of a lot of cash to run a private prictice, and of course any rewards for the years of education/training to gain the skills to do a job which most people would run a mile from (including me!) must be properly rewarded.

My 'beef' has never been about private practice anyway. I wish I could afford to go to one myself.

But me being a poor pensioner like:(.......it is out of the question!

GotToChange

Thank you, I understand a little more clearly now, I didn't ask the dentist himself enough questions I think and now I seem to be on a bit of a conveyor belt that I want to pause a little.
I have mild perio, which I am of course, happy to have had detected (last saw NHS dentist 1.5 years ago - could something have been missed at that point, or is this all down to me?) and he has told me that it will be 1 hour x 2 visits (Upper and Lower Right, the Upper and Lower Left). I do not have lots and lots of teeth - in fact, my primary enquiry with him was for an implant as I have a two-tooth gap where a cantilevered bridge and crown finally failed (after c. 20 years).
According to his exam, this is actually a three-tooth gap (!), so there aren't many teeth in that quadrant, I am sorry to say. Also, I never got wisdom teeth and I have at least one missing from each other quadrant. It sounds a mess, but honestly, I do have a nice smile and white, fairly even teeth, although now the front are slowly migrating into the gap left by the loss of bridge (hence my inital enquiry, not knowing that I had the perio and no real reason to suspect....).
Anyway, I have been quoted £800 - he will do this himself; as far as I know, there isn't a separate hygenist and I have not been given the option. Then there will be another (£90) perio survey.
I do realise that this is a lifetime condition and of course I want to do the best - it just seems that it was an arbitary figure that didn't alter when the extent of the problem was ascertained. I have already paid out £200 and not even had the exposed teeth cleaned (which I hoped for) and I fear that starting again from scratch with another dentist (in lieu of being able to go to NHS) is just more and more money being spent to establish what I already know.
I'm not looking for bargain basement, but I'm not looking to be shafted either... would I be able to call a dentist and simply enquire of their charges for the procedure or will it be a case of "we need to see it/you...." etc ?

You are wonderful to answer so quickly, thank you again.

Just to add, that I didn't go blithely expecting an implant and nothing else, I of course wanted to ascertain that everything was in good order -and get it there as necessary if possible. As it happens, the implant is actually looking unlikely as there isn't enough room (depth) due to my "slight" overbite - when he talked of correcting that with various crowns and building up on back teeth, I could just see my limited funds disappearing, let alone not particularly wanting too much tampering with other teeth - and then looking in the mirror at myself with the back teeth set together properly and all I saw was a Desperate Dan jaw. I am bothered though about the migration of the UR2 AND UR3.

brook2jack

BC a nhs practice costs £120 ish an hour to run, which is why appointments are short and treatment offered is limited because the only way to make it work financially is to see lots of people very quickly, typically upwards of 40 a day.Far fewer people are seen in a day in private practice ... typically a private dentist will have a list size a third of a nhs dentist.

private practices are more expensive to run as more and better materials ,equipment, techniques are used which is why there is only a 5% difference in what a dentist makes who works NHS or privately.

As a rough guide 66 to 72% of the income taken into a surgery will go on running costs.

brook2jack

Got to Change, unfortunately without a dentist doing a full perio exam ,xrays etc they cannot say how much treatment you need and what it will cost. However do you have a regular dentist now, if so who do they refer to as the prices quoted seem quite high end? Is this dentist one you just wanted to see for implants and if so were you recommended to them?

Front teeth never move backwards to fill up gaps unless you have periodontal disease and this sounds quite active if you are now noticing movement. As I'm sure the dentist said to you do not even consider implants until your gum condition is tip top. If you smoke stop now as it is a huge factor in both gum disease and implants failing.

If you do not have a "regular" dentist get one now (on recommendation), discuss what you want re periodontal treatment and eventually implants . Most ordinary private dentists who employ hygienists should be able to treat moderate periodontal disease without referral to a specialist and you will be better set up for continuing treatment and monitoring.

GotToChange

OK, I see. Thank you.

I am not SURE that I am noticing movement; I have always had a slight gap at either side of UR1 and UL1 (good for flossing), I think I am hyper-senstive now due to the larger missing-teeth gap further along.

This is the thing though; when I first saw him, we talked about various scenatios and charges, one of which was the utmost cost of treating perio; £800. This was for a severe case - which I do not have (according to the survey that I have had carried out = mild). Still quoted £800 - so there seems to be no variation. It does not surprise me that you tell me that this is high - and this is a one-man practice (admittedly, luxury decor and state-of-the-art (as far as I know ) equipment)in a small Notts town and he is lovely..... but still, £800 (plus another £90)?

I suppose I would need to start all over again with another dentist if I think I am being "slightly" over-charged... but I'm not too keen on more X-rays - had two small and one panoramic. I don't have anything "else" wrong, apart from the gap and the perio - which I know is no small thing and which of course I want treating. I have been researching implants for a few years so understand the contra-indications and (apart form there being no room!) limitations; I am only now able able to afford to even explore the possibility and it looks as though it isn't an option anyway. I quit smoking over four years ago but do recall that a dentist told me it takes years for your mouth to recover and again, the NHS dentist I last saw (now disappeared off the face of the planet) never gave me any cause for alarm (but then on that occasion, I wasn't even paying for NHS....). I maintain (what I thought of) as good oral hygiene - my teeth aren't so closley packed that there are inaccessible areas and I have recently upraded from Oral-B to Sonicare and gums look much much healthier.....

I really don't know what to do now but your advice and opinons are gratefully welcomed.

brook2jack

The ultimate end then is to retain what you have in a healthy state. In which case perhaps you should turn your search to a good private general dentist who will be able to look after your gum problems well and your general dental health well and pick things up before they become a problem.

This will not nearly be in the same league of expenditure.... many dentists offer maintainance plans where for £10 to £13 ish pounds a month you get two check ups ,two hygiene appointments a year plus xrays, emergency treatment , insurance and a discount off further treatment. At say £45 a half hour hygiene appointment your gum problems could be dealt with more economically and on a long term basis. You will develop a relationship with a dentist and be able to plan together where you to from here as there are many alternatives to implants.

There are a variety of payment plans and schemes varying from surgery to surgery , but the important thing is to get recommendations for your choice.