Should I insist on NHS treatment to my dentist?

kevinlad

Recently I was told I need a root canal treatment and a crown afterwards. The first thing my dentist told me was the equipment and materials they are going to use. She explained in long details but the first thing I asked was how much it will cost. She answered around £1500 (!). I asked is this necessary and could I opt for NHS treatment. She said yes but then lost interest and just asked me to sign something. Now can anyone tell me:

1. If I want my dentist to treat me nicely (your teeth in their hands!), should I give up and do it privately (I'm not sure I can afford it though). Having said that are they really allowed to treat patients differently (apart from equipment and materials) just because they are NHS patients?

2. Do dentists earn more from private treatments (she does not own the practice but one of the many dentists working there, so I guess she is receiving a fixed salary).

What should I do (with pain at the moment of writing)?
Kevin

Toothsmith

If they are offering both systems then you are quite right to expect that done on the NHS you are getting nothing less than the dentist's full care and attention.

Simple economics probably mean that they cannot offer the very best drill systems (Which have to be single use then disposed of) and fillers to an NHS patient, but a root filling can be done perfectly well with more basic materials so long as the correct time is spent on it, and basic things like rubber dam are used to isolate the tooth.

The dentist should not be 'rushing' it or bodging it just because you're NHS.

Yes - the dentist will earn more by doing it private, because the NHS contract is fixed, whatever they do, and so any private fees will be on top of that.

But - some of what you are spending will be going on the extra and better materials used on you.

brook2jack

The simple answer is time ,equipment, materials are different privately. The NHS fee will get you the cheapest equipment, materials and shortest time.

Top quality root treatment will involve use of microscope for teeth with multiple roots, the use of specialist materials and equipment which cost more alone than the total nhs fee. The laboratory fee alone for a top quality private crown can be more than the total nhs fee. The time spent should be alot more than that spent on NHS treatment because when you pay privately you pay for time.

You may be surprised to hear dentists do not , on the whole, earn any more from private dentistry (figures published show 5% difference nhs to private) as the overheads in terms of materials ,costs, time are much much higher for private treatment.

All of that being said no dental treatment is 100% guaranteed private or nhs and you should ask your dentist about the likely success rate for treatment on this tooth to give you an idea of how much you want to invest on saving it.

welshdent

We would earn more for doing a root filling privately but thats not hard as we dont earn anything at all for doing it on the NHS! Not justifying it just saying

DentalNomad

£1500 typically should get you seen and treated by a specialist endodontist (root canal expert) AND a crown on top.

Is this dentist a specialist in endodontics? If not then she has no place charging that amount.

Although as a dentist I'm not supposed to say this - there is NO WAY I would have any of my teeth root treated on the NHS, unless I personally knew the dentist in question and it was a favour of sorts.

Using the best materials available for a root canal treatment costs vastly more than the insulting £48 NHS dentists can charge their patients.

How root canal treatments made their way into the band 2 slot boggles my mind.

brook2jack

Ah but dentalnomad it's not just one root treatment, band two covers check ups, x rays , gum treatment, all fillings and all root treatments.

As a nhs surgery costs £130 upwards an hour to run and a total band two treatment will typically earn a practice £66 in total it is a nonsense.

DentalNomad

Absolutely. Considering a specialist could easily spend 90 minutes x 2 on a molar endo alone... I fail to understand how the NHS banding system reflects the complexity involved.

Of course now they call it a "Swings and roundabouts" contract, when what they actually mean is it's a "We have no clue what is going on, we messed it up, hard cheese" contract.

Of course every dentist is different, but I book a total of 2 hours minimum for a molar endo, to ensure I've done the best job I can. Materials set me back close to £100 per molar. Patients get the impression that they are entitled to this level of attention for their £48 on the NHS... Sorry but if every patient needed endodontics and this level of care was given to each and every one then say goodbye to your NHS dentist because he/she'll be bankrupt within the year.

welshdent

I wouldnt have an NHS endo either!

Josepina

Interesting thread maybe someone can hekp me?

On 16th April I developed a dental abscess and chipped a big section on my molar. I'm a doctor so started myself on antibiotics + booked in to see my dentist, I'm a NHS patient.
Dentist said because tooth had been heavily filled previously and was now badly chipped it needed a crown. He said he didn't think it needed root canal treatment. I accepted this and at extra cost decided to pay the extra for a white crown.
When the crown was fitted on 1st May I asked him again about the lump from the abscess (this was not painful but I was aware it was there and could feel it with my tongue). He spayed my tooth with cold air which wasn't painful so he said it wasn't a problem.
On 4th May I was going on holiday and again I realised I was developing an abscess, because I was going to a remote location I restarted the antibiotics and continued them for 2 weeks until my return.
I went back to my dentist on 24th May and now he says I need a root canal treatment.
He's given me 4 options, 1 = NHS £45, 2 = he does it privately £177, 3 = another dentist within same practise who has special interest in RCT £250, 4 = specialist endodontist £800.
He says if he does it he will drill thru new crown, do RCT then fill crown. I'm thinking he should really be replacing that crown because filling it won't give such a good seal?
Overall I feel disappointed in him, I think he should have known the abscess would recur and he should have done RCT before the crown, I feel like he's just trying to make as much money out of me as possible. Am I right in thinking this or am I being too harsh on him? Any advice really appreciated.

Toothsmith

That's a lot of options he's given you! But as one is NHS, then that's fine, as you're an NHS patient.

Did you tell him you'd self-medicated? And that you'd diagnosed an abscess on yourself?

Lots of patients 'think' they have abscesses when they don't - if he didn't know you'd taken antibiotics, then there might possible not have been much sign of one for him to see.

The tooth being non-responsive to cold would make me think there was a problem though, rather than things were OK.

It would seem like an error of diagnosis has been made here, but in a busy NHS practice, when a patient's self-medication might have masked symptoms, it's possible to see how that might have happened.

On a bit of an aside here - I found Drs were the most polar of patients when I was converting my practice to private 14 yrs ago.

There were those who understood the problems of time constraints within the NHS and understood exactly what I was trying to do, and willingly signed up for it - and there were those who were vehemently opposed to it. They'd sold their lives to the NHS and the NHS was exactly how they wanted their care nomatter how imperfect the system. There were very few 'on the fence'.

I still maintain that 'private' options in a mainly NHS practice are the worst of all worlds.

Unless the practice is incredibly well organised, the vast majority of it will still be under great time pressure, and yet you'll be choosing to pay more for individual items that the dentist will not be doing every single day.

Proper 'private' practice involves slowing everything down and making the customer experience a slower, more relaxing journey right from the booking proceedure to the final result, and continuing aftercare. You can't do that if you're still looking after thousands of patients.

I would suggest that you look around for dental care where time can be taken, and things can be done right. It will cost you more, but hopefully, the result should be that by one means or another, a drill and your teeth see a lot less of each other.

brook2jack

It's never good to self diagnose a dental abcess as there are multiple types of different abcess eg gum/ tooth etc and many causes of swellings that are not abcess related. Unfortunately taking antibiotics supresses symptoms and can make it difficult to diagnose especially as early stages don't always show up well on an x ray.

If you told your dentist you had a swelling and had started antibiotics then they should have x rayed the tooth and investigated further before doing the crown. It is never ideal to do any root treatment particularly on a molar through a crown. That being said 25% of healthy teeth will need a root treatment at some point after having a crown.

If the dentist knew you had self prescribed antibiotics, that you had had a swelling before the crown and had not investigated the causes then I think you should have a conversation with them over the replacement of the crown and root filling. There is not much point in having a well fitting crown if the root treatment is sub optimal.

If however it was not made clear to him you had taken antibiotics then things are a little less clear as abs remove many of the symptoms used to diagnose a tooth (periapical) abcess.

Root treatment success rates will vary from dentist to dentist, a specialist. Will have a much higher success rate than a general dentists as they take longer and use specialist equipment.