Can a dentist insist you see a hygienist?

Rella

I'm having a cosmetic procedure (inman aligner) done with a private dentist, which I've paid for upfront. I also see an NHS dentist (who I've had for a couple of years) for normal checkups. Today I saw my private dentist and when I got back to reception to make the next appointment the receptionist said he'd sent a message that I needed to make a hygienist appointment. The dentist hadn't mentioned it to me although he did have to clean a bit of plaque off but nothing major. I was in a hurry so (stupidly) didn't query it and booked the hygienist appointment.

However I've now checked on their website what the cost would be and it says between £50 and £80 for a hygienist visit which I'm not willing to pay. I don't believe that I need the hygienist because I saw my NHS dentist a few weeks back and he did a quick descale (one tooth - much less than on previous visits) and then said that I didn't need to keeping coming back every 6 months because I was getting much better at keeping them clean, so a year would be fine. I've no fillings and my teeth look fine to me scale-wise although the cosmetic dentist put a "stop" on one incisor 2 weeks ago which I am having a bit of trouble cleaning around - it was there that he cleaned today.

Can the dentist refuse to finish the cosmetic procedure if I won't see the hygienist? I'm worried they will do this but I feel a bit railroaded into it. Either my private dentist is trying to get some more money out of me or my NHS dentist didn't clean them very well.

brook2jack

When you have a brace you need to maintain a much higher standard of oral hygiene because decay and gum disease occur much more easily when wearing alligners with rapid and disastrous consequences.

You've spent alot of money on braces so if the orthodontist is concerned there is a problem why spoil the possible outcome for the treatment and more importantly the preventative advice and cleaning techniques the hygienist will show you to have the correct hygiene routine for someone wearing braces. It is not your nhs dentist who didn't clean your teeth properly it's you who needs the hygienist to show you the techniques to clean your teeth with alligners properly so the thousands you have invested in your teeth now won't be wasted in future.

londondent

As brook said, Its imperative to maintain excellent oral hygiene whilst wearing appliances in your mouth. Any lapse in Diet/oral hygiene could very well compromise the final aesthetic result because of swollen gums or early de calcification of the enamel causing brown/white spots on your teeth.

Remember A hygienist is not Just there to clean your teeth, the preventive advice they can offer is far more valuable, and helps you to maintain a healthier smile.

Toothsmith

I'd agree with my colleagues above!

Rella

I'm not trying to spoil the outcome, I'm querying whether it is necessary given that my teeth were fine as inspected by a dentist less than four weeks ago and my private dentist has said nothing on the subject of my oral hygiene until today.

Just because I found the money for the aligner does not mean that I find potentially £80 and at least £50 for a hygienist visit acceptable.

I would also like to know whether I have to see his hygienist or whether I can arrange to see someone elsewhere who is cheaper (my previous private dentist charges £35). I'm likely to only need a few more weeks with the aligner (two weeks ago he said 2-4 weeks, he wouldn't be drawn today) so it seems a bit OTT to me.

Thanks.

Rella

Sorry, to be clear regarding the first para of my last post, I'm not querying with the forum whether the hygienist is necessary - I'll take that up with the dentist. I'm querying whether he can refuse to treat me further if I refuse to see his hygienist.

Toothsmith

You're comparing two different things.

Generally, an NHS dentist will look at you and say "There is no disease here - therefore you are fine". And that's great, as far as it goes.

You have gone to your private dentist and said, "I appreciate that there is nothing wrong with my teeth, but I want you to do something to make them look better".

This dentist has said "There is nothing wrong with your teeth, but I am willing to use my skill and judgement to improve how they look if that is what you want."

Now - no treament is risk free, and if you are doing something for someone purely for cosmetic reasons, it is vital that you do everything that you can to make sure that the treatment causes no damage.

Braces can irritate the gums, and plaque control has to be really good to ensure that gum problems are kept to an absolute minimum.

So, whilst your gums might have been perfectly acceptable to an NHS dentist looking for signs of active disease, they could easily still look to be a potential problem to a dentist looking to provide you with the cosmetic treatment you have requested.

It's a bit of a shame he's not been able to communicate this to you in a way that you're happy with. Really, he should have explained it a lot better. But I can see the reasoning behind his request for you to see the hygienist, and I would hope once you've seen her, you will feel it's money well spent.

Toothsmith

Rella wrote: »

Sorry, to be clear regarding the first para of my last post, I'm not querying with the forum whether the hygienist is necessary - I'll take that up with the dentist. I'm querying whether he can refuse to treat me further if I refuse to see his hygienist.

If he is unhappy with the state of your gums or your oral hygiene, then it would be right and proper of him to refuse to proceed with a purely cosmetic treatment that he feels might cause you harm.

I have seen (kids) with poor oral hygine who have been made a right mess of by orthodontists pushing on with treatment when really it should have been refused.

brook2jack

A hygienist can only work to a dentists prescription, so to see a hygienist at another practice you would either need a check up there or a referral from your orthodontist.

Your alligners may only need a few more weeks but most orthodontists would want you to wear some sort of retainer or to have retainers glued to the back of the teeth. These also need more careful cleaning.

You have a problem with your oral hygiene, the orthodontist is trying to ensure you have preventative advice and treatment to preserve the longterm result you have spent time and money on, rather than leaving you to your own devices and allowing problems to develop.

If you needed scaling it means plaque has been left undisturbed for 72 hours and has started to solidify. So 72 hours after you have seen your nhs dentist problems are starting again. Now your nhs check ups are going to be even further apart so any problems will have longer to build up. In my opinion the orthodontist is not trying to get more money out of you but trying to give you the tools to protect your investment.

The relationship between a dentist and patient is one of trust. If a dentist advises something is clinically necessary a patient can refuse but that relationship is eroded and the patient has to accept the compromised treatment that may ensue eg if oral hygiene is not immaculate it may be good practice to finish orthodontic treatment before an optimal result achieved to save the health of the teeth. So the orthodontist may have to alter treatment if they feel you are not following good oral health practice.

Rella

He didn't explain anything to me at all, just got his receptionist to do the dirty work.

Look thanks, but none of you have answered the question. I am quite willing to see a hygienist if he deems it necessary, but I am not willing to see the one at his practice, partly because of cost and partly because of convenience (she only works one day a week). If I see an independent hygienist and they say "your teeth really need a clean" then fair go. If they say "they really didn't need doing" then I'm going to be cross, but at least he hasn't made £80 out of it.

Rella

No, the NHS dentist was 4 weeks ago. Not 72 hours.

Yes I know I will have to wear a fixed retainer.

Ok, you've part answered that I can't go see another hygienist without a dentist referral, (which will end up costing almost as much if not more) thanks for that. I fully admit that I don't trust this bloke mainly because he wasn't upfront with me and I'm pretty annoyed about it. I'll see what they say tomorrow.