Getting me teeth fixed.

theheathen

I know a few dentists and long suffering dental patients post here so I thought I'd seeks some input. Am 30 and my teeth are in need of some considerably attention. I recently saw a NHS dentist, and after having waited nearly 6 weeks for my appointment, and explaining the various issues I was having, I received no meaningful treatment and was sent on my way and told to return in 6 months. Apart from numerous issues caused by acid erosion on my back teeth, I have a root canalled left mandible 3rd molar cutting the back of my mouth to shreds as a restoration fell out and was not replaced. I also have a left maxillary first molar that has been root canalled with what was described as an abscess (although I believe it to be a granuloma) which was also not treated. My experience of NHS dentistry s very much in accord with other people I've spoken to. If you register as a patient with a dentition in need of significant work, you may as well no bother attending, as there is very little chance of the necessary work being done. At this point I think there is little point in my pursuing further NHS treatment.

As it happens I have an old friend whose father runs a dental lab. He said that for a couple of hundred quid to cover material costs (semi precious casting alloy) he would deliver a mouth full of posterior PFM crowns and empress crowns for front teeth. He said all I'd have to do is find a dentist to do the prep work, take the impressions, and affix some temporary crowns. Sounds great, but this isn't exactly a regular arrangement, and finding a dentist prepared to do it has proved difficult. I'm now thinking of looking abroad to see if I can find a dentist willing to work on this basis. I'm budgeting a couple of thousand for 2 simple extractions and the prep of the remaining teeth for crowns/bridgework and cementation of the crowns once made. Going the conventional route os out of the question, I just don't have £10k+ to spend, so I'm hoping to find a wy to make things work this way

Toothsmith

Dentists geneally pick the labs they use and stick to them, as they get to know the quality of the work that technician produces.

If anything goes wrong, it will be the dentist that carries the can, not the technician - so the dentist needs to be confident of the technician he is using.

What if one of the crowns broke, and the dentist said it was a manufacturing fault, and the technician said it was the dentist's fault? With you knowing the technician, you'd be far more likely to believe him, and so the dentist would be at a disadvantage.

Personally, I wouldn't touch this arrangement with a bargepole.

However - this technician must have dentists who use him regularly, and, seeing the impressions they send in, he'd be ideally placed to recommend a good one to you. Have you tried that? Although it would be my guess that a dentist producing consistantly good work would also be a dentist who would be on the dear side.

The other thing to say though is that the 'nuts and bolts' cost of the crowns is only a small proportion of your bill. The big cost is the time you are sat in the chair for.

From what you describe, there is much more going on in your mouth than can be cured by encasing things is ceramic.

There needs to be some thought given to why your teeth have got into this state in only 12-25 years.

As for your budget, I don't really think you appreciate what is involved in crowning the rest of your teeth.

If you just whack off all the tooth structure in one go, how is anybody supposed to know how you used to bite together?

Things need to be carefully measured (You would notice and find it uncomfortable if your bite was more than 1/100mm out) and recorded.

It would be better done in stages so that the bite can be adjusted and balanced as it's built up.

(This is assuming that this is a resonable treatment in the first place - it does all sound a bit OTT to me)

My recommendation would be that you went to see a dentist recommended by your mates dad, and get it done properly rather than cheaply.

(BTW, abscess and granuloma are pretty much the same thing)

theheathen

Toothsmith wrote: »

Dentists geneally pick the labs they use and stick to them, as they get to know the quality of the work that technician produces.

If anything goes wrong, it will be the dentist that carries the can, not the technician - so the dentist needs to be confident of the technician he is using.

What if one of the crowns broke, and the dentist said it was a manufacturing fault, and the technician said it was the dentist's fault? With you knowing the technician, you'd be far more likely to believe him, and so the dentist would be at a disadvantage.

Personally, I wouldn't touch this arrangement with a bargepole.

However - this technician must have dentists who use him regularly, and, seeing the impressions they send in, he'd be ideally placed to recommend a good one to you. Have you tried that? Although it would be my guess that a dentist producing consistantly good work would also be a dentist who would be on the dear side.

The other thing to say though is that the 'nuts and bolts' cost of the crowns is only a small proportion of your bill. The big cost is the time you are sat in the chair for.

From what you describe, there is much more going on in your mouth than can be cured by encasing things is ceramic.

There needs to be some thought given to why your teeth have got into this state in only 12-25 years.

As for your budget, I don't really think you appreciate what is involved in crowning the rest of your teeth.

If you just whack off all the tooth structure in one go, how is anybody supposed to know how you used to bite together?

Things need to be carefully measured (You would notice and find it uncomfortable if your bite was more than 1/100mm out) and recorded.

It would be better done in stages so that the bite can be adjusted and balanced as it's built up.

(This is assuming that this is a resonable treatment in the first place - it does all sound a bit OTT to me)

My recommendation would be that you went to see a dentist recommended by your mates dad, and get it done properly rather than cheaply.

(BTW, abscess and granuloma are pretty much the same thing)

OK, setting aside your other comments for a moment. I'm informed that the necessary prep work would take about half a working day for a competent dentist. The follow-up to cement and make adjustments a few hours. Your tone suggests that £2k for what would amount to in total a single day's worth of work would be insufficient remuneration. Having reviewed lab fees from other various places out of curiosity, the actual lab work is a small fraction of the cost of crown/bridgework, the vast bulk going to meet the income expectations of a profession seemingly drunk on the possibilities provided by a state enforced monopoly. The arrangement I have proposed does rather expose the reality that dentists are lining their pockets, aided by the pathetic state of NHS dental services. Why not bill lab work separately? Let patients see that the £700+ they've been charged for an all ceramic crown cost you maybe £100 in lab fees? ( a lot less if you offshore fabrication) Even accounting for expenses that's any eye watering hourly rate.

brook2jack

Acid erosion ... What caused this diet, stomach problems, hiatus hernia.... Has this been diagnosed and treated properly?

Is it just erosion or is there some other factors going on as well .... Parafunction (grinding?).

Is there at least one root treatment that needs redoing (several visits over several weeks)?

Has the erosion taken place over several years? Then you can't just "whack" a load of crowns on... Over a period of months or longer the teeth may have to be rebuilt to build up and adjust your bite and see how well you tolerate it. You may have to go through several sets of temporary measures until you are ready for crowns. In the end crowns may not be the best treatment... Depending what's causing your problems.

It will be a disaster if all your teeth are crowned if you have acid erosion that is still going on. Your teeth will be lost alot quicker as the acid will just eat away under the crowns.

All of this is academic until you have a proper treatment plan from a dentist you trust.

Complex problems that develop over years and particularly anything that requires multiple crowns should never be done over a couple of days, but in a planned and considered fashion.

As to your last point about lab bills.... Denplan patients pay a monthly fee that covers their treatment and then just pay lab bills on top. However a top of the range crown lab bill can be £400 plus. Semi precious crowns are by no means top of the line... They are standard NHS fayre.

theheathen

brook2jack wrote: »

Acid erosion ... What caused this diet, stomach problems, hiatus hernia.... Has this been diagnosed and treated properly?

Is it just erosion or is there some other factors going on as well .... Parafunction (grinding?).

Is there at least one root treatment that needs redoing (several visits over several weeks)?

Has the erosion taken place over several years? Then you can't just "whack" a load of crowns on... Over a period of months or longer the teeth may have to be rebuilt to build up and adjust your bite and see how well you tolerate it. You may have to go through several sets of temporary measures until you are ready for crowns. In the end crowns may not be the best treatment... Depending what's causing your problems.

It will be a disaster if all your teeth are crowned if you have acid erosion that is still going on. Your teeth will be lost alot quicker as the acid will just eat away under the crowns.

All of this is academic until you have a proper treatment plan from a dentist you trust.

Complex problems that develop over years and particularly anything that requires multiple crowns should never be done over a couple of days, but in a planned and considered fashion.

As to your last point about lab bills.... Denplan patients pay a monthly fee that covers their treatment and then just pay lab bills on top. However a top of the range crown lab bill can be £400 plus. Semi precious crowns are by no means top of the line... They are standard NHS fayre.

The NHS dentist suggested soft drinks, but as I don't consume them this cannot be the cause. I do suffer from moderate GERD, and whilst it's under control, it hasn't completely abated.

Denplan seems to me to simply be a way of conning patients. In how many cases do you think the actual lab fee is what appears on the Denplan patients bill? By way of blowing the lid of this a little, here is the fee schedule for a Chinese dental lab, one that has many UK private practises as customers....

Work Unit
Order Price Lab Work and Material
No. US$ Description

CROWN AND BRIDGE
Porcelain Fused to Metal
(alloy cost for Noble and High Noble not included)
900 US$75.00 Captek (including gold alloy)
930A US$24.50 High Noble PFM
930B US$24.50 Noble PFM
940 US$24.50 Non Noble PFM
931A US$44.50 High Noble PFM including post/pin
931B US$44.50 Noble PFM including post/pin
933A US$12.50 High Noble PFM Metal coping Try in (no porcelain)
933B US$12.50 Noble PFM Metal coping Try in (no porcelain)
933 US$12.50 PFM Metal coping Try in (no porcelain)
934 US$12.50 PFM porcelain only
937 US$49.00 Titanium alloy PFM crown
941 US$44.50 Non Noble PFM including post/pin
946 US$11.00 Post/Pin Core (non-Noble metal)

All Ceramic Work
970 US$51.00 Empress inlay/onlay
971 US$51.00 Empress crown
972 US$51.00 Empress veneer
973 US$51.00 0.3 mm e.Max Thin veneer
978 A US$115.00 Cercon crown
978 B US$135.00 Cercon bridge (per unit)

Other Bridge and Crown
(alloy cost for Noble and High Noble not included)
903 US$170.00 Cercon Implant
912 US$24.50 Non Noble Maryland bridge
911 B US$24.50 Noble Maryland bridge
911 A US$24.50 High Noble Maryland bridge
945 US$33.50 Non Noble full metal crowns/inlay/onlay
935 B US$33.50 Noble full metal crown/inlay/onlay
935 A US$33.50 High Noble full metal crown/inlay/onlay
920 US$24.50 King's Crown (Au 97%) (Gold not included)
999 US$62.50 High strength acrylic veneer
936 US$11.00 Non Noble post/pin core
936 B US$11.00 Noble post/pin core
936 A US$11.00 High Noble post/pin core
959 US$11.00 Temporary crown
960 US$69.00 Implant crown (Non Noble)

***** Alloy Prices *****

Base Alloy No Charge Ni-Cr Alloy, from Aalbadent
Co., USA

Noble Alloy USD13.75/gram Pd 53.5%, Ag 37.5%,
Silver color, from Aurident, USA (1 gram = 15.43 grains)

High Noble Alloy for PFM USD38.00/gram Au 65.0%, Ag 24.5%, Pd
1.9%, Pt 0.1%; pale yellow color, from Aurident, USA (1 gram = 15.43
grains)

High Noble Alloy for Full Metal Crowns USD44.00/gram Au89.5%,
rich yellow color, from Aurident, USA (1 gram = 15.43 grains)


Now I guarantee you that dentists taking Denplan and outsourcing their work are not showing these type of lab fees on the bill. In fact I'd bet the fate of the universe on it.

brook2jack

All my denplan patients get a copy of their lab bills. As do the denplan patients of my colleagues in my practice. In addition all the denplan patients I have ever had from other practices have also had the same. That being said the majority of my patients are not on denplan, it is just one of the schemes we offer.

All my other patients get their copies of their lab prescriptions . It is illegal to use non CE certified labs and for this and many other reasons I only use British labs. Also the labs pick up work and come in for consults with patients and get lab work back in a week. I have no idea how long lab work would take to get to China and back and be made.Indeed when the problems with poisonous metals in Chinese crowns came out it was American dentists who had used these services extensively and had the problems not British which explains why prices are in dollars. However some of the most high tech laboratory work has to be sent to specialist labs abroad (invisilign to US £1200 plus a case, proceram crowns to Holland I think £140 a crown , etc). Dentures take at least four to five visits to make and sending them to China would mean they would make several trips around the world.

Has anyone suggested high fluoride toothpaste (prescription only) to you? If you have only partially controlled GERD you should not even consider ANY advanced restorative treatment at the moment until the problem is under good longterm control .

There are thousands of dentists in the UK some bad and unethical but the majority ethical and hardworking trying to do their best in a very challenging job in ever increasingly litigious and regulated arena.

Toothsmith

theheathen wrote: »

OK, setting aside your other comments for a moment. I'm informed that the necessary prep work would take about half a working day for a competent dentist. The follow-up to cement and make adjustments a few hours. Your tone suggests that £2k for what would amount to in total a single day's worth of work would be insufficient remuneration. Having reviewed lab fees from other various places out of curiosity, the actual lab work is a small fraction of the cost of crown/bridgework, the vast bulk going to meet the income expectations of a profession seemingly drunk on the possibilities provided by a state enforced monopoly. The arrangement I have proposed does rather expose the reality that dentists are lining their pockets, aided by the pathetic state of NHS dental services. Why not bill lab work separately? Let patients see that the £700+ they've been charged for an all ceramic crown cost you maybe £100 in lab fees? ( a lot less if you offshore fabrication) Even accounting for expenses that's any eye watering hourly rate.

Whatever!

VfM4meplse

theheathen wrote: »

Even accounting for expenses that's any eye watering hourly rate.

It is reasonable to pay an appropriate amount for the expertise required. You can shop around as much as you like but at the end of the day you'll still have to pay for the professional services of a dentist.

theheathen

brook2jack wrote: »

All my denplan patients get a copy of their lab bills. As do the denplan patients of my colleagues in my practice. In addition all the denplan patients I have ever had from other practices have also had the same. That being said the majority of my patients are not on denplan, it is just one of the schemes we offer.

All my other patients get their copies of their lab prescriptions . It is illegal to use non CE certified labs and for this and many other reasons I only use British labs. Also the labs pick up work and come in for consults with patients and get lab work back in a week. I have no idea how long lab work would take to get to China and back and be made.Indeed when the problems with poisonous metals in Chinese crowns came out it was American dentists who had used these services extensively and had the problems not British which explains why prices are in dollars. However some of the most high tech laboratory work has to be sent to specialist labs abroad (invisilign to US £1200 plus a case, proceram crowns to Holland I think £140 a crown , etc). Dentures take at least four to five visits to make and sending them to China would mean they would make several trips around the world.

Has anyone suggested high fluoride toothpaste (prescription only) to you? If you have only partially controlled GERD you should not even consider ANY advanced restorative treatment at the moment until the problem is under good longterm control .

There are thousands of dentists in the UK some bad and unethical but the majority ethical and hardworking trying to do their best in a very challenging job in ever increasingly litigious and regulated arena.

The acid reflux is about as under control as it's going to be. Pushing doses of medication higher simply makes the side effects intolerable. Higher doses also carry the risk of permanent weakening of bones.

As for Chinese dental labs, contrary to what you may have heard, they are mostly highly reputable, and use exactly the same certified casting alloys, ceramics and sundries as UK labs. UK workers have seen their incomes eroded by outsourcing, so it seems only fair that they should be able to take advantage of the global market in dental services and have wage arbitrage work in their favour for a change.

The issue is that like so much in healthcare a veil of secrecy surrounds pricing, and this exists solely to obfuscate the very high fees being charges by dentists. Why can't dentists simply charge patients for their time? Within the scope of general dentistry this seems a reasonable request. Dentists could state the cost for their time on an hourly basis, and patients would pick up the bill for any significant material costs and lab work.

Your contention that most dentists are honest is at odds with the evidence. It may not be a palatable fact for you to deal with, but the new dental contract which replaced the piecework contract you used to work under as an NHS practitioner, was brought in largely to deal with large scale systematic abuse of that system. As soon as the prefix 'cosmetic' became commonly attached to 'dentistry' the direction the profession was headed was clear. Out with prophylactic treatments and early intervention, in with watching things rot and salivating at the monies to be made restoring those now diseased quadrants with snow white crowns. NHS dentistry is now little more than a conveyor belt providing dentists with opportunities to bait and switch patients to private treatments. Need a 3 unit bridge? Can't do it on the NHS I'm afraid (despite signing a contract that say you should if necessary), but for the low low price of £2000 I can do it privately. Or maybe it could really be the dentists lucky day, a large redundancy payment sir? How about an implant and a few crowns, special offer just for today £4000.

Am I saying all dentists are like that? No. Dentistry does however have far far more than its fair share of mountebanks.

theheathen

VfM4meplse wrote: »

It is reasonable to pay an appropriate amount for the expertise required. You can shop around as much as you like but at the end of the day you'll still have to pay for the professional services of a dentist.

And what is reasonable? It's a poor outcome for society that a profession whose training is very heavily subsidised by the state, decides that whatever the market will bear is a reasonable fee. Your point in no way refutes my contention that dentists have unrealistic income expectations based on the training undertaken. Arguments about airhead celebrities earning a fortune are moot. There is no state enforced monopoly in celebrity, whereas there is in the dental profession.

theheathen

Toothsmith wrote: »

Whatever!

I'd be glib too. Did you know the average dentist now earns significantly more than the average GP? As a profession you excel at making out you're hard done by, whilst being remunerated very handsomely.