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

Toothsmith

That's good!

mda99das

I wonder how many of the replies are from private dentists. It would be interesting to see the opinions of an NHS dentist.

I do advise my pts the risk of ID nerve parasthesia during RCT. I have a pt who had RCT done in Poland, and now has mental nerve parasthesia. The RCT looks good though and is asymptomatic.

Toothsmith

Best advice is best advice, it doesn't matter which system you operate on.

There are only a maximum of 6 teeth out of 32 which an incredibly cack-handed dentist could possibly cause ID parathesia on anyway. And even then he'd need to be suffering the mother of all hangovers and sleep depravation as well.

You are right that with only 3 funding points for the time it takes to do it properly, it is highly tempting to make up all sorts of reasons why the tooth should be extracted instead (For the same 3 points), but that way the path of the 'Dark Side' is, as my hero Yoda would say!

If any dentist feels so influenced, then it is time to leave the NHS before solicitors take an interest in your career.

That's a good warning about dental tourism though.

leni

I asked about extraction and he kept saying he'd rather keep the tooth. Anyway the PCT are now investigating.

Meanwhile I was successful in getting a new NHS dentist at another location and my appointment is on 1st feb. The tooth is not hurting so much now but I think thats a mizture of antibiotics, painkillers and bonjela.

Thanks for the advice

mda99das

The chances of ID parasthesia are very very slim. A PA would tell you if the ID canal is very close proximity anyway...

However you could still get parasthesia from ID blocks, especially if articaine is used, which is the reason why I dont use if for ID blocks.

I have one very very obese patient who takes 20-25 mins for sucessful anasthesia. To do work on molar teeth requires 1xlignocaine ID block.
1x buccal infiltration with articaine. Works a treat...

mda99das

Toothsmith, if a dentist feels that a procedure is out of his expertise I feel that he has done the right thing and referred it to someone that has more experience. Look at the GDC guidlines....

Toothsmith

I would agree 100% if it was genuinely outside what he felt comfortable doing.

The PCT will have data on how many root fillings the dentist did prior to the introduction of the new contract though, and if, after it, there is a significant drop in the number of teeth he is 'comfortable' root filling himself, I think they are entitled to ask a few questions.

mda99das

Very true toothsmith. The dentists with a strong business acument would know their hourly rate / UDA target and realise that a molar endo in 1hr is not worth it, and try and put them off this option.

What about in house referal to say a VDP?

Toothsmith

So long as the patient was fully informed that the VDP was not as experienced as the referring dentist.

But what if the patient said 'No - I want you to do it'

What then?

Any dentist who has signed this contract HAS to provide what he or she has signed up to, and that is a full range of dental services normally carried out at that practice.

This may be a timely place to remind peopel that there is a PETITION on the 10 Downing Street web site to try and get this monstrosity of a dental contract ended.

I doubt it will acually do anything, but I'd be grateful for all the signatures it can get.

bank_of_slate

mda99das wrote:

The chances of ID parasthesia are very very slim. A PA would tell you if the ID canal is very close proximity anyway...




I have one very very obese patient who takes 20-25 mins for sucessful anasthesia. To do work on molar teeth requires 1xlignocaine ID block.
1x buccal infiltration with articaine. Works a treat...

For those who are not fluent in 'dentist' a PA ia a peri apical x-ray!

Try a mallet, it's quicker!
...Linda xx