Getting me teeth fixed.

welshdent

What level of dental training do you actually have to know what treatments are better than others? You allege that we are all money grabbing yet I have a patient who specifically wanted implants. I referred them to the local implantologist who specifically advised against implants and that they would be better served with ... wait for it .... a partial denture. The lab costs on a 2 unit bridge and a single tooth denture and not drastically different for me. I was also brought up on the advice "big bridges fail big time". I am regularly mopping up major problems where people have had massive span bridges placed. Fractured and or decayed abutments, broken porcelain that can not be repaired. Loss of vitality in abutments. All sorts of reasons ... but failed none the less and often the only treatment left is a denture. Last week I placed 2 inlays on one patient, for whom I had root filled both the molar teeth 3 months previously. Total cost to the patient, £216. Total cost to me, significantly more. Your allegations are not standing up when comparing these things to me. I am NOT alone believe me. I know MANY dentists that do the same things on a regular basis

welshdent

theheathen wrote: »

.

As for the root canal. A general dentist that is comfortable performing the procedure should have no problem, there is no need to see a specialist, unless you fancy paying even more..

Key word. Comfortable.


I am comfortable doing MOST. I refer very few out. Mostly failures for which I can see no reasons why or complex anatomy that is impossible for me to treat either during instrumentation or obturation.

The difference with me an other average dentists is I have bought an operating microscope out of the obscene sums of money I allegedly earn. A 15K scope for a treatment I actually am only paid £30 to do. I am clearly a shyster. That instrument alone makes me comfortable ... but who am I or you to tell someone else without that kit what they are comfortable doing? The GDC tells us we have a duty to not take on work that we do not feel competent in undertaking. If that means referring out all endodontic treatment for a practitioner then so be it. There is no system of cash back, rewards of remuneration to the referring dentist so they can hardly be accused of profiting from the referral. The specialists and those who are practice limited to endodontics spend a LOT of time getting VERY good at doing these treatments. An MSc costs around 9K a year in endo. The microscope minimum charge would be around 10K for a basic entry level one. A system b and obtura kit around 3K. You are looking at at least 2K for a handpiece and maybe additional for an apex locator if not built in. 1K for a decent ultrasonic unit and tips. Plus its a very labour intensive procedure. A Minimum of 30 mins hypochlorite exposure is recommended. It doesnt take long for the costs to creep up.
I know you either dont care or are un interested in these little details ... but they are the reality.

And yes in many cases a crown IS recommended. A root filled tooth with no other damage is around 6 times weaker than a non root filled tooth. The masticatory muscles are capable of delivering a great deal of force to the teeth and they can and will break if not adequately protected.

thistledome

theheathen wrote: »

Being sesquipedalian is not a requisite for participation. Are you a patient or practitioner?

You sound like a cross between Edna Wellthorpe and Kenny Williams

A quality thread, thanks for the :rotfl:

theheathen

welshdent wrote: »

What level of dental training do you actually have to know what treatments are better than others? You allege that we are all money grabbing yet I have a patient who specifically wanted implants. I referred them to the local implantologist who specifically advised against implants and that they would be better served with ... wait for it .... a partial denture. The lab costs on a 2 unit bridge and a single tooth denture and not drastically different for me. I was also brought up on the advice "big bridges fail big time". I am regularly mopping up major problems where people have had massive span bridges placed. Fractured and or decayed abutments, broken porcelain that can not be repaired. Loss of vitality in abutments. All sorts of reasons ... but failed none the less and often the only treatment left is a denture. Last week I placed 2 inlays on one patient, for whom I had root filled both the molar teeth 3 months previously. Total cost to the patient, £216. Total cost to me, significantly more. Your allegations are not standing up when comparing these things to me. I am NOT alone believe me. I know MANY dentists that do the same things on a regular basis

A partial is a horrendous bargain basement way to restore a missing tooth/teeth. As regards long span bridges, as long as you're working roughly to Ante's law why should they fail? Maybe the labs concerned should switch to materials rather more durable than shortbread, and the dentists concerned stop trying to use blancmange as a cement.

As for your anecdote, I've said before that there is little scope for getting rich off of the new system, one of the reasons practitioners abandoned it like rats from a sinking ship. The name of the game now is up selling NHS patents. In most NHS practises I assure you the patient you mentioned would have had the teeth extracted and a partial denture provided. Clinically the dentist is covered as this is an acceptable way to resolve the issues presented.

As for dental training, this is going to come as quite the cataclysm to you, but it is possible to acquire and assimilate knowledge outside of a formal educational environment.

theheathen

welshdent wrote: »

Key word. Comfortable.


I am comfortable doing MOST. I refer very few out. Mostly failures for which I can see no reasons why or complex anatomy that is impossible for me to treat either during instrumentation or obturation.

The difference with me an other average dentists is I have bought an operating microscope out of the obscene sums of money I allegedly earn. A 15K scope for a treatment I actually am only paid £30 to do. I am clearly a shyster. That instrument alone makes me comfortable ... but who am I or you to tell someone else without that kit what they are comfortable doing? The GDC tells us we have a duty to not take on work that we do not feel competent in undertaking. If that means referring out all endodontic treatment for a practitioner then so be it. There is no system of cash back, rewards of remuneration to the referring dentist so they can hardly be accused of profiting from the referral. The specialists and those who are practice limited to endodontics spend a LOT of time getting VERY good at doing these treatments. An MSc costs around 9K a year in endo. The microscope minimum charge would be around 10K for a basic entry level one. A system b and obtura kit around 3K. You are looking at at least 2K for a handpiece and maybe additional for an apex locator if not built in. 1K for a decent ultrasonic unit and tips. Plus its a very labour intensive procedure. A Minimum of 30 mins hypochlorite exposure is recommended. It doesnt take long for the costs to creep up.
I know you either dont care or are un interested in these little details ... but they are the reality.

And yes in many cases a crown IS recommended. A root filled tooth with no other damage is around 6 times weaker than a non root filled tooth. The masticatory muscles are capable of delivering a great deal of force to the teeth and they can and will break if not adequately protected.

You keep referencing NHS fees, once again for clarity sake I don't think there is much scope for getting rich purely of NHS work. However, NHS dentistry is little more now than a sales opportunity for much higher prices private services. £30 is too low a fee to be paid for a root canal, and yet dentists offering services on the free market seem to think £800 is reasonable . With regards the necessity of a crown, I mentioned not because I thought it was an unnecessary addition, but purely to prepare the poster for likely additional costs.

welshdent

re partials\

In your opinion it may be but you do not speak for everyone. Some people are simply not suitable for anything more for various reasons. May be poor quality abutment teeth, poor oral hygiene, sinus or other anatomical issues. You can not simply say a partial is " horrendous bargain basement way to restore a missing tooth/teeth" because it simply isnt true. I was looking at a lab guide today from a dental magazine and their charges are £472 for a particular type of denture. Thats hardly bargain basement. I see you have ignored my "anecdote" because it doesnt suit your arguement. Dont gloss over it by making an incorrect assumption. You are implying we would all take the teeth out. I havent so why ignore me? What about the patient I am seeing who I have sectioned the mesiobucal root from an UL6 and root filled it whilst also root filling the remnants of UR7 along with extraction of UL1 and addition to partial all on a band 2. All so that I can prevent further tooth loss and thus make his good denture remain good during his bone healing. If we are all just whipping teeth out left right and centre why am I doing this? This patient can not have a bridge as he doesnt have enough teeth and he doesnt want implants.

Why should a bridge fail? Well you again have ignored all the reasons I gave and NONE of them apply to mechanics but all are very common reasons for failure. There is no need to be facetious regarding materials and cements. None of the bridges I have seen fail, have failed because of a crap material. Sure sometimes the porcelain breaks but that is NOT due to bad materials. It may be due to long term bond fatigue, catching the "tooth" on an unexpected hard lump in some food etc. FWIW I have never been tempted to use blancmange to cement crowns. Perhaps if you ate less of it your teeth would last longer.

welshdent

theheathen wrote: »

You keep referencing NHS fees, once again for clarity sake I don't think there is much scope for getting rich purely of NHS work. However, NHS dentistry is little more now than a sales opportunity for much higher prices private services. £30 is too low a fee to be paid for a root canal, and yet dentists offering services on the free market seem to think £800 is. With regards the necessity of a crown, I mentioned not because I thought it was an unnecessary addition, but purely to prepare the poster for likely additional costs.

My earnings are about 97% NHS and the rest comes from occasional tooth whitenings and the occasional composite filling or all ceramic crown. I am clearly missing your sales opportunity somewhere. Either that or again ... not all dentists are living up to your generalisations

theheathen

welshdent wrote: »

My earnings are about 97% NHS and the rest comes from occasional tooth whitenings and the occasional composite filling or all ceramic crown. I am clearly missing your sales opportunity somewhere. Either that or again ... not all dentists are living up to your generalisations

Of course not, and I've said as much in this thread. I don't know the socio-economic conditions of the area in which you practice, but your numbers certainly suggest you're not working in an affluent area.

welshdent

So are we all shysters? Because the only gestures you have made to the contrary is an extremely small one.

Savvy_Sue

theheathen wrote: »

As for dental training, this is going to come as quite the cataclysm to you, but it is possible to acquire and assimilate knowledge outside of a formal educational environment.

Call me old-fashioned, but before anyone other than DH gets anywhere near my mouth they'd better have some formal dental training behind them.