MSE News: OFT calls for dentist industry shake-up

welshdent

dolly I take significant offense at your opening paragraph. I find it ill informed and rather judgemental. I work as an NHS practitioner and it is TOUGH believe you me. I work in 2 practices. I drive a mini, another drives a 7 year old golf someone else drives a newer more basic golf. There are similar stories. It is franly irrelevant what people drive. My cousin is a teacher and drives a brand new audi tt. What does that say about them? They still live with their parents and choose to spend their money how they wish as do I. Now I appreciate you may well have had problems and believe me I am very critical of what I percieve to be poor unethical dentists. But you have no idea how our contract works and you have no idea the pressures we face that you can not see. This fallacy we are all swanning around in porsches leaving patients with ruined mouths is an utter nonsense. I pride myself on proving as high a standard of care I can within the confines of a horribly underfunded system. No I do not mean my pay! I mean how much it actually costs us to give you treatment! That cost is borne entirely by us as is buying the equipment and materials, paying staff and keeping up to date with the ever changing technique and materials.
Sorry for my rant but it REALLY winds me up when I see comments like that.

brook2jack

sheri3466 wrote: »

Can I just say, as a practicing dental surgeon, that scaling and polishing remove harmful hard deposits (calculus / tartar) and soft plaque deposits from teeth / gums. This helps to prevent and treat potentially destructive periodontal disease (gum disease). So please don't post nonsense like 'it is purely cosmetic'. Also, please remember, dental treatment on the NHS is a bargain - where else in the world can you have an operation for under £20, which is what having a tooth out actually is?![/QUOTE

The problem is the NHS contract wanted fewer and simpler courses of treatment. The clinical benefit of the "social scale" where people had tartar/staining removed every six months but didn't change their flossing/cleaning habits is negligable as after 72 hours the tartar reforms. This is very different from treating active gum disease but even in this scenario all a dentist is achieving is making it easier for a patient to manage their gum disease. Gum problems are solved by 80% patient effort and 20% dentist. A six monthly removal of tartar achieves nothing long term clinically.

The problem is the NHS doesn't pay for preventative treatment, it doesn't pay for you to spend the time demonstrating flossing, tepe brushes etc and periodontal treatment ( treatment of gum disease ) is woefully under funded.

samasama

Fortunately(?) I don't earn enough to have to pay for any of my dental treatment :undecided

Here's a link to the list of charges and explanations of treatment bands for NHS dental treatment.
(EDIT : I can't post the link as I'm too new ... search NHS dental charges and there's a link to the April 2012 charges - some of the nhs.uk links give more details on the treatment bands.

I suggest printing it off and taking it with you!

I too was referred to the hygienist - £45 a go. So I saved up and went - to be told I needed to go and see her at least once a month for quite a while. Other than checking my teeth and advising me to get dental toothpick things and a stupidly expensive electric toothbrush (almost £100 at the surgery - about £70 in Argos), she didn't do much for my hard-saved cash. In fact she was very patronising when I said there was no way I could afford the toothbrush (quote "well if you're not going to make an effort to improve your dental care it seems rather pointless asking me for advice, your teeth and gums will continue to deteriorate without using that brush"). I then pointed out I couldn't really afford her charges either and she lost all interest in talking further, she rapidly cleaned my teeth (took just over a minute) and hurried me out of the door. Her attitude had changed instantly from happy/chatty to rapid/dismissive. That £45 fee took 3 weeks saving (from the family food money) and to go more regularly would mean me losing a lot of weight!! As it turns out, with a lot of concentration on flossing and cleaning I've managed to improve things myself - at the last visit the dentist said "oh, I see the trips to the hygienist are paying off" !!!

There are good and bad in all people/professions ... I'm not saying all dentists/hygienists act the same - I've had superb private care, superb NHS care and unbelievably appalling NHS care.

j.e.j.

samasama wrote: »

That £45 fee took 3 weeks saving (from the family food money)

I think this is something a lot of people on here just don't understand. What seems like a relatively small amount of money is actually quite hard to come by if someone is on a very low income.

and no, you don't 'need' an electric toothbrush

welshdent

Equally by the same token, we have no control over the fees that are set. You DO get a hell of a lot for that £45. I accept for some it is a lot to stretch to but where does it all stop?? We are not a charity. Our staff dont work for free. They are not employed by the NHS. They are employed by us. Where do we get the materials from to actually fill your teeth? Where do we get the tools to do the work?
The government set the fees we just do the work. But as a comparison, £45 is extremely reasonable for what you can potentially get compared to what it costs us to provide or what you would have to pay privately even if the fees were low. Also you do make an interesting point re not NEEDING an electric toothbrush. However that investment could be the one thing that prevents you needing any other work doing again. Buying a cheap toothbrush and toothpaste, not using them correctly could be a false economy for the additional dental work that may be needed. Compared to a £45 toothbrush that potentially could mean you dont need anything done.

Pennylane

welshdent wrote: »

Equally by the same token, we have no control over the fees that are set. You DO get a hell of a lot for that £45. I accept for some it is a lot to stretch to but where does it all stop?? We are not a charity. Our staff dont work for free. They are not employed by the NHS. They are employed by us. Where do we get the materials from to actually fill your teeth? Where do we get the tools to do the work?
The government set the fees we just do the work. But as a comparison, £45 is extremely reasonable for what you can potentially get compared to what it costs us to provide or what you would have to pay privately even if the fees were low. Also you do make an interesting point re not NEEDING an electric toothbrush. However that investment could be the one thing that prevents you needing any other work doing again. Buying a cheap toothbrush and toothpaste, not using them correctly could be a false economy for the additional dental work that may be needed. Compared to a £45 toothbrush that potentially could mean you dont need anything done.

Welshdent - Regarding Samasama's post, I don't think you have much idea of how hard it is for some people to save up £45 to visit the hygienist or £100 for an electric toothbrush. I could easily choose to spend £100 on a toothbrush these days but when my kids were small we literally didn't have 2 pennies to rub together. So I can see where Samasama is coming from.

welshdent

So can I but no one seems to see where I am coming from. We have no control over it. The DOH set the fees. there is little point complaining to dentists about it because we have ZERO influence over it. Re the toothbrush, I was just highlighting that "saving" by getting a cheap hand brush can be a false economy if not used right as it can end up costing far more in the future. No one HAS to have dentistry done. I have an 89 year old patient who has every single tooth in his head and has never had ANYTHING done.
I completely understand that some peoples financial position means that they find it hard to afford even the lower costing dental procedures but I am trying to highlight a wider picture. Everyone seems very focused on a narrow field of immediate cost but there is so much more to be considered if you stop and think.

j.e.j.

welshdent wrote: »

Equally by the same token, we have no control over the fees that are set. You DO get a hell of a lot for that £45. I accept for some it is a lot to stretch to but where does it all stop?? We are not a charity. Our staff dont work for free. They are not employed by the NHS. They are employed by us. Where do we get the materials from to actually fill your teeth? Where do we get the tools to do the work?
The government set the fees we just do the work. But as a comparison, £45 is extremely reasonable for what you can potentially get compared to what it costs us to provide or what you would have to pay privately even if the fees were low. Also you do make an interesting point re not NEEDING an electric toothbrush. However that investment could be the one thing that prevents you needing any other work doing again. Buying a cheap toothbrush and toothpaste, not using them correctly could be a false economy for the additional dental work that may be needed. Compared to a £45 toothbrush that potentially could mean you dont need anything done.

Well I bow to your knowledge on the electric toothbrush issue I'm sticking with my normal OralB one and my £1 aquafresh :money::rotfl:

I think the bit that I've put in bold is where the misperceptions (and arguments!) arise? You're not a charity, and more to the point you're not a 'health service' as we understand it, - you have to run it like a business.

If someone goes to the doctors or to the hospital, they don't pay (well, they do, thru the tax system). It should (IMO) be the same for dentistry, given that it is essential for health. But I guess that's slightly off topic, and more one for Discussion Time.

welshdent

I actually agree. Well to a point! What I think is the DOH need to be explicit with what IS and ISNT available on the NHS. I personally favour a core service. Currently they pain a picture of you can have it all then leave it to us to look like the bad guys explaining what is and isnt available to you as an NHS patient.
A prime example is bridge work. Patients are not entitled to a bridge on the NHS. They are entitled to the most appropriate method of filling a space should it NEED filling. Now for a single tooth anteriorly that may well mean a bridge but it can also be a denture or an implant. It depends on the situation. For multiple missing teeth then a bridge probably is NOT appropriate. It is an expensive solution that in all likelyhood will not last as long as a denture and cause more problems.

A lower first molar tooth being extracted with teeth in front and beyond in all honesty is unlikely to warrant any replacement on the NHS... but this isnt made clear by the DOH. It is left to us to explain it to people.

Believe it or not I feel a core service would satisfy a hell of a lot of people and would then lead to probably more competitive private treatments. With the lab I use, some normally band 3 treatments can be provided more cheaply privately than as part of an NHS treatment plan. Those that just want to rock up and have a tooth pulled out wouyldnt notice much difference. Those that WANT nice work but end up with basic nhs work would probably end up with nicer work. It is indeed a massive subject area and not for this thread but I DO agree that standard NHS dentistry should be provided for free.

bargainhunterz1

The problem we have is one person who is unhappy about something they complain to at least 10 other people, conversely if someone is happy, only one person if you are lucky hears about it

A lot of the time the problem is where people want cosmetic work done on the NHS, for example stain removal ( usually from smoking or drinking coffee etc) They are then aggrieved when this is unavailable on the NHS.

Stains do not cause any issue to your health so why should the NHS cover it? Whilst I understand it is difficult to quit smoking, there are many people who claim they cannot afford £35-45 for the stains to be removed but they can afford the pack a day of cigarettes 7 days a week.

The NHS is stretched, I would like to provide more cosmetic options but I understand that when we live in a world where cancer treatments are restricted why should people be offered veneers to cover 6 of their front teeth?

The system at present works very very well for the vast majority who seek NHS treatment. Where in the world could you have any number of fillings and extractions to the pricely sum of £47 with a general clean, check up and xrays??


The profession is being robustly regulated and all the costs are at a burden on the practice/dentist, the government has nicely packaged it that way.

If the government set up their own centres it would cost them a great deal more
Does it not occur to people that most of the press is propaganda?
We do not get fair press in the slightest, and if there are issues its usually a very very small minority that game.


I agree with the above posts, I drive a nice car as I live with my parents, had I owned a practice or my own home, I would not have been able to afford it

Its funny how people only pay for what they want and not what they need.I have never heard anyone complain about their trip to the hairdressers or nail salon, but woe betide us money grabbing dentists. We have worked hard to be where we are, kept up to date with professional development, paid for all the checks and so forth.
ok that is my rant over!