What's the difference between Independent and Private dentists???

Scrudge

I noticed a few surgeries have Independent and Private price lists with Independent prices being considerably cheaper for some items (especially check ups). What's the difference between the schemes apart from prices?

I do not have any fillings yet but had sealants put on my molars about 10 years ago. I have not seen a dentist for a couple of years but have developed a few small holes mainly through small chip-offs of biting edges of a couple of molars. I do not think I have caries - enamel was mechanically compromised (probably through grinding at night) and normal mouth acid has just etched small holes in dentin. I don't think there is any serious infection. When I try to explore the holes with the dental tool similar to a bent needle I have unpleasant feeling but not pain.

Currently I am appltying CG Tooth Mousse several times a day in the hope of remineralising the teeth and in particular the holes. (Have been doing this for two weeks)

I do not want any drilling to be done i.e. I do not want to enlarge the holes and would rather seal them as they are (after cleaning and drying of cause). Ideally I would like to seal them with normall fissure sealant, or at least glass ionomer as it does not require drilling. I wonder how much would such ionomer restorations be as I can't find them on price lists? Are there any better materials that could be used that would not necisitate drilling?

Toothsmith

You seem to be a very knowlegeable patient!

You are doing very sensible things as well.

There really is no difference tecnically between private and independent.

Both are outside the NHS, and so both are 'private'.

The thing is that most people associate 'private' dentistry with 'really expensive'

It was in the early 90s, after the last 'new contract' when a lot of dentists bailed out of the NHS that the term 'Independent' really surfaced. It was supposed to put people's minds at ease that although it wasn't NHS any more, it really wouldn't cost the earth!

The problem that these dentists found was that when you try and hold prices down at near-NHS levels, you have to still work at NHS speed in order to cover your overheads.

But, now you have a patient base who are paying more than NHS fees (With exemptions ant treatment maximum charges on the NHS not applying to independent practice, patients were often paying a lot more than NHS) they expect something a bit better.

So, it was often the worst of both worlds, higher prices, but no real increase in 'customer service'.

It is now a term that has largely fallen into disuse, although with a new crop of 'private' dentists escaping from this latest 'new contract' it is probably re-surfacing as they try their luck down that road!

Personally, I see 'private' dentistry as a concept, not a price list.

Compared to NHS dental charges, yes it is quite expensive, but the NHS charges have been held artificially low by the state run monopoly for decades.

Compared to similar services, and not so similar services (Legal fees, car repair costs, plumbers fees, vet bills, etc etc) Private dentistry in this country is good value for money.

The way to be 'private' though is to not have a huge patient list, so that you can really provide a service for your patients. Have good long check up appointments so that you can really have a good look round, and time for a good chat with the patient afterwards about what's going on, and what is likely to happen in the future.

Good length appointements for treatment, in case anything happens that may need a change of plan, and so there is plenty of time to clean & disinfect the surgery between patients.

And some decent spaces every day so that patients with problems can be seen straight away.

This, to my mind is private dentistry. If you are still being herded in and out on a conveyor belt, and waiting weeks for an emergency appointment, it is just expensive NHS!

I often wonder how an NHS dentist can have a 'private' price list, apart from just to provide things 'not available on the NHS - although everything clinically necessary IS available, and if it's not necessary, why does it need to be done anyway? How can you suddenly create time in a busy NHS session to see one of your 'private' patients?

Having 'Independent' and 'Private' price lists in the same practice is really just a marketing tool.

There are likely to be some crowns, or denture types that will be available on one list and not the other, but essentially for everything else, I would suggest it will be the same dentist doing the same thing with pretty similar materials.

I wouldn't have thought you could have a practice working a private 'concept' and an 'independent' concept at the same time.

What you need Scrudge in a dentist who subscribes to the 'minimal intervention' concept. That isn't really related to the charging structure, but the individual dentist.

Scrudge

Toothsmith wrote:

I wouldn't have thought you could have a practice working a private 'concept' and an 'independent' concept at the same time.

What you need Scrudge in a dentist who subscribes to the 'minimal intervention' concept. That isn't really related to the charging structure, but the individual dentist.

Thanks for explaining it all. Yes after reading the post it does seem strange that quite a lot of Practices in Cambridgeshire have both:

http://www.peterboroughdentalpractice.co.uk/werrington-services.htm#

http://www.antwerphouse.co.uk/price_list.htm

I will now think carefully about using such practices as it is really not transparent - if you go for independent you might fear that the service is vastly substandard. If you go private with them you might feel that you are paying more then you could.

What's the best way of finding a real 'minimal intervention' concept dentist? Half the dentists state minimising decay and future problems through prevention as their objective and I suppose the other half will say something to this effect and they all probably think that they are right. Also I have no friends / collegues who are too concerned about minimal intervention so I have no-one to ask recomendations. Are there any professional bodies such dentists belong to or even possibly publish their findings?

Toothsmith

Have PM'd you Scrudge!

I'm originally from Peterborough, and know a few dentists there!

Teerah

Toothsmith wrote:

You are doing very sensible things as well.

Sorry Toothsmith, must disagree. The OP states they havent been for a few years but they have some chipped areas in unfilled molars. It is unlikely these teeth have fractured cusps through grinding alone and even if it where I doubt that minimal treatment with a glass ionomer would be advisable, if enamel cant stand it, this filling type certainly wont. Although minimal intervention is highly desirable, neither of us can say if this is really possible in this patient and the OP is certainly in no position to self diagnose. I would advise a thorough examination.

Toothsmith

Fair point!

I'm a bit full of cold at the moment and didn't read the OP thoroughly!

Having now done so though, the only bit I didn't like was the self-prodding with a DIY probe!

The picture I got in my head of the mouth as described was that of a typical moderate wear pattern. The peaks of a few cusps worn through to the dentine, and the dentine just beginning to dish.

I got the feeling we are dealing with an informed patient here, and he is actively seeking a dentist having not been for a 'couple of years' - which, let's face it, is now a 'recommended' period on the NHS for a healthy patient to go between check ups! (Although I know when a patient says 'a couple of years' it can often mean many more!!)

Personally, if I saw a patient with moderate wear, then the first thing I would do would be to provide some sort of night-time splint to try and stop the grinding.

I doubt I would attempt to restore the wear at all so long as it were symptomless, and not excessive for the age of the patient. Teeth wearing, after all, is a perfectly natural process, and one which the teeth have evolved to cope with. I would probably place composite into the 'dished' bits of dentine once they become deep enough to hold a bonded filling without the need for drilling away any more tooth.

I completely agree with you though, that the first and most important thing is to get a thorough check up, to confirm that it is 'only' wear that is going on.