Is my dentist trying to pull a fast one?

jgallcash

I got an emergency appointment today as i have got the beginning of tooth ache. I am a fee paying NHS patient and have only visitied this new surgery for a check up and scale and polish about 3 months ago.

The dentist was lovely and showed me an x-ray that clearly showed the problem. A big shadow on a tooth that had a previous tooth canal showed that i had an infection. For now she has given me some antibiotics so that it doesn't get worse until my next appointment next week.

She has told me that as this is a 're-root canal' and is a complex peice of work, she doesn't think they will be able to carry out the work on the NHS and that it would be private work carried out by a more experienced dentist.

The options are to re do the canal at a cost of approx £400 plus a crown costing approx £200 or the other option; which she suggested, was to remove the tooth and have a replacement one cast at a cost of £2000

There is no way that i could afford either of these options and i'm worried that the only option they will give me as an NHS patient is to remove it for £45ish.

After explaining this to NHS direct the have told me:

"You will be able to have all treatment provided under the NHS that your dentist feels is clinically necessary in order to keep your teeth, gums and mouth healthy. If your dentist says that you need a particular type of treatment, you should not be asked to pay for it privately."

this is quoted from a department of health publication HERE

I dont know how to tackle this one as reading the above it seems to me that they could just say that they are only willing to remove the tooth on the NHS, that any other option would cost.

Does anyone have any experience or thoughts on this one please? I'm worried sick

Jojo_the_Tightfisted

Change dentist and contact the PCT.

Teerah

I dont think they are breaking any rules unless they are offering to do the root canal privately themselves at your surgery. If your dentist feels they cannot redo the root canal treatment themselves and is offering to refer you elsewhere to have it done then this is within the rules. I am presuming the 2nd option was an implant? If so then this would only ever be a private option.

LondonDiva

If they are offering to do the work privately, I'd let them do the work and then refuse to pay more than the max NHS cost for the treatment.

If they push - I would report them to the PCT for breach of contract and potential professional misconduct.

As you can tell, I'm fed up of dentists refusing NHS treatment, but happily providing private services when the expertise is in house. The new contract is with the practice & principal not a practioner & f they can provide it privately, they can on the NHS.

Have the treatment and then contact the dental contracts manager / PALS.

You can even report them anonymously if you are really worried.

domdent

LondonDiva wrote: »

If they are offering to do the work privately, I'd let them do the work and then refuse to pay more than the max NHS cost for the treatment.

If they push - I would report them to the PCT for breach of contract and potential professional misconduct.

As you can tell, I'm fed up of dentists refusing NHS treatment, but happily providing private services when the expertise is in house. The new contract is with the practice & principal not a practioner & f they can provide it privately, they can on the NHS.

Have the treatment and then contact the dental contracts manager / PALS.

You can even report them anonymously if you are really worried.

They may have a visiting specialist who does not have a contract to do nhs work.
Do you think they can routinely provide £600 endo retreatment on the nhs for the nhs fee of £0

Toothsmith

jgallcash wrote: »

"You will be able to have all treatment provided under the NHS that your dentist feels is clinically necessary in order to keep your teeth, gums and mouth healthy. If your dentist says that you need a particular type of treatment, you should not be asked to pay for it privately."

They should, of course, add "And that your dentist is qualified to do"

Just forget dentistry for the moment, and imagine a visit to your Dr.

If he said "I think you need a heart bypass, I'm going to refer you to a specialist" You wouldn't think twice. You wouldn't say " Hmm, are you pulling a fast one? - I demand you do it here!"

It can be the same with dentists and more complex work. Re-root filling a tooth successfully is more complex than doing it first time, and chances of it being sucessful are much reduced. It needs the skill and equipment of the specialist.

The fact that PCTs or the health service don't invest in specialist services in dentistry isn't the fault of your dentist. All she can do is her best, and advise you of what is available - and for you to decide which option you go for.

It is true to say that there are some NHS dentists who are avoiding doing anything but the very simplest treatment plans on the NHS, and trying to charge privately, or refer, everything else.

What IS wrong would be for a dentist to tell you that they can't do something necessary on the NHS, but still offer to do it privately. Or even to refer something that they should reasonably be expected to be competent at. This can be a bit grey though.

My feeling here is that your dentist is being straight with you, and that referring you to re-do a root filling is perfectly justifiable.

If there is anyone to be cmplained about, it is probably the PCT for not having and secondary care NHS dental services in place. But you'd have better results banging your head against a wall as trying that one!

(This is all assuming the person your dentist is refering to IS an outside specialist - if it's another dentist in the same practice - particularly if that dentist has an NHS contract as well, then you might get away with it)

Toothsmith

domdent wrote: »

They may have a visiting specialist who does not have a contract to do nhs work.
Do you think they can routinely provide £600 endo retreatment on the nhs for the nhs fee of £0

The practicality of it isn't actually relevent to the case.

The contract terms were clear, and if the dentists at the practice couldn't work to it, they shouldn't have signed it.

You can't take taxpayers money for reward if your not prepared to honour the agreement you signed in order to get it. Nomatter how stupid or impractical the contract.

Katie-Kat-Kins

Right I'm not a dentist, but I have had A LOT of dental treatment in my time and have seen how the private and NHS provision work together too.

I think the problem is that you don't seem particularly clear on what options you have been offered.

Your dentist is saying that he personally cannot do the re-root filling, toothsmith's comments on the reasonableness of this are spot on.

So assuming you don't have the root canal redone your options are as follows:-
Have the tooth removed on the NHS and not replaced with anything. This is the absolute cheapest and minimum.
Have the tooth removed and replaced with a false tooth. Now a simple bridge or plate false tooth would probably be covered by the NHS and may well do the job but not be entirely satisfactory to you.
Or the gold standard treatment would be to use a dental implant as the replacement. This will be the £2000, this is never offered on the NHS as there are cheaper satisfactory false tooth options available. This is also a fairly standard sort of price for one tooth.

I think you need to talk through the options with your dentist again before you accuse anyone of pulling a fastone. If you would ideally like to preserve the tooth ask your dentist whether there is anyway to get that done on the NHS, it is more difficult to dodge a direct question if they are being a bit difficult! If the answer is no you need to weigh up the price of the private treatment and the likely result from the NHS options and make sure your dentist has made you fully aware of ALL the options.

I have two bridges and most of the time they are pretty trouble free, and soooo much cheaper than implants.

Toothsmith

Funnily enough, there is a thread similar to this going on on a dental forum I subscribe to.

One suggestion on there follows the following reasoning:-

Nowadays, it's not up to dentists who they refer to, but the dentist should refer to the local PCT, who will then pass the referral on to the appropriate local NHS service. They usually consult with the patient and take 'patienty choice' into account when deciding which hospital to refer to.

This is how it's usually done for things like wisdom teeth or other oral surgery proceedures.

If an NHS dentist used the same pathway, and wrote to the PCT saying "Patient 'A' has a failing root filling on a molar. It is necessary for this to be re-done, please could you refer to an appropriate specialist on the NHS?"

Then the onus would be on the PCT to source the appropriate NHS service, and not rely on dentists doing work above their comfort level.

As far as I know, no dentist has ever tried this appraoch yet, but it's certainly worth a go if you can persuade your dentist to try it. It'll probably stop PCTs trying to lay the blame on dentists in genuine cases.

jgallcash

Thanks for the replies, Katp I am not accusing anyone of pulling a fast one, i'm just not aware of the differences or complexities that a re-root canal might endure.

As my original post says the dentist was lovely and in no way gave me the impression that she was not genuine.

She didn't however tell me of any treatment that was available on the NHS to fix the problem. No mention of bridges or a false tooth. I have another appointment next week with MY dentist (this was an emergency dentist appointment) in order to do some other small work and discuss the options further then.

I'm planning on asking my dentist if and what the options are on the NHS, hopefully this will clear up a few worries.. I work in education so I dont have a clue about Bridges etc.

LondonDiva

Toothsmith wrote: »

The practicality of it isn't actually relevent to the case.

The contract terms were clear, and if the dentists at the practice couldn't work to it, they shouldn't have signed it.

You can't take taxpayers money for reward if your not prepared to honour the agreement you signed in order to get it. Nomatter how stupid or impractical the contract.

:T:TWhat he said.

If enough dentists had refused to sign the contract, a much better one would have had to be implemented, rather than this unsatisfactory compromise for all parties.

As Toothsmith said, if there is a dentist (Principal / associate or a partner to the NHS contract) in the practice that has the skills to carry out the treatment privately, it MUST be offered on the NHS as well as the practice / contract holder has the expertise in house.

OP - check if the dentist they are offering to carry out the work privately regularly practices there. If s/he does, the treatment should be covered by the NHS. If so, I'd have the treatment and then write a cheque for band x treatment.

Good luck.