NHS Dentistry Charges - what is a scale and polish?

sa_06

Hi folks,

After attending an emergency dental appointment this morning - been in agony over the weekend - to check a lump that's appeared in my gum, I'd like to get second opinions on the following from an unbiased POV (though, I'm waiting on the NHS Scotland admin advisor service calling me back to clarify this stuff).

Appointment involved a detailed examination (and upsell on practice products, as usual ), X-Ray, and anti biotics under the gum. Total charges were given as £40. When asked for a fee breakdown (as I was surprised it wasn't given, I've no idea why I've not noticed it before now unless that's a new policy), it listed £10 for "Scale and Polish", £30 antibiotics. When I queried this with the reception lady (I wasn't surprised at the charge at this point, as I expected to pay for the check, i just want my records to be accurate, since I hadn't had a scale and polish to my knowledge) she and her colleagues stated that:

An NHS scale and polish was "if one tooth or more is scaled and polished". Out of curiosity, I asked where the NHS regulations say this, she got out a booklet. But she couldn't point to the paragraph where it defined "one tooth or more" and she retracted it to say "a scale and polish is in the general area", and that there was no way to avoid this fee, because as soon as the dentist picks up a scaling brush that's the fee added.

Q1. Can I avoid paying for a scale and polish in future if it's an emergency dental appointment, is it actually not optional like she said? I can't really afford ANY dental treatment just now so if it is optional I'd like to be able to say at any future emergency appointments to not do it. It would make sense to charge me for the checkup though, I realise. But why not just call it that on the bill/my records then? Why would they put something inaccurate on my records?

Q2. Why would I pay for a "scale and polish" of one tooth only..? Why wouldn't I ask for an entire scale and polish in that case? Am I being a bit thick but if I'm going to pay for it anyway, in future should I ask that all my teeth are done?

Q3. What DOES the NHS define as a "scale and polish" if her "one tooth or more" wasn't actually written down anywhere? I feel as though I didn't have a scale and polish (I've had them before), but my practice clearly thinks I have. According to me, the dentist prodded around near the lump for a while; according to the practice owner, he did a scale and polish. I assume they know the regs, but it would be nice to see it in writing about what the scope of each treatment according to the NHS is...?

Q4. The anti biotics, it was explained, might help the lump swelling disappear. That's cool, and very welcome, but I'd kinda assumed it would be prescription charges - silly me! I've never had major dental work before, so I suppose what I'm asking is: if a dentist offers me anti biotics in future, would it be appropriate to ask for a prescription instead? Can they do this?

Due to the attitude of the reception staff I'm thinking of changing my dentist - I don't mind paying for treatment but I'm on a very tight budget (I was in pain all weekend, fearful of paying an emergency fee on top) and I just can't afford to have random, unknown costs levied at the till after I've seen the dentist. It literally has to come out of my food bill, and that £40 I've spent today will come out of a £50 weekly shopping bill - great

Q5. Would it be acceptable or appropriate in future to query everything a dentist is doing and ask how much it will cost beforehand? I kind of feel like I go to the dentist every 6 months, have no idea how much to budget for, and then never question it after. It's the first time I've asked for a fee breakdown, for example. I wouldn't do this with any other service I buy, and I've no idea why I've not done it before now.

brook2jack

Unfortunately you had toothache, if you want toothache sorted out you can't specify a budget for it to be sorted out . It is different if you are having elective treatment or if it is not an emergency then by all means ask for a breakdown of costs before treatment starts and then you can plan your treatment.

The practice is quite right there is no minimum or maximum number of teeth to be scaled to qualify for a scale and polish fee which is also claimable for simple periodontal treatment ie if you had a gum abcess which was treated. the regulations are enormous and run to lots of pages http://www.sehd.scot.nhs.uk/pca/PCA2009(D)06.pdf There are literally hundreds of different charges.

By far the cheapest thing to do is to get dental treatment before you are in an emergency situation as it is a false economy to put treatment off ..it will only get worse and more expensive. If you are on a low income you may be entitled to help with dental charges ask for a form at your doctors or dentist.

sa_06

Hi Brook! Many thanks for your reply.

Just to clarify, I go religiously to my 6month dental checks, the last time I was there was about 3 - 4months ago. I've never, ever missed one since I was about 10 years old. But I've had pain in this area of my mouth for about 18 months on and off every few months, I've bought some "extra strength" sensitive toothpaste from the same dentist about 1 yr ago (which unfortunately didn't do much, but i figured it was worth a shot ).

Also - I wouldn't be entitled to free treatment as I earn too much for that, I checked earlier in the year. Unfortunately supporting more than myself means although I appear too cash rich for government help, we just don't have the disposable income to cover dental treatment beyond checkups - this emergency fee literally has my food cash down to a tenner this week. I'll be resorting to the MSE bulk cooking threads later in the week :rotfl:Bloody depressing!

Many thanks for linking the PDF with the clarification on charges - it's the kind of thing I was looking for - off to take a look now!

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Edit: Wow you weren't joking - that file is huge. Unfortunately I've been unable to locate the bits where it confirms "there is no minimum or maximum number of teeth to be scaled to qualify for a scale and polish fee which is also claimable for simple periodontal treatment ie if you had a gum abcess which was treated"

(also - to clarify - they haven't "treated" my gum lump (it's not a tooth that's hurting, really, not that it matters for this discussion!) as far as I'm aware as they don't know what it is - I've been given anti biotics and refer to the dentist hospital for an appointment, I didn't add that info)

I'm going to assume it's somewhere in there though, so that's good to get it clarified.

I still wonder if the £30 anti biotics fee could have been reduced in any way, and if the scale/polish could be avoided in future ; heck, even if they changed it to "check up" that would make more sense I only queried it being there because I wanted to make sure my records were accurate if they were being sent to the hospital, but maybe that's what they call all types of appointments on all patient records, for all I know...

brook2jack

"Poking around for a while" could very well be subgingival scaling or drainage of a gum abcess or curretage of a cyst around a wisdom tooth all of which would qualify for a code 1001 treatment or as it is simply called "scale and polish" .
'
More complex gum treatment does depend on number of teeth and number of visits but simple scaling does not need a minimum number of teeth to claim it.

You should also have been charged for your xrays (£3.16 to £14 upwards) as part of your treatment, so the breakdown of £10.10 for s and p and the rest for antibiotics doesn't sound right.

Incidentally there is a standard NHS charge just for issuing a prescription for this sort of problem £6.05 but it doesn't sound as if that was what was required if you had something put under the gums. I think you need to clarify this as there is no NHS charge equating to £30 ish for antibiotic type treatment.

sa_06

brook2jack wrote: »

"Poking around for a while" could very well be subgingival scaling or drainage of a gum abcess or curretage of a cyst around a wisdom tooth all of which would qualify for a code 1001 treatment or as it is simply called "scale and polish" .

Could have been what you call "subgingival scaling" then. Not draining an abcess since they don't know if it is that, nor confirmation that it's a cyst.

brook2jack wrote: »

More complex gum treatment does depend on number of teeth and number of visits but simple scaling does not need a minimum number of teeth to claim it.

That's good to have it confirmed elsewhere than the reception lady So in future I should probably ask that they're all done then I guess!

brook2jack wrote: »

You should also have been charged for your xrays (£3.16 to £14 upwards) as part of your treatment, so the breakdown of £10.10 for s and p and the rest for antibiotics doesn't sound right.

I can confirm there was no charge for X-rays (although i did pay this the last time I was there, 4 or 5 months ago - small x rays, not the fuller gum ones like they did today). So i'm as confused as you on that score.

brook2jack wrote: »

Incidentally there is a standard NHS charge just for issuing a prescription for this sort of problem £6.05 but it doesn't sound as if that was what was required if you had something put under the gums. I think you need to clarify this as there is no NHS charge equating to £30 ish for antibiotic type treatment.

Again, didn't know the fee for issuing a prescription, £6-odd seems cheap! I have no idea if other anti biotics were an option - again, I didn't think to ask, since I heard the word "anti biotics" I assumed this would be a prescription fee of some sort and immediately clear if i queried prices (just not £30 - again, don't mind paying this if it is accurate). It is called "Periochip" on the bill if that helps.

brook2jack

Periochip is a private treatment , not available on the NHS and is not an antibiotic it is an "antiseptic" type of treatment (chlorhexidine on a dissolvable membrane that releases antiseptic over some time and is used for gum problems).
There definately is a charge for x rays £9.82 minimum for an opg (full) x ray.

NHS receptions are very busy places and mistakes can be made. Your breakdown of costs doesn't sound right in that you haven't been charged for some things and charged oddly overall.

sa_06

This reception wasn't busy, the waiting room had an elderly gentleman (blind) with his wife (forgot her glasses) so I got chatting to them in the waiting room because she asked for help seeing what was written on the forms. They went before me. After, the waiting room was empty (the ENTIRE room, never seen it like that before!). So defintely no time / busy distractions there, although simple human mistakes do occur - I've made them myself

Not sure what to do now. I was going to just switch dentists tbh - but now you've got me worried that I'll get chased for more charges if they realised there's been a mistake. The dentist definitely told me I was getting anti biotics when he was prodding my gum (lump) - he checked my allergies etc.

So I'm more confused than ever now Do I query my bill again or leave it?

brook2jack

sa_06 wrote: »

The dentist definitely told me I was getting anti biotics when he was prodding my gum (lump) - he checked my allergies and I had to confirm there wasn't any St John Wart in the anti biotics due to contraception issues.

So I'm more confused than ever now Do I query my bill again or leave it?

I am really confused here ... St Johns Wort is in no antibiotics or conventional medicines but should be mentioned to a doctor if you are self medicating with it as it interacts with many medicines such as anticoagulants, antihistamines etc

Antibiotics only affect contraceptive pills as they can cause an upset tummy and it's the upset tummy that stops the pill working.

It is possible if you were allergic to the normal antibiotics that he may have used the periochip as an alternative.

As to querying the charge or changing dentists only you can decide.If you change ask for recommendations from friends/family first.

sa_06

Yes, Brook, I've taken that out, because doing some googling I've realised it isn't related. I just remember a GP telling me about it when taking things and the warnings about ensuring stuff doesn't interact badly - ignore that part! I suspect those warnings went too far and I've mixed up the anti biotics issue up in with it.

I'm allergic to asprin, which might be relevant for prescription purposes then.

I will ask for recommendations for NHS dentists in the area, thank you again for your help/clarification!

sa_06

Hang on a second - some websites appear to be saying that Scottish residents get free eye tests, free prescriptions (which I knew about) and free dental checkups from 2007 onwards. Yet I'm with the NHS dentist and we ALWAYS have a fee to pay at checkups even if no work is done. (Obviously that's what I expect, since I thought we had a checkup fee to pay... and naturally for any work done like fillings, which are very very rare - 1 in about 6 years).

Is that true or not? Have we been paying for a scale and polish every 6 months thinking that's the checkup fee?

If this is true, this is total news to me - I hate getting a polish and scale (too hot on the teeth) and just thought it was part of the checkup process if you needed it. Now i find it might be optional, nay, the very thing we've been charged for?! But not billed for the actual checkup?

welshdent

a free check up would I imagine apply to the routine examinations. An emergency one probably not. Difficult to say without seeing you and your notes. In scotland it is fee per item son unfortunately for the patient they do need to be billed for each thing done. Something to bear in mind about the S+P charge .... it may well be that they DID do sub gingival curettage .... but that is actually a higher fee so they may well have been trying to keep costs down for you.