NHS dental charges

afm_2

Hi!
I'm sorry if this should be clear to me but I was looking at the NHS charges and saw that any NHS treatment plan performed within a two-month period will be covered by just one charge (maximum band of the work done). I have been having dental treatment for the same problem for 2 months now. Everytime I get a new appointment it is always for more than a month later. So my question is, will I have to pay a charge for every 2 months period? Or is it just one charge until the finish the work?

Also, when I first got treatment for this issue, I called the dental practice and said that I had pain and wanted an appointment. They saw me on the same day and it was mentioned then that it was an emergency appointment. I have had to go back several times for same day appointments all related with the same problem. Do I have to pay a charge for each of these emergency appointments? Or does it all fall under the same band given that the issue has been the same for all of them?

Finally, is it normal for treatment to take this long? They say that they can't get me appointments sooner because the dentist only goes to that practice twice a week and there are no appointments available. However, since the first treatment, I was told I would need several appointments. Shouldn't they just book a few at a time?

Sorry for all these question but many dentists tend to make things unclear and difficult. And having had issues before with being overcharged, I would like to be fully aware of what are the charges that apply.

Thank you!

welshdent

Its a complicated system set up by public servants to annoy dentists and frustrate patients!

Basically if you have a "problem" and attend in an emergency/rushed slot then usually you can expect to pay to have that managed on a short term measure. Thats termed a band 4 or band 1 urgent course of treatment. That may be a temporary filling or dressing or even a small filling or single extraction. It is designed to get you out of trouble.
If further work is needed or some form of problem is spotted at your regular check up then it falls in to bands 1 2 or 3.

A course of treatment includes examination and whatever else is prescribed. The prescription determines what band you fall in to. When you are charged for a band 3 for a crown you are NOT paying a band 3 for a crown. You are paying band 3 for a course of treatment that INCLUDES a crown. The banding also does not mean you can have everything for one price. You can have what is necessary and advised.

An example of this may be that you have advanced gum disease and some holes. A dentist is quite entitled to place temporary fillings in and clean your mouth up for one band 2 and then call you back in 3 months and place permanent fillings and or take some teeth out for an additional band 2.
You may need some teeth out but do not want gaps so you may have a band 3 to have the teeth out and an immediate denture or bridge. Following healing of the bone you may be required to have another band 3 to place a final restoration.

The treatments are not strictly time limited to 2 months. If you have a course of treatment planned and make appointments which you attend then you would not normally IMO be asked to pay multiple times. IF however you do not make appointments and it has passed longer than 2 months then it is likely the practice will close that course of treatment off because they can not keep the treatment course open indefinitely. Similarly if you fail appointments, cancel multiple appointments at the last minute you may find that treatment is closed off. To have further treatment you would need to pay again.

If you pay to have a denture bridge or crown started but fail to return to have it fitted you would also need to pay again should you return in the future.

Regarding treatment times. All depends on what you are having done and how busy the practice is. If you needed a root filling with me then it is likely you would be waiting a few weeks because I need an hour and a half per appointment and we just do not have that amount of time sitting around at short notice. If you needed a small filling then you can probably get in a lot quicker.

afm_2

Thanks for your reply.
The treatment is for two root canal treatments to two molars. I have been there already 4 times to have the pulp/roots cleared. I now have to go back next month to have them filled but she will only do one tooth and then later do the other. Would you let your patients wait 2 months to get the roots filled? I feel that I should have the right to ask for 2 appointments that are not so far apart. Do I?

I am not sure if I have understood correctly how the charges work. So I had an appointment that was possibly considered and emergency one. Thus, for that, I would have to pay Band 1. The problem continued and I had several same day appointments due to pain in the same area and also for a broken tooth (one that is being treated broke after the treatment started) -- these would still be under the same Band 1 charge that I have to pay, right?

Then I had 3 more appointments for root canal treatment and will have a few more. These would fall in to band 2, right? Would I have to pay a full band 2 or the difference between band 1 and 2?

Thank you so much for always helping out with dental queries

welshdent

It is not unreasonable to leave a root filling procedure to settle. I often do it to allow the medicaments time to work. Root fillings are not as straightforward as one may like. I can not comment on your individual case as I Can not see you or your notes but I can illustrate some examples that I have seen and have been told is permitted by the powers that be.

Firstly root canal treatment can be as little is one course of treatment or as many as 4.

I say 4 because one may count an emergency appointment due to pain as one where you are seen to numb the tooth and take an inflamed nerve out then place a dressing.

After that usually on back teeth I like to place what is called a cuspal coverage restoration to reinforce the tooth so that actually would end up making it a band 3 treatment (crown or onlay). Due to the cost implication and lack of guarantee of root canal treatment success I will often provide the root filling to stabilise the tooth as a band 2. Place a dressing and then review in 3 months to make sure the tooth is ok. If it is then There would be a new course of treatment for the restoration on top.
If a crown is not planned (often it isnt needed on front teeth) then the root filling and sealant filling may be placed all in 1 go as a band 2 outright. If I do not think a tooth should be left without crowning or if a crown had to be removed to do the root filling then you may find the dentist advises to do the root filling and cap all on 1 course of treatment.
If the tooth has a chronic infection and a draining sinus I think it unwise to fill in one go. Generally I would do the initial stage of cleaning and dress it with an antibacterial dressing for a couple of weeks to see if it settles and the sinus goes. If that works then I may fill and then leave it to make sure it is ok for a couple of months.

It all depends on what is the intial diagnosis and how the dentist feel it is most appropriate to manage your case. ALL my patients have it all fully explained to them before I start and if they are unhappy about anything I discuss with them and explain my reasons for what I have proposed. I then get written consent so nothing should come as a surprise. I do not however compromise my treatment plan if I do not think it is appropriate because I could get in to trouble that way.

My advice is to discuss fully what is wrong, what you are having and if you are likely to need crowns down the line. It IS acceptible to have multiple courses of treatment if it is for a health gain i.e. ensuring a root filling is successful. I find people get more upset when things that were more expensive do not work than the cheaper option! LOL.

As an aside I have left a tooth with a large area of bone loss from infection with just a calcium hydroxide dressing in it (after cleaning) for 3 months on occasions and it has worked well. If for whatever reason the treatment is not working it is a lot easier to re do if it is just a paste compared to a well compacted gutta percha filling. But as I said, I make it as clear as I can before I start what is happening and why.

brook2jack

Emergency treatment is band four (same charge as band one) that will be charged for your toothache appointment.Each tooth could be classed as a seperate band four treatment. Band four treatments are independeant of other treatments and charged seperately.

Your root fillings will be band two and you will pay full price for that.

The teeth may well need crowning after a time and that will be a new band three charge which you pay full price for as NHS course of treatment cannot last longer than two months and three months is a rough estimate as to how long most dentists would wait before crowning a root filled tooth. .

This , of course is England and Wales. Scotland and NI have different charges and individual treatments are charged seperately.

afm_2

Thanks for your replies!

I have had 5 emergency appointments due to the same problem. Will those be charged separately? They shouldn't be, right? And emergency treatment should be charged when I get the treatment done right?

Also, the dentist is taking this long to solve the problem not because she thinks it is advisable to do so. It is just that they only have free slots one month ahead. That shouldn't be making my treatment more expensive given that is it not because it is needed, it is because they have no appointments available.

Just 2 final questions:
1. Can I be registered at two NHS dental practices at the same time? I want to have a second opinion from another dentist and move to that practice after this work is done. I was thinking of getting my check-up at the new practice this Friday so that I get registered with them, but I still need to have this treatment finished at the current practice. Would that be possible?

2. Since the treatment started, I am having an awful pain all over my teeth (it changes a lot) and then it feels like the teeth contract or something and I get pain all around the face, head, jaw. This is basically taking over my life as it is constant and nothing stops it. I was told that I was possibly grinding my teeth at night but I know I sleep with my mouth open (difficulty breathing through the nose ). However, it feels like one of the new temporary fillings is higher than the filling that was there before. Could that be the cause of all of this? I am getting desperate and no one seems to really care I don't know where to turn to get a solution to this.

Sorry for all these question but I have never had problems like this and I feel completely lost.


welshdent: I wish I had a dentist like you. My dentist does not explain anything (I have no idea of what is going to be done next, nor if I will need crowns, nothing) and if I ask she behaves as if I am wasting her time. Can't wait to have this finished and move on to another dentist.

brook2jack

You do not need to finish this treatment at dentist one. If you are not happy and having a check up elsewhere then you can have your treatment done there but will have to pay your outstanding bill at dentist one.

There is no registration anymore in England and Wales. You are only registered for the duration of a course of treatment after that there is no obligation for a dentist to see you.

You obviously have quite a few problems and getting them sorted piecemeal will end in disaster. Go to the dentist you trust, get the treatment done there and stock with them.

afm_2

The problem I have is that when I tried to move to another dentist, they refused to continue the treatment that was started at my current practice saying that they didn't want to get involved. I have left that dental practice in tears and will never go back.

For that reason, I won't even mention to this new practice that I would like them to finish the treatment . I will just ask them to check if they can see any other problem given the pain that I feel (no one has even looked at my upper teeth and they hurt soooo much!) I will also see a private dentist next week to discuss this RCTs.

So, is it ok if I go to this new practice this Friday and continue the treatment with the current one?

I am sorry to insist on this but, do you think that the change on the filling's height would have a effect like the one I describe? Thank you for all the help!

afm_2

brook2jack wrote: »

You obviously have quite a few problems and getting them sorted piecemeal will end in disaster. Go to the dentist you trust, get the treatment done there and stock with them.

Just to add that I don't have a few problems. It has always been the same pain and they did these two rcts without even testing the teeth no tap, no cold test, nothing. I just have a pain there and, as they said, it can be referred so, for me, it can well be an upper tooth doing all of this. The problem is that after messing so much with my teeth, this pain all over the mouth/face/head/jaw started and I can't find a solution.

As a scientist, I never start anything without testing all the possibilities and would expect that, when dealing with people's health, dentists would do the same.

brook2jack

From your previous posts you have seen several dentists who have tried to sort out your pain by taking a Top wisdom tooth out and starting root treatments on two teeth. None of these appear to have sorted your pain. You have had x rays etc so it would appear that what is causing your pain may be quite difficult to diagnose. On the face of it a high temporary filling may cause some problems but as from your previous postings this has been an ongoing problem it is difficult to say.

So your history of difficult to diagnose pain, needing two root fillings (one of which is difficult and needs specialist treatment) means you do have a few problems which even without any other work is going to take time to resolve.

welshdent

brook seems to have covered most things. I would say though that personally I would not be charging you each time for new courses of treatment if it were my fault you were booked ahead. You would have the one course of treatment opened and as long as you booked in and attended as planned then I see no problems. As for getting to the cause of your problems I would need to examine you. Its not THAT often I am not able to find the cause of a problem and generally I do not dive in to someting irreversible unless I am confident of the diagnosis. We have a host of tests to build up a picture, from taking an x ray right to the lovely band with a mirror handle. If I am struggling I generally would refer you myself for a second opinion. Thats something you could ask for if there is a nearby dental hospital.
Regards taking on someone else's work, generally no we would not want to interfere. There is no registration in england or wales so you can see anyone with space but I would not advise seeing 2 at the same time for different things. Best bet is to go as a new patient to someone, even with incomplete work, and go from there.