Private v. NHS Dentist

welshdent

X rays are only a guide. Sadly with the human body it is simply impossible to say for certain the information you are looking for. We can give a guide based on our experience but x rays only tell a small amount of the story. Until we go in and remove the decay we do not know for sure how extensive it is. Also a deep amount of decay in you may settle just fine. A shallower amount of decay in someone else could be all the nerve needs to flare up and die off needed root treatment or extraction of the tooth.
We do procedures and take approaches that evidence indicates usually works, but in medicine there are ALWAYS outliers. Without seeing your mouth we can not make our own judgments but we CAN say what I have outlined because we make those judgement calls every day.

Undervalued

welshdent wrote: »

X rays are only a guide. Sadly with the human body it is simply impossible to say for certain the information you are looking for. We can give a guide based on our experience but x rays only tell a small amount of the story. Until we go in and remove the decay we do not know for sure how extensive it is. Also a deep amount of decay in you may settle just fine. A shallower amount of decay in someone else could be all the nerve needs to flare up and die off needed root treatment or extraction of the tooth.
We do procedures and take approaches that evidence indicates usually works, but in medicine there are ALWAYS outliers. Without seeing your mouth we can not make our own judgments but we CAN say what I have outlined because we make those judgement calls every day.

Yes, thanks.

I can fully understand what you are saying and can see similarities with my own line of work.

The blunt financial question, from the client's point of view, is who should be taking the risk?

One argument, from the patient's perspective, is the the dentist has the training and has had the opportunity to look for as long as they felt necessary. They have also had, at my expense, X-Rays to help them. If, despite this they have made the wrong call I would be the one picking up the tab. I suppose this is a bit like paying for your lawyer's advice even if you don't win your case!

Rightly or wrongly I suspect most people buying a service for the first time are a bit uneasy. My feelings about the practice / person were OK ish. As I said, had I been looking and had they offered NHS I'm pretty sure I would make the change. The prices I've been quoted are (for no particular reason) at the top end of what I had imagined paying if I went private. Had they said a couple of hundred more it would have been easy, I'd have walked away. What I'm not prepared to do is say yes then have it creep up.

My inclination is to have one attempt at getting a guarantee on price and ongoing cost and if they decline call it a day.

brook2jack

An x ray is only a two dimensional representation of a split second of the hard bits of a three dimensional living piece of tissue. It doesn't even give you a proper representation of decay which may not appear on a x ray at all! It doesn't show cracks on teeth which are very dificult to diagnose and are often only spotted once the tooth is drilled. It doesn't show you soft tissues.

It gives you no idea if an individuals inflammatory or immune system. It gives you no idea of how an individuals body will react to treatment.

A dentist could spend all day examining you but will not know these answers until he treats you.

Thus is the essential difference between a human and a car. Different treatments are appropriate and have different effects on an individual. No one can guarantee what the outcome of any treatment will be.

The end result is a dentist would be mad to guarantee you will be in any band until they have finished treatment. You have to be dentally fit and the treatment you may need may bring you over into the next band not due to the dentists fault but how your body reacts to the disease present.

You are an individual not a mass produced piece of machinery with a manual and easy fixes. It is why medicine and dentistry is so different from engineering, you have the mechanical and biological challenges on top. Any dental treatment always has its risks and these can be impossible to predict in advance. You are just being asked to pay for treatment to get you fit and to accept it may not be possible to predict what that treatment will be.

All consent forms nhs and private say that treatment may change from the treatment plan and the consequence for this in denplan is more complex treatment may mean a higher band.

The bottom line is there is no dentist in the world who will guarantee that a treatment plan is all that there is to be done, and no dentist who will guarantee what band on denplan you will be on. There is no way any dentist can guarantee they will not find a problem they did not know about before treatment starts, so costs may always creep up eg a deep filling may turn out to need a root treatment, a small filling turns out larger.

welshdent

Better than I could have put it ;-)

Undervalued

Many thanks brook2jack and welshdent for your detailed replies. I wish I'd asked earlier!

It is a great pity this information was not forthcoming from the practice before I made an appointment.

I was given the clear impression (wrongly it now seems) that I would leave the "detailed assessment" with two clear figures. One would be for any remedial work that was needed and the other a fixed monthly price for insurance.

Instead I have a estimate for £380 for work which would cost me £45 on the NHS, a fairly wide band as a "guide" to what the ongoing monthly cost may be and no guarantee that I will not have to pay for further work before I can be accepted!

Had I known what I know now I wouldn't have booked and I'd have saved the thirty pounds I've already spent.

welshdent

What you get for 45 ad what you get for 380 while achieving similar aims are not likely to be the "same" also they have probably quoted for what they believe is needed but can not possiy quote for what MAY be needed as things change. But it would be wise to explain things could change. Also if you are on a maintenance plan, once they are happy you are fit - If that changes in say 6 months time and a root filling is needed then it would be covered by the plan (usually!)

little_woman

I moved to North Hampshire about 14 years ago, to find no NHS dentists in the area. But I have not been disappointed. Yes it can cost more, but I am always told in advance what the options are, costs, what is essential and what is not so I can decide what I want. I also have had work done which would never have been done on the NHS, and it was nice to have the choice.

I now pay £13.50 a month and no longer live in fear of seeing the dentist (which I did when living in London with a NHS dentist). My 83 yr old mother now also goes private and has found she gets better treatment and its also cheaper than getting private treatement from a NHS dentist! But I think thats because all our dentists are private, and they have to be competitive, as its just a case of ringing round to compare prices when first choosing a dentist as well as getting recommendations from friends for which dentist!

Undervalued

welshdent wrote: »

What you get for 45 ad what you get for 380 while achieving similar aims are not likely to be the "same"

Well I would certainly hope that is the case!

I'm sure you must understand that, from a first time customer / client / patient point of view, this is difficult to grasp and almost impossible to verify.

Some information about the advantages to be had from private dentistry may have helped. I can't imagine I'm the first person to have these dilemmas.

Maybe I'm looking at this too much from a commercial / client point of view whereas you and they are in effect saying "trust me, I'm a Doctor".

As I tried to explain at the beginning of all this I was hoping to have found something slightly better, more understanding and personal than my current impression of the NHS and was willing to pay £25 or so per month for the privilege. Maybe that is not realistic? This setup rather reminded me of a modern version of my current NHS practice when it first opened 30 years ago. A couple of young (ish) dentists working in a converted semi in a residential road. For twenty years or more I would (and did) recommend my old dentist to my friends. In the last five years or so we all felt standards were slipping and the surgery became, frankly, shabby. Interestingly none of us has been advised he has retired, we have found this out on the grapevine from other patients who tried to book. The place is apparently being done up and somebody else is taking over. I have no idea on what basis, we have not been told!

My decision to look elsewhere has overlapped with this. Maybe I should hold fire and see what happens at the old place?

brook2jack

There is no such thing as registration in england and wales on the nhs any more so a dentist no longer has a "list " of patients. Thats why no one was informed the practice was being sold. If you live in Scotland or NI and it has been a "year or so" since you were last in you won't be registered anyway.

Depending on what area it is there may still be negotiations going on with the pct for the surgery to continue with some nhs treatment. The contracts for nhs work cannot transfer to new owners and have to be bid for in a contracting process. In many areas they will not give out new contracts even if the previous owner had a nhs contract.

Never assume because a practice offered nhs treatment in the past it will in the future and always make sure when booking an appointment you know if it is nhs or private.

Ultimately the relationship between a dentist and patient has to be one of trust. If you don't trust the dentist find someone else because ultimately there will come a point where you have to trust them to do their job. It is stressful as a patient being treated by someone you don't trust and stressful as a dentist to treat someone who is mistrustful .

Ilona

I have been reading this with interest, and would like to say thank you to the dentists on here, you are very easy to understand with your clear and concise answers.

My dentist has private and NHS patients. I elected to stay with the NHS side as I am more than happy with the treatment I get. However, I was given the option of having private treatment for a lengthy and complicated bridge job, which I chose to take. It was a lot more expensive obviously, but with the bridge being four teeth right at the front it had to be perfect. For other smaller jobs like fillings I find NHS is perfectly acceptable. Mind you I haven't had any work done for about three years now, I always get 10 out of 10 for dental hygiene.
Ilona