Dental treatment abroad

brook2jack

http://www.gdc-uk.org/General+public/Fitness+to+Practise+Hearings/Recent+hearings/DOBOS+Andrea.htm

Degenerate .......
Have a look at this and five other Hungarian dentists on the same day (26 May 2010) who had fitness to practice hearings because they did not have malpractice insurance only picked up because the UK GDC checked.They were all suspended from the dental register in the UK. Their employer is only now trying to negotiate retrospective cover with the insurers, unsucessfully so far.If they can't it won't be of much consolation to the people who had treatment in the last few years "reassured" by having checks in the UK.
Read the determination of the fitness to practice committee who felt it was a serious offense. They all worked for the same company Vitalpoint who also work as Vital and VitalEurope. Sound familiar? Wonder who is in charge of checking their indemnity in Hungary?

A quick trawl through the internet will quickly also reveal other problems with general Dental Council registration in the past. Many forums also report various peoples problems with this particular company as well as some praising it.

Paul-B_4

brook2jack wrote: »

Please be aware that no British dentist will take on the maintainance of eg implants placed abroad .

This is because once they take on responsibility for care of the implants , if something goes wrong with the implant the British dentist becomes partially liable and when push comes to shove a lawyer is going to find it much easier to pursue a British dentist, in British courts with British indemnity than trying to recover money in a foreign legal system.

I would advise no one in any country to travel abroad for complex dental treatment.I have seen excellent work by excellent dentists fail or cause problems, due to no ones fault,and it is hard to see how easy it would be to sort out these unforeseen problems quickly when extensive travel is necessary.

What you should prize is dental care not dental treatment.... i.e.look at how you are going to look after your dental health for the years to come. From your brief description I would say your most important treatment will not be from the dentist but from the hygienist to tackle your gum disease ,cleaning and decay problems. This is unglamourous, time consuming work that should take place over weeks or months and should be done before you even think of restoring the rest of your mouth to give the chance of work lasting for years.

I have some patients who insist on travelling great distances to see me. I always try to encourage them to see a dentist close to home , since if they have an emergency the last thing they want to do is travel hours in the car to get emergency treatment.

The best dental treatment you will ever get is with a dentist you trust and with whom you can build up a longterm relationship so they know you and your mouth. The worst is all in one treatment treating many years of problems in a short space of time without looking and treating what caused the problems in the first place.

If you speak the language, spend a regular amount of time abroad so you continue with regular maintainance and use the dentist for your regular care you can get really excellent treatment .The problem is if you haven't recieved good treatment you probably won't know straight away and if you don't recieve regular care it may not be picked up until too late. Only this week I've seen a patient who has had an implant in this country who is delighted with it. Xrays revealed it is failing, so I've emailed the dentist who placed it who is getting the patient in to see what can be done. If this patient had not kept regular check ups the first he would have known was in a couple of years time when the implant became loose or fell out.

So what you are saying is that if I were to travel to, say, Kerala, have a course of dentistry and then return to the UK I would be unable to sign on with any UK dentist forever?

Where does that leave the last government's promise that every UK citizen has the right to register with an NHS dentist, then? Does that mean that if I subsequently develop an abcess I cannot be treated in the UK?

That doesn't make much sense to me, and if it's true it doesn't say much for the morality of the dental profession back here in the UK. In fact I don't believe you; if that was in fact the case and was reflected throughout the medical profession no-one would ever be able to be treated abroad because on return to the UK he or she could not register with a UK doctor or receive treatment for any complications following such treatment.

brook2jack

What I said is that no British dentist will take on the maintainance of eg implants placed abroad, not they would not take you on as a patient, just they would not take responsibility for implants.They can advise you of problems but you should return to the implant provider for checks etc.

Implants are a treatment that require meticulous preparation and placement and can go wrong at many stages. If things are not done properly and sometimes even if they are done properly the implants can fail. Whatever happens they need maintainance and the crowns on top will occaisionally need replacing. If a dentist takes over the maintainance of the implant then they can become legally liable for that implant .I have patients who have implants placed in the UK and abroad. I do not touch them except to assess their health . if something needs doing they go back to their implantologist, that is the advice given by experts on the many courses I've been on.Even something as simple as cementing a crown back on with a little too much cement can cause an implant to fail. You talk of the morality of the dental profession but do you think it right that someone could be sued for problems caused by treatment carried out elsewhere?

The other problem is that there is often no forwarding of notes or communication with the general dentist so they have no idea of the system used, the torque used to fit the superstructure, and because there are thousands of different implant systems some unique to each country very often it is impossible to get the replacement parts.Taking over the care of complex treatment "blind " is a nightmare and when people have problems from complex treatment it can be a nightmare trying to find someone to refer to to salvage the mess.

You are also mistaken in saying that you could not register with a NHS dentist, you could but the NHS will not pick up the tab for sorting out problems arising from dental treatment abroad except to extract the offending teeth. The NHS has never had the resources to cover implants except for a very tiny amount of people with very particular problems, who had implants placed in the NHS system.

You are right in inferring that many in the NHS are questioning whether the NHS should pick up the pieces from medical and dental treatment carried out abroad ,especially cosmetic. This is why it is so important to make sure there is sufficient indemnity carried by the dentist to cover costs if something goes wrong.

Does this sound harsh? Bear in mind if you have a car accident in the UK you will often be charged for a doctors consultation if it is regarding an injury sustained in the accident and you can also be charged for the ambulance etc . This is because the expectation is these costs will be covered by the claim on the car insurance.

Toothsmith

Paul-B wrote: »

So what you are saying is that if I were to travel to, say, Kerala, have a course of dentistry and then return to the UK I would be unable to sign on with any UK dentist forever?

Where does that leave the last government's promise that every UK citizen has the right to register with an NHS dentist, then? Does that mean that if I subsequently develop an abcess I cannot be treated in the UK?

That doesn't make much sense to me, and if it's true it doesn't say much for the morality of the dental profession back here in the UK. In fact I don't believe you; if that was in fact the case and was reflected throughout the medical profession no-one would ever be able to be treated abroad because on return to the UK he or she could not register with a UK doctor or receive treatment for any complications following such treatment.

Paul,

What you're mixing up here is advanced restorative work, and NHS dentistry.

In an earlier post you mentioned being able to get all dentistry on the NHS and how great it used to be.

That was then - when all dentistry really had to offer was extractions and dentures. And for a whole year (1947) NHS dentistry was free!

In 1948, the Government realised that NHS dentistry was a moneypit, as everyone was having their teeth fixed (well, new falsies anyway) and it was costing the country a fortune. So the first NHS 'charges' were introduced.

As time has gone on, more and more treatments have been developed. Root fillings have evolved, crowns, bridges, treating gum disease, white fillings etc etc.

As each one has come up, they have been included on the NHS, but because there is only so much money for NHS dentistry, the jam has had to be spread a bit thinner, and the 'NHS' charges have risen as a proportion of the total cost.

In the last 20 yrs the rubber bands have been stretched so tight that they have all begun to break.

The treatments are becoming more complicated, but success rates (when done properly) have risen and risen, and now many more people are keeping their teeth much longer.

NHS funding simply hasn't kept up - leaving dentists with the choice of leaving the NHS and setting their own fees for doing the job properly and at a speed they can control, or sticckig with the NHS and doing a job that in one way or another will be compromised. (But there are still some NHS dentists doing a wonderful job)

Really advanced things like implants have never been available on the NHS (Apart from one or two exceptional cases) so really, Paul, nothing has changed there.

If you want NHS treatment, then as you say, you are entitled to it, and you wouldn't find it that hard to get. If you're in England, then the max. charge for a single course of treatment would be £198.

For that, you'd get all the fillings you need in the teeth that can be saved, the bad ones out, and a denture to replace the gaps. Much like you would have done back in the 'good old days'.

In all honesty, if you don't fancy a huge change in your dental routine, and a lifetime of complicated maintenance, and the need for fantastic oral hygiene every time you pick up a toothbrush - then this is probably the right treatment for you anyway.

If you want something all fantastic and 'Hollywood' then that is your choice, but it's a choice you'll need to pay for.

Have it done where you want, but make sure the place you choose will first of all spend some time with you to make sure you understand why your mouth got into the state where it needed this work done in the first place.

Make sure they get you out of pain first, and stabalise things whilst you demonstrate that you can change your habits.

Only let them start drilling things into your bone when you and they are confident that the work will have a fighting chance of success.

Make sure that you have a place to go for regular routine checks and maintenance that is easily accessible to you.

And no, the average NHS practice in this country is NOT the place to take it for routine maintenance. They will probably refuse to look after you simply because the engeneering work necessary to look after it properly is above their experience level.

If you get problems around things like high-end resorative work, unless you go to a sepecialist in this country, the average general dentist would refer you into hospital. It's not a case of 'morality', it's more a case of just not knowing where to start.

welshdent

Thanks to brook2jack and toothsmith for pretty much saying all I was going to say!

We are not scaremongering. We have nothing to gain from it contrary to some peoples beliefs. All we care about is people being made aware of pitfalls and how to avoid them. There are many bad dentists in the UK. But as had been alluded to ... you have legal avenues to persue in such cases.

Incidentally, commenting on the broken instrument in a tooth. That is not imo a bodge. I have seen cases where specialists have done this to the tooth. The bodge would be in not telling you it happened. A Root filling is the last chance saloon for a tooth and carries with it certain risks, not least - no guarantee it will work. A study from australia whose authors names escape me, showed that in the right circumstances, more than 70% of root fillings with broken instruments were deemed to be successful.

"...Because you are in such a rush, trying to get as far as possible down the curved canals of the molar using a rasp bit on your drill rather than manual files, pushing your luck and breaking the tip off in one of the canals..."

I dont really think that using rotaries is the major problem here. I doubt very much if anyone I had root treated would know I had taken a hand file to length first. In fact on occasions you cant and need the rotary to get you there. There are also I am sure many dentists who do the vast bulk of their work with rotaries and rarely if ever fracture an instrument tip. There is infact a technique out there that does only use one or 2 rotary files to go right to the end. You need a special hand piece for that though and I believe a company that stood to lose financially from less sales of files bought the company selling the hand piece then shelved it . There is also no guarantee that the same would not have happened to a hand file. Nickel Titanium files are bendier than stainless steel hand files in most cases. What I would be more interested in is was a rubber dam used and was hypochlorite used. IF it was then an fracture at the apex of a tooth leaving a file tip would not in itself be as significant because you can disinfect the remaining canal. Particularly coronally where there is more chance of bacterial ingress. And often yes the file DOES obturate very well. But as I said, the other protocols would be more important IMO.

welshdent

p.s. for what its worth I wouldnt and I do not touch implants with a barge pole for all the reasons already stated. The patients I have that have implants are advised to see the practice that provided them for their routine implant care.

hethmar

NB, The dentists name on the site is given as Marek. Ive checked the GDC register for a Marek but there doesnt appear to be one?

Eri_2

Hi Paul,
I can recommend you a dentistry in Hungary, Szeged. One of my friends was there, and he was very satisfied with everything. The doctor was very helpful, and he can speak in english. Actually they can speak in 4 languages. The clinic was well equipped.
They name is Dental Studio Line, you can search it as dentalstudio-line in Google.

miamoo

welshdent wrote: »

p.s. for what its worth I wouldnt and I do not touch implants with a barge pole for all the reasons already stated. The patients I have that have implants are advised to see the practice that provided them for their routine implant care.

Just wanted to add that I have an implant, and I have never been asked by the dentist who provided it, i have had 3 dentists since the implant and none of the dentists asked where I have had any of my work done. I have never been asked if I have had work done abroad either.
Can I just say that if you know a patient had an implant abroad was in pain, and was a regular patient and couldnt afford/ unable to get back there, you would even look at their problem!

brook2jack

The problem is if you get pain you really have to go to the dentist who provided the implant. They know what system has been used,what torque used on the superstructure, they have the original xrays taken just after the implant was placed. They know what cement was used on the superstructure.

Without these you are working blind , moreover once you touch the implant you become legally liable for it. You can prescribe antibiotics but you can't touch the implant. Even scaling it with the wrong type of instruments can cause problems.

So in short it really is best to be close to whatever practice provided the implant.