root canal treatment - NHS and private costs & pros and cons

welshdent

brook2jack wrote: »

The first study you quote with an average cost of£115 per filling in the UK is the cost of dental treatment in NHS dental clinics these are clinics which provide treatment to groups with special needs. These are clinics owned and operated by the NHS where the dentists are paid a salary (typically £28000 to £45000) . It is not a comparison of cost of treatment in normal general dental service.

It is interesting as Community clinics are run by the NHS and not for profit so what the study shows is how much more expensive it is to PROVIDE dentistry here than elsewhere in Europe.

Not only that, having fouind the full article it is rubbished by the BDA ... now most on here would think that was protectionism but I think we both know it isnt!!!

http://www.independent.co.uk/life-style/health-and-families/health-news/ouch-british-dental-care-the-most-expensive-in-europe-769227.html

kazmeister

Oh boy what an interesting thread, said from someone who is currently sitting here with toothache (and has a prebooked appt on Monday!)

I hear all sides of the debate here and am totally shocked to think what my bill is going to be as I have a tooth that has decayed underneath a bridge. I have had problems with my teeth ever since I was a child and as my mother said my diet was no different to my brothers so why are my teeth so rubbish - could it be anything to do with a diagnosis of coeliac disease when I was 37 which could have been there since childhood as other associated problems have been.

As for the dentistry and seeing the costs quoted here, I will probably have to borrow the money knowing that the treatment I need is going to involve possible root canal work and more. Unfortunately my last major treatment involved an abcess that had my face swollen up to my eye, my NHS dentist referring me to the hospital to have it lanced, copious amounts of antibiotics (which then led to acute hives which went on for weeks) the hospital telling me my NHS dentist wasnt up to the work I needed and had to go private. I came out of that episode approx £1200 lighter (5 or 6 years ago) in floods of tears with a bridge that whistled when I breathed in, it felt like someone elses teeth as they stuck out like goofy. I asked the dentist to redo it as I wasnt paying £1200 for something I wasnt happy with! It was replaced FOC and I am still with the same dentist!

So as a dual income family with no savings, a mortgage, 2 children to support including a son hoping to go to university how am I supposed to find the money to keep my teeth healthy - I have so far paid £58 for a consultation and 3 xrays and £40 for the hygienist and can only guess the cost of the rest. Lower right 4, 5 and 7 were used as anchors for a bridge over a missing 6. Dentist is talking about splitting the bridge in an attempt to sort out 4 which has basically had it.

I understand the overheads and stuff but how are people expected to pay such high bills to keep themselves healthy

welshdent

If he can section it to remove lr4 from the structure that makes things a lot more simple. It's difficult to judge without seeing you but whatever is involved would be a lot less managing one tooth than a 4 unit bridge

kazmeister

the bridge was actually originally made in 2 parts with some kind of join between 5 and the missing 6 which is where I think he is hoping to split it but then I would be left with possibly a missing 4 and 6 with only an anchor on one side of each. I really dont want another 6 unit bridge and cant afford implants. Cant afford any of it really but the throbbing hurts, have just had swill with corsodyl but it looks like I'll be double dosing pain killers again

welshdent

Have you been told you need lr4 out? Is it a hopeless case? The joint would complicate things and as I say I can't really tell without seeing it. It nay not be as bad as u think though

kazmeister

lol - my teeth have always been worst case scenarios, I had abcesses under both my front top teeth when I was 16, had the nerves taken out so they went grey and brittle. Had them both crowned around 19. Both broke off within 6 months and were put on metal posts. One metal post "got metal fatigue" and broke off and I had my first bridge at the front. Its been constant ever since!

Thanks for the replies anyway and I hope the original poster gets sorted too.

usignuolo

I notice that nobody has commented on the NHS information centre report that says one dentist in four earns over £1000k per annum (before tax but after running expenses).

I assume my dentists have paid off their premises because I have lived round here for 30 years and I remember when their building came up for sale (around 25 year ago) and I recall what it was before, and of course there has been some conversion but not a great deal, and at the time it was being sold off cheap for a variety of reasons.

My dentist is the senior partner and been there from day one, and unless they had to remortgage it for some reason, I assume it has been paid off. Of course I do not know for certain but my neighbour who knows him personally, mentioned to me last year that he knew (the dentist) was looking forward to a comfortable retirement sailing the boat he keeps moored down on the coast.

As they are not investing in any specialist equipment for specialist techniques (having taken a decision to refer them on) they obviously have basic equipment replacement costs but are not investing in things like £15,000 microscopes etc for endondontics.

I am not criticising my dentists for taking on only private patients as it happens, it is indeed their choice. But they are not cheap and with relatively low overheads and a full complement of patients, they must be earning decent money. If dentists earn such modest salaries as is claimed here, why is the NHS Information centre issuing the statistics quoted above? Are they all false?

Dentists do seem rather unrealistic about how people can afford to pay for treatment if they do not have access to NHS treatment. I am not poor or unwaged but cannot find £2000 for an implant as readily as dentists recommend them.

My real complaint is against politicians for failing to tackle this issue on behalf of the poor and unwaged and in particular against Labour for screwing it up royally and just mouthing platitudes.

welshdent

I dont know where the NHS info centre is getting their information but 25% of the dentists I know do not appear to be taking home over 100K a year (or indeed 1000!!). They wouldnt have figures for private income anyway and even of they did I doubt very much it would state if the income was entirely from dentistry or not. A couple of guys I know near me own a nightclub as well as a dental practice. I think I know of 1 person close to this but the hours he does are ridiculous. 5 days a week 8.30 to 6 with 30 mins for lunch and going in on weekends to write referral letters. What a lot of people fail to realise when it comes to NHS earnings in general practice is that none of us are salaried. While the specifics have changed, in general we are only paid for work carried out. Compare it to a kitchen fitter. If they fit 1 kitchen they get paid to fit 1 kitchen. If they fit 20 they are paid to fit 20. So if a dentist did indeed have pre tax gross earnings of 100K they would have had to do a LOT of dentistry on a LOT of patients. A lot of patients that would otherwise have found it significantly harder to access that dentistry.
You are still making a great deal of assumptions as to how your practice chooses to provide their dentistry. A lot of unseen expenditure occurs within a practice. Be it new dental chairs, new surgeries in general. You should really take a look at the price lists of dental equipment. I was at a dental conference in chicago 3 years ago. When there I saw a high spec digital microscope that permits you to practice at high magnification and illumination whilst viewing a TV screen. Excellent piece of kit. Over there $7K. Here .... £20K.
Endodontics is not the only specialism out there. Just because they refer that out doesnt mean they refer everything out. You say there is relatively low overheads. I work in a practice that is almost entirely NHS with its patient base. The lab work we supply isvery much on the cheaper side due to our restricted budget. My lab bill annually is around 15K a year. Thats just dentures crowns and bridge work. In a private practice where the higher end work is obtained ... lab fee for an NHS crown is around about $40 - 50. The equivalent private crown is around £100 +. Buying decent white filling materials can cost hundreds of pounds. I thankfully have nothing to do with buying in of materials and paying staff. No I just give 55% of my gross earnings to my principal. The average expenses of a practice are anecdotally 60% of overall gross income no counting any loan repayments.
You say dentists seem unrealistic about people being able to afford to pay for treatment. I would challenge that. I know a lot of practices that are extremely reasonable with their charges. Do you consider say £20 for a check up over the top? What about white fillings starting at £30? £300 for a white crown on a back tooth? £250 for tooth whitening? Are these unreasonable prices?
You comment on the price of implants. Do you know how much it costs to train to do these? The best part of £30000 .... and the rest .... plus equipment costs. My friend does them and just to break even for a single tooth implant he needs to charge £1600 so thats a profit of £400 on an extremely complex procedure ... a procedure that massively increases indemnity charges which are 2K a year ANYWAY without doing implants. Thats on top of paying for the compulsory CPD and registration fee which is set to increase by 25% to about 500 and something maybe even 600.

Toothsmith

usignuolo wrote: »

Dentists do seem rather unrealistic about how people can afford to pay for treatment if they do not have access to NHS treatment. I am not poor or unwaged but cannot find £2000 for an implant as readily as dentists recommend them.

My real complaint is against politicians for failing to tackle this issue on behalf of the poor and unwaged and in particular against Labour for screwing it up royally and just mouthing platitudes.

Dentists have to give patients every option - it's part of 'informed consent'. A dentist can be sued if they don't explain every option.

Implants ARE the A1 way to replace a tooth if you lose one - they are expensive, but the dentist still has to tell you about them.

There are other, cheaper ways to replace a tooth though, although they are something of a compromise, they work and are good.

The problem the dentist has is that he must get over the fact that the ONLY way to replace a tooth without doing some sort of damage to other teeth is an implant, and everything else has a degree of risk to other teeth.

Yet 10-15 years ago, these other ways were all we had, and they were pretty good then!

Personally, I'd only have an implant if I lost a front tooth. If I lost a back tooth, as I still have my other teeth I probably wouldn't even have it replaced.

If I wasn't absolutely rolling in it (Which of course I am, being a dentist) Then I'd probably have a Maryland bridge to replace a front tooth.

There are always options.

donteatthat

usignuolo wrote: »

I am not criticising my dentists for taking on only private patients as it happens, it is indeed their choice. But they are not cheap and with relatively low overheads and a full complement of patients, they must be earning decent money. If dentists earn such modest salaries as is claimed here, why is the NHS Information centre issuing the statistics quoted above? Are they all false?

With respect, you really have no idea what you are talking about. Relatively low overheads? And making assumptions over whether mortgages are paid off or not. Good grief. I would be careful spouting opinions as fact on things you don't have an understanding of.
Do you know what business rates are?
Do you know what wages bills are? Employers National Insurance contributions? Oh - thats going up btw.
Do you know what the materials cost per month? Oh - they've gone up 30% because of the exchange rate as most things we use are imported from Europe. And you say you don't understand why dentists are more expensive in the UK - hmmmm. I'm not even sure that's true anyway.
Indemnity costs?
Autoclave servicing costs - 4 x per year? Health and safety checks? Radiography equipment checks? Compressor maintenance?
Clinical waste? Electric? CPD? Dental chairs purchase and maintenance? Laboratory bills? Cardnet charges? X-ray equipment?
Business loans to provide the up to date (unproven) cross infection requirements. I could go on listing overheads- but why bother.
Let me enlighten you as to what a big practice costs to run (and we're not in London)- I'm one 6 dentists running a practice of 7 dentists and 3 hygienists with 15 support staff. Our overheads are around £100k PER MONTH to keep the place going, and that doesn't include the 6 partner dentists getting paid. We are going to be borrowing around £100k to comply with HTM01-05. It's nothing flash - not a spa practice, just a long established one with a very nice bunch of patients. And yes, the mortgage on the building is nearly paid off as it happens, but thats small fry in comparison to everything else we shell out per month.
Our accountants and solicitors charge more per hour than us, and without the overheads we have.
As for statistics spouted by the government - take them with a massive pinch of salt as they tell you nothing of any use, but then I thought everyone had figured out by now that HMG lies about pretty much everything.