NHS dentist fobbing me off, or has he got a point?

mda99das

murphydog, how much do you want to save the tooth?
On the NHS they will use handfiles to clean out the system. There is no way that you can use rotary files (machine which gives a better level of cleaning) on the pathetic funding the NHS supplies. In fact the 3 funding points won't even cover the cost of the files.
Its totally up to you, the end result on the x-ray may look good, but who knows how well it has been disinfected from the inside. There is no way you can do that with handfiles and a bit of hypochlorite.

snowmaid

Toothsmith wrote: »

It also has to be said though that the way some PCTs treat dentists trying their best to provide a decent service can be equally despicable! It's almost as if dentistry is being forced out of the health service.

That I can believe and I think that given a few years, all health will basically be privatised.

Toothsmith

mda99das wrote: »

Toothsmith its all part of the big lie.
Are you trying to tell me NHS dentistry is as good as private?
If it is as good then why did you go private?
Maybe you should read

http://www.nhsdentistrythebiglie.co.uk/

I went private because I couldn't work in the situation where I was contractually barred from telling the truth!

I am not telling you that NHS dentistry is as good as private. But if an NHS dentist tells his patient anything but this, they could be hauled in front of the GDC!

That's one of the main points of the 'Big Lie'.

Toothsmith

mda99das wrote: »

murphydog, how much do you want to save the tooth?
On the NHS they will use handfiles to clean out the system. There is no way that you can use rotary files (machine which gives a better level of cleaning) on the pathetic funding the NHS supplies. In fact the 3 funding points won't even cover the cost of the files.
Its totally up to you, the end result on the x-ray may look good, but who knows how well it has been disinfected from the inside. There is no way you can do that with handfiles and a bit of hypochlorite.

I know quite an eminent specialist who still swears by hand filing.

I quite agree with you over the costs - but if a dentist agrees to see a patient under the terms of his NHS contract, then he agrees to provide all necessary treatment under that contract.

It is not ethical or allowable for a professional to do a lesser standard of work than his best just because of a funding situation.

If it is impossible to provide adequate care under a particular system, then a professional's only choice is to leave that system.

Providing poorer care, or misleading a patient as to the terms of the contract is not ethical.

nineteenseventyseven

mda99das wrote: »

murphydog, how much do you want to save the tooth?
On the NHS they will use handfiles to clean out the system. There is no way that you can use rotary files (machine which gives a better level of cleaning) on the pathetic funding the NHS supplies. In fact the 3 funding points won't even cover the cost of the files.
Its totally up to you, the end result on the x-ray may look good, but who knows how well it has been disinfected from the inside. There is no way you can do that with handfiles and a bit of hypochlorite.

I would have to disagree with your comment that RCT completed with hand files can't be as good as that carried out with rotary files. There are a number of specialist endodontists who still us hand files as they have excellent results. It is easier and quicker to carry out a good standard of RCT with rotary instruments. Unfortunately these instruments are very expensive and for the NHS fee payable to the dental practice it is often not financially viable to use them.

As I'm sure you know, the purpose of any file system is to allow access of irrigant to the apical portion of the root canal system. Any file system can achieve this if done well.

welshdent

snowmaid wrote: »

He is flouting regulations and his contract, the swines!!!:mad::mad: It's called gaming and they try encourage you to go private as it is more money for them. Go onto the NHS website and see what they are supposed to provide. Thing is all they want to do is get in as many patients for as much money as they can. If a job is going to cost £200 and its going to take a few hours, they think they are 'losing' money. Stick to your guns. You pay enough for the services as part of your NI. This is really ticking me off.

If I'm wrong, I am sure someone will be along to correct me very soon! :cool:

http://www.nhs.uk/Livewell/dentalhealth/Pages/Dentaltreatments.aspx
http://www.nhs.uk/news/2012/05may/Pages/oft-dental-charges-and-complaints.aspx

Its not actually gaming
Gaming is for example telling someone they need 3 fillings but can only have one every 3 months on 3 courses of treatment.
Not saying any of it is right just getting the terms clarified.

The whole endodontics "problem" is multi factorial. YES if a dentist says it is needed then strictly speaking it should be done on the NHS. YES we do not get any payment for providing them despite it probably being the most expensive non lab based treatment we can provide. Both with clinical time and also the equipment needed to carry it out. Yes I do them routinely and rarely if ever refer out.

HOWEVER. To the general public there is understandably an assumption that if someone is a dentist they should be able to do them. In an ideal world that would be true. However when it comes to dental procedures and with a particular eye on endodontics, it is FAR from a simple procedure that one should just do and get it right. The further back in the mouth you go, the harder and harder it gets. You need to factor in anatomy of not just the tooth but also the patient. Can you gain sufficient access to the tooth to instrument it appropriately. Can the patient tollerate the time demands required with keeping their mouth open.

Thanks to the cynical attitude of the department of health placing zero value on the procedure there is wholly the wrong attitude towards it.
SO in summary, many dentists are not as good at doing the procedure as one would like them all to be. It may be a lack of skill or it may be a lack of (very expensive) equipment. Would I want someone that lacked confidence in their own ability doing a procedure just because I am "entitled" to it? Would I want to in effect force someone to do a procedure they are not happy doing just because I am entitled to it? Abso bleeding lutely NOT. In previous itterations of the dental contracts that dentist could easily refer on to someone else to do the work however the new contract means this is not really possible. If you needed 3 fillings and 1 root filling you ONLY get 3 UDAs for all of it. That means someone goes without as the UDAs are not transferrable. Someone does the treatment for free if you get someone else involved.

If a dentist feels the root filling is not achievable in their hands they are obligated to recognise their lack of skill. However PCTs and LHBs have by the most part NOT commissioned any form of endodontic specialist system and dental hospitals in the main do not accept primary treatment (i.e. a root filling that is being undertaken on a specific tooth for the first time). They expect the practitioner to have at least TRIED. The problem with that is by trying they risk damaging the tooth beyond repair.

The dentist is then forced in to a difficult place. They tell you they can not do it and refer you to a specialist. They have no NHS referral option so they can only refer privately. The risks are you complain and it causes bad feeling. Alternatively they "have a go" and you sue when it goes wrong and they have little in the way of defence.

So in summary while I agree entirely one is entitled to have the treatment provided, without all the clinical information I am not so fast to condem the dentist. Even IF they refer within the practice there is no financial incentive to them to do so. We do not get any referral fees for doing this. The system sucks and root canal treatment is a very complex and specialised procedure dealing in millimetres of accuracy. even when it is done right there is no guarantee the procedure is right.

Before I am accused of just siding with the dentist. As I said, I routinely do them and have invested thousands with zero assistance to improve my own skills. I can count on 2 hands the number of people I have been forced to refer in for treatment.

welshdent

snowmaid wrote: »

It's hard not to be 'emotional' when people are being ripped off. I was told by my dentist that there weren't funds available and that I had to go private. That is rubbish. Dentists are contracted to the NHS to provide services.

Thats not strictly true. We are contracted to deliver UDAs. We are in no way tied in to the NHS other than to contractually provide these UDAs. If we do all of the annual allocation before the 31st of march then we actually can and do run out of funds. They should say to you that one option is go private or wait until april when the new allocation starts up.

welshdent

mda99das wrote: »

Toothsmith its all part of the big lie.
Are you trying to tell me NHS dentistry is as good as private?
If it is as good then why did you go private?
Maybe you should read

http://www.nhsdentistrythebiglie.co.uk/

I am sure toothsmith knows that website very well

Is NHS dentistry as good as private? Now thats a big un!

I dont think its fair or correct to make that statement but thats because I am privvy to the knowledge that helps me say what is good and bad dentistry.

Fundamentally it all should come down to the skill of the dentist be they private or NHS. BUT private gives the dentist and the patient more options and in theory private should give the dentist the ability to use better materials which SHOULD translate in to better results. Thats not to say NHS dentistry is bad but No matter what the press says about it, it REALLY is badly funded. Lab fees alone for crown and bridge work is a prime example. A crown at NHS level is about £30 - 50 depending on the lab. The private fee for different materials and more characterisation can actually be more than the NHS pay the dentist for the whole course of treatment. You do not have to be a mathematical genius to figure out that if you spend more than you are paid then you will soon be going bust. NHS dentistry works because the practitioners see a lot of people and use the most cost effective materials they can.

If you have a good NHS dentist using cheaper materials the logically they would give you better results than a bad private dentist using expensive materials. The determining factor is the dentist. The best way to get a good DENTIST is to read toothsmiths sig and start there. But you WILL get more choice privately. You SHOULD get more time with them too.

welshdent

sticking my hand above the parapet re files .... I use whatever is IMO appropriate. Rotary or hand. I do however use them economically. I get the triniti files which are much cheaper than their counterparts or I use reciproc. Currently doing an endo dip and all I see to be doing is hand filing!!!

snowmaid

welshdent wrote: »

sticking my hand above the parapet re files .... I use whatever is IMO appropriate. Rotary or hand. I do however use them economically. I get the triniti files which are much cheaper than their counterparts or I use reciproc. Currently doing an endo dip and all I see to be doing is hand filing!!!

So....just where are you based and are you accepting new NHS patients??........:D