NHS Dental Advice re: Bridge

ellybelly3

I saw a previous old thread and wondered if anyone could advise me.

My husband needed a tooth replacing as an existing, old crown kept coming out and could no longer be replaced. The dentist offered 3 options all at £198, a partial denture, partial bridge (sticking to the back of neighbouring teeth) and a full bridge (spanning 3 teeth).

My husband opted for the least invasive partial denture but despite several trips back to the dentist it wouldn't fit properly or stay in. The dentist snipped off one of the wires which made it worse.

He then went for the partial bridge as he didn't want to damage his other teeth more than necessary, but again this wouldn't stay in and he was back every few weeks to have it stuck back on. Again the dentist cut off one of the side retainers to try to get it to stay in, it didn't help and my husband had to give it up as a bad job.

I'd like to mention that my husband has very good oral hygiene and wasn't reckless with what he was eating, but can only eat on that side of his mouth due to facial palsy on the other so any chewing action is amplified.

They then discussed the full bridge, and the practice manager said my husband would have to pay again, (even though it was not his fault that the previous 2 treatments had not worked) and said it would be another £198, which I now understand is the NHS price.
So at this time they must have been offering it on the NHS.

My husband decided to leave it for a while to think about it and in the meantime the dentist left. This week we saw her replacement and he has now quoted over £400 for the same treatment but says it has to be carried out privately.

I guess my first question is, should I pursue the practice for some sort of discount as my husband has paid for 2 separate treatments, neither of which have worked and which we feel are not his fault?

Secondly, would it be worth trying to get the bridge on the NHS as other treatments have proved ineffective? As I mentioned my husband has facial palsy, which means he can only smile and open his mouth to any real extent on the side with the missing tooth. To many onlookers he already appears strange and a missing tooth just exacerbates this, as people think he is some sort of weirdo. As you can imagine this is upsetting. Also, he can't really chew on the other side so a missing tooth on the good side is doubly difficult.

We are not trying to rip off the NHS or anything but feel it's a bit hard on us when the treatment that was paid for didn't work, twice, and the treatment is not just a vanity thing.

Any advice that can be given would be appreciated.

Thanks.

welshdent

You would have had to pay the additional 198 on the NHS for a bridge because they are not guaranteed on the health service. Failure of a previous item does not automatically mean a replacement would be free for dentures and bridges. The dentist can NOT charge you because they do not get the money for it the PCT (judging by the prices you have told me I am assuming you are in england). Basically its not a case of trying to rip the nhs off. Its simply a case that they will deduct it from the dentist at source who would have also had to pay to have the items made in the first place. Put simply the dentist would end up being better off financially handing you a wad of cash and say go somewhere else. The NHS in dentistry works completely differently to all other parts of the service. All general practice dentists in the health service are independent.
Unfortunately when dealing with the human body, despite ones best efforts sometimes things just dont work as they intended. Bridgework especially resin retained ones can be particularly difficult if someone has a heavy bite because you are literally relying on special glue to hold them on. Dentures are approximately 10% as effective as natural teeth. Sometimes, despite all the adjustments we can make ... people just dont get on with them. At the end of the day its just a lump of acrylic. Your husbands facial palsy may be the reason he can not get along with the denture as much of the tollerance comes from muscular control.
Now by the sound of things you were very lucky with the last dentist to be offered all that as I know most wont. They have clearly tried to provide all they can to meet your husbands needs. The problems you initially have is the time left deciding. You have not specified how long it was? If we are talking weeks/months then its not really feasible to continue to offer things. Now as you have stated you now have a new dentist seeing your husband.
Stick 5 dentists in a room with one clinical problem and you will probably end up with 20 different treatment plans. We all have differing views on what is possible, necessary etc. Personally I do very few bridges of the type you indicate. I do not like the risks of killing off otherwise healthy teeth. Also the regulations do not state we HAVE to provide them. We must provide what is clinically necessary in our judgment.The previous dentist may well have deemed that it was but that may not be the case with this dentist. It is unreasonable to hold a completely independent dentist to someone else's treatment plan particularly if a) they disagree with it and b) would have to shoulder the financial burden for another dentists plans.
My suggestion would be to discuss things with the practice manager. Explain how you feel regarding the previous attempts and the new proposal from the new dentist. You DO have to pay if you were to have work done on the NHS. Thats out of the dentists hands. If you want NHS work and expect the dentist to abide by the regulations then you have to as well.

A compromise may be a) ask for a referral to a local teaching dental hospital or district general that has a restorative dentistry department.
POSSIBLY although I would find it unlikely, you may be able to coax the principal dentist in to a compromise on a private item by you agreeing to covering the costs of the lab fees. I dont think it is likely because again you are asking someone to accept another dentists treatment plan that they would have to accept legal and financial responsibility. The principal would at least have had a percentage of any income from the previous denture and bridge although given the costs to provide them in the first place those revenues would have been small to say the least. The new dentist more than likely would be very hamstrung by giving you any work free or at cost price. Imagine buying something in tesco then taking it back to sainsburys and asking them to refund you. Thats basically what you would be doing.

Personally, I think referral would be your best option.

brook2jack

Unfortunately dentures are very difficult to get used to, they require practice like riding a bike to use. Some people never get used to them as they will move about and that is not the dentists fault. The dentist then made a bridge which few would do on the nhs.

Again with this type of bridge the success rate can be unpredictable. By now your husbands treatment has cost the dentist and she lost money having to do adjustments..

Another dentist has seen your husband who cannot also be asked to lose money making a third option. Your husband was unusually lucky to be offered a bridge on the nhs in the first place and I think the very best you may be able to ask for is for the second dentist to make a new bridge on the nhs and pay again 198 as a goodwill gesture . But the problems you have had are no ones fault the first dentist has tried their best the second dentist doesnt have to follow the first dentist treatment plan.

Sadly not being able to get used to dentures does not mean that you are entitled to bridge work or even more so implant work particularly if there are gaps else where. However permanent weakness/ palsy can make denture wearing difficult so a bridge possibly could be justified. One word of warning which I'm sure the original dentist gave hence your husband choosing a less invasive treatment.... 25% of teeth prepared for crowns/ bridges die off and require root treatment.

ellybelly3

Thanks both for your advice. I guess I didn't really see the 2 dentists as 2 separate providers of treatment, not knowing much about the way dentist surgeries work I thought of the surgery as a whole being responsible not the individual dentists.

I think we might have to try going back to see the dentist and asking if they would consider doing the work on the NHS and paying the £198, fingers crossed.

I am a bit worried about what you said about the other teeth dying off, would it be possbile to remove the bridge and carry out the root canal work and then replace the bridge? Or might my husband then end up with several missing teeth?

The original dentist did mention an implant but that was lots of money. Would anyone recommend, if money wasn't an issue, that this is the more reliable way forward?

I guess these days you think everything can be fixed, but that's not always the case!

Thanks for all your advice.

Dizzy_Ditzy

i had "temporary partial dentures" done almos a year ago, not getting on too well with them now and at the time of having them done i asked my dentist to refer me to the dental hospital to ask about implants- if i had been seen at the time i would have stood a good chance of getting them but i wasnt and the option for implants was only available to head and neck cancer patients. However, they did offer me a permanent bridge which i am going for in a few weeks time, so while its going to be a long wait, ask your OH's dentist to refer him tothe restorative dentistry department of your local teaching hospital.

brook2jack

We can't see your husband so can't really comment on suitability for implants. They are very good in the right person.... someone who doesn't smoke, grind their teeth and has absolutely excellent oral hygiene. Yes they cost around £2000.

If teeth under bridge need root treatment you normally drill through the bridge as taking it off can damage the teeth.

welshdent

thats if you can find the canal with all the metal work in t he way ... I HATE doing endos through crowns and bridgework.

elly theoretically it IS possible to do a root filling and keep it all there however the tooth is going to be weaker following treatment and you have to cut a hole in the bridge at the back of the tooth to do it. This may damage the bridge more than was intended and as such may mean your husband will no longer like its appearance. Root filled teeth are not great bridge retainers due to their increased weakness.

brook2jack

queen_of_cheap wrote: »

i asked my dentist to refer me to the dental hospital to ask about implants- if i had been seen at the time i would have stood a good chance of getting them but i wasnt and the option for implants was only available to head and neck cancer patients. .

For the vast majority of health authorities for many many years implants have only been available for cancer, various congenital abnormalities (conditions you were born with) and very very very occaisionally trauma.

I have not heard of anyone for many many many years getting implants because of denture problems and most PCTs, dental hospitals and hospitals advise this outright.

Dizzy_Ditzy

brook2jack wrote: »

For the vast majority of health authorities for many many years implants have only been available for cancer, various congenital abnormalities (conditions you were born with) and very very very occaisionally trauma.

I have not heard of anyone for many many many years getting implants because of denture problems and most PCTs, dental hospitals and hospitals advise this outright.

thanks for correcting me, this was based on the information that I was given at the time

Daniel_Kelsoe

Be aware that some dentists may try to mislead you.

I had a bridge provided under the NHS. It served me well for many years then had to be replaced. I was told by my new dentist that it could not be replaced under the NHS because it was cosmetic, but that he could do it privately for £1,500. He did not give me a written estimate.

However, you will see on the directgov website that bridges may be fitted under the NHS and are charged under Band 3, currently £209.

It has been said on this forum that a dentist may refuse treatment that he does not consider medically necessary and that no dentist is bound by the opinion of another dentist. This raises several questions.

How does a dentist decide whether a treatment is medically necessary or not? What are the guidelines from the NHS and the Royal College of Surgeons? How does he communicate with the patient? In my case, there was no discussion and no explanation and I am left with the impression that my dentist's motivation was financial and not medical. Why otherwise would he offer me private treatment if it was not medically necessary?

It has also been said on this forum that if a dentist loses money on NHS treatments he cannot be expected to provide them. It is unacceptable for a medical practitioner to allow financial considerations to prevail over medical judgements, whether he works in the NHS or private practice. The directgov website says that a dentist is not permitted to refuse NHS treatment and to offer the same treatment privately and that any treatment under the NHS has to be of the same quality as that offered privately.

I would add that a dentist's financial affairs are of no concern to his patients. That is a matter for him, his professional association and the government. Our concern is to get the best treatment at the best price.

Toothsmith

A dentist is allowed to provide the most cost-effective treatment to solve the problem on the NHS.

Obviously, with not being able to see you, we cannot see how everything else looks in your mouth, and why the bridge failed, or exactly what would be necessary to replace the missing teeth.

But it would be aceptable for the dentist to offer you a denture as the NHS option, (It's a perfectly valid and acceptable treatment for replacing missing teeth) and provide a bridge as a private option should you request it.

As I said, I don't know, and can't see the specifics of your case. But this would be acceptable under the terms of the NHS contract.