Lying dentist - what to do?

Hollypolly

It can be difficult for a dentist when seeing a new patient to know if the decay they have is active or not. Sounds odd but patients can have had active decay and its stop so the dentist will keep an I eye on it at checkup's with the help of x-rays and may never treat it. So if you are a new patient it can be hard to tell if it's been like that for a while or not.

Most dentist I have worked with will not do treatment whilst a patient is pregnant unless it's to get you out of pain and then will normally do a temporary dressing . There is certain stages of a pregnancy a dentist will avoid treatment.

With the way the NHS dentistry is dentist will not do or are allowed to put white fillings in molar teeth when an amalgam is cheaper!!!

Toothsmith

Hollypolly wrote: »

With the way the NHS dentistry is dentist will not do or are allowed to put white fillings in molar teeth when an amalgam is cheaper!!!

Not true.

The way the NHS contract is worded, the dentist must provide the 'most appropriate' treatment.

For smallish fillings on back teeth, white filling has been regarded as functionally superior to amalgam for several years now.

A point that the Chief dental officer picked up on in a recent directive which I posted on MSE a few months ago here http://forums.moneysavingexpert.com/showthread.html?t=1763029&highlight=white+fillings+nhs

The long and the short of it is that small with fillings on back teeth should be the material of choice ON THE NHS!

Hollypolly

I can only say what I have seen, you must be one of the good guys out there!!

Toothsmith

Hollypolly wrote: »

I can only say what I have seen, you must be one of the good guys out there!!

I like to think so - but I have not got an NHS contract and just see everybody privately.

Much simpler!

jugglebug

Toothsmith wrote: »

Not true.

The way the NHS contract is worded, the dentist must provide the 'most appropriate' treatment.

For smallish fillings on back teeth, white filling has been regarded as functionally superior to amalgam for several years now.

A point that the Chief dental officer picked up on in a recent directive which I posted on MSE a few months ago here http://forums.moneysavingexpert.com/showthread.html?t=1763029&highlight=white+fillings+nhs

The long and the short of it is that small with fillings on back teeth should be the material of choice ON THE NHS!

Of course smallish white fillings have always been available on the NHS for as far back as I can remember. It's just a fact conveniently forgotten. However the dividing line between what is smallish and what is too big is a clinical one which the NHS has no guidance on. It leaves it completely to the discretion of the dentist.
Therefore they have to decide for themselves, which means if you see me on monday I may decide the treatment required is too big and therefore amalgam is indicated.
Then you might come in to see my colleague to get it done on tuesday who trained somewhere else / has a different prescription on his glasses / better operating light / worse operating light. So comes to a different decision.
However as they will be responsible for the restoration it is their decision that matters!
It also means a patient can't go and "demand" a white filling because they have read it on here. Yes there are cases where they should get one, but many where they shouldn't and you have to trust your dentist. If you don't go find another one, just be aware that as long as you choose a NHS service there are 3 people in the decision making process, and the man from the NHS is the one who holds the purse strings not you as you must realise the NHS fee you pay is not the whole amount.
If you want the decisions to be based entirely on your needs and wishes then he can't be involved.

welshdent

sofietrouble wrote: »

Yes, I read about 'all necessary treatment' needing to be available on the NHS. So technically if he felt the white fillings were necessary to me at that point in time they should have been on the NHS.

He also said that I needed to see a hygenist for a clean at a cost of £55 and this was not available on the NHS either, and I declined that also, much to his annoyance. (I floss my teeth every day and use a really good electric toothbrush - my mum has terrible gum disease and I have been so scared of getting it also I am practically obsessive about how much care I take over my teeth!! So I really didn't feel the need to see a hygenist either.)


Do NHS dentists get paid extra if they 'sell' extra private services to NHS patients also? I don't know how it works but that would appear to be why he was trying to get me to have four white fillings and a hygenist appointment!

White fillings in back teeth are usually viewed as cosmetic so would not normally be provided on the nhs. "Necessary" would relate to there being decay that needs management. What you choose to restore the tooth with following the removal of decayed tooth is for you to discuss with the dentist. There are pros and cons of all materials.

Periodontal work (scale and polish and advanced treatements) are allowed on the nhs when deemed clinically necessary. I do them daily.

dentists dont strictly get paid in the sense that you are thinking by the nhs work in the first place. They are all self employed unless in hospitals or community. Those classed as "NHS" will work in a practice that has an agreed contract value for an agreed amount of work with the PCT/LHB. They will earn money on the basis of the amount of courses of treatments completed. once the total is carried out they can not really do nhs work as they will get negative pay. likewise if they under perform, money is clawed back. white fillings would normally be private and such paid fee per item. A dentist should not view you as an NHS patient in my opinion. They should view you as a patient. They should tell you what you need and how they can manage it and it should be up to you what you have. That work does not have to be on the nhs. If you want nice white fillings and realistic tooth like crowns then they will be provided as private items. Funding to the practice will then be separate to NHS funding but it would depend on how much work is done and what the fee scales are as to if that dentist actually earns more money. An example ... a small filling needed in a back tooth. A private one may cost the patient 40 if its really small. Add on the cost of tan nhs examination so total around 55 ish paid by the patient. total of 61 ish to the practice. Now do that on the nhs and its a band 2 so 3 UDAs. roughly 21 ish per uda but the value varies practice to practice. An amalgam filling placed and the practice is paid roughly 63 AND the cost of the material is lower so the NHS actually is more cost effective than the "sold" private item.

That is eliminated however if more than one filling is needed. Privately it is still 40 per filling but on the nhs the fee remains the same regardless of how many fillings are needed