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

Annonay

welshdent wrote: »

Today for example I spent 15 minutes getting one on a tooth. I guarantee you I would not have done the treatment if I could not manage it.

That doesn't leave long for the actual RCT work.

murphydog999, who appears to have gone private, had the work treatment done in 2x30 min appointments.

I who went via the NHS also only have 30 min appointments.

15 mins to do this? Really???

brook2jack

I personally wouldn't anywhere where saliva might contaminate the cavity, but am happy to on alot of top front teeth.

However there is not the same body of research, practice, litigation, and advice that there is for the use of rubber dam in all root treatments. There is absolutely no doubt in terms of success rates , safety not only with the instruments but also with the large amounts of solutions you are washing the canals out with that rubber dam must be used. The British endodontic society says its use is mandatory. The same cannot be said in placing composite (white) fillings.

Ps the picture you posted is very old fashioned rubber dam . It also doesn't allow for a very badly broken down tooth in an awkward place ,at an awkward angle which may require building up and the use of sealers to get a good seal in the dam. Murphydogs tooth was in a very accessible place, only had one root and presumably wasn't very broken down. Privately a molar tooth with up to four roots may take two to three hours to root fill well.

welshdent

Fwiw I spent 2 hours on the tooth in total, plenty of time to disinfect the canals that were already identified. And that was on the nhs. I wouldn't be so quick to judge. Technical the gold standard for adhesive dentistry is under rubber dam for moisture control but unlike endodontics there are other ways to get decent moisture control to place a good restoration. Also there are other reasons why one would use rubber dam in root fillings that are not applicable for composite work. Additionally the time taken for a root filling is a lot longer than that for fillings. I usually take between 1 and 2 hours for a root filling and 15-30 mins for a white filling. It's easier keeping things dry for minutes than hours.

Annonay

welshdent wrote: »

... I usually take between 1 and 2 hours for a root filling and 15-30 mins for a white filling. It's easier keeping things dry for minutes than hours.

You spend 2 hours doing something you will only get paid about £68 for :eek:
(£48 NHS charge plus the £20 stated today a dentist gets from the NHS for a band 2 treatment)
Presumably there's at least another session too, so presumably that'll be another 2 hours.
4 hours for £68 - you could earn more working in Aldi!
(or even Maccy D's once you take the overheads into account)

Ah well, my dentist (which is NHS) or the OP's (which seems to have been private) did it in 30 mins. (two sessions required, so 1 hour total)

As you seem to agree it's easy to keep things dry for this period, then that's possibly why a rubber dam was not necessary.

However, I feel the pain of the customer you were treating having to keep their mouth open for 2 hours! :eek:
30 mins and my jaws were starting to ache!

welshdent

Mad isn't it?? But I don't work on the philosophy that I'm not paid much so I will do it badly. My patient was delighted with his treatment today. Also he wasn't open for 2 hours. Because he had rubber dam on it meant he could relax his mouth while the bleach was working all safely sealed off by the dam. I take a lot of pride in what I do and it's not about the money. Every one I do makes me better and helps me with my masters degree (in endodontics) I don't view root canal treatment as a sprint to get done quickly. The irrigants I use need time to actually work and be effective. Consider this. We are trying to kill bacteria. If you were bleaching your toilet, what is more effective. Squirting bleach down then flushing it away shortly after or using the bleach gel and leaving it for say 30 Minutes?
There is no second visit. In the absence of pus or other problems I tend to do my treatments in one visit. Having just written an essay on single and multi visit treatment, there is no evidence that says one is better than the other as long as recommended protocols are followed

murphydog999

Annonay wrote: »

murphydog999, who appears to have gone private, had the work treatment done in 2x30 min appointments.

Just to qualify this. I didn't go private, that would have cost 3x the amount, this is sort of NHS plus. I wouldn't have got seen for another 6-8 weeks, not just at this practice, at others I spoke to, on the NHS. This was paying a bit extra to be fast tracked really.

My second apt was 45 minutes in total, but I had 2 x-rays one at the start and one at the finish.

I also didn't have a rubber dam, but as brook says, it was one straight root, near the front, so presumably not that difficult.

Toothsmith

murphydog999 wrote: »

Just to qualify this. I didn't go private, that would have cost 3x the amount, this is sort of NHS plus. I wouldn't have got seen for another 6-8 weeks, not just at this practice, at others I spoke to, on the NHS. This was paying a bit extra to be fast tracked really.

My second apt was 45 minutes in total, but I had 2 x-rays one at the start and one at the finish.

I also didn't have a rubber dam, but as brook says, it was one straight root, near the front, so presumably not that difficult.

I'm afraid that if your dentist is operating a system like that, he could very easily be struck off and end up in prison if anyone in authority got wind of it.

It is one of the big No-Nos of the NHS is that 'top up' fees are not allowed.

That's why there is all the fuss when certain drugs are not available on the NHS. If a patient wants to pay for that drug, then they must have the whole of their treatment done privately.

It's the same with dentistry. You pay for an item privately, or you have it on the NHS. The dentist IS NOT ALLOWED to do it 'on the NHS' but pop a bit extra in his back pocket to get you in quickly/use a different material/do it a bit better.

OK - you may well be happy and won't complain, but one day someone will, and when that happens you will see your dentist hung out to dry by the authorities and more than likely the local/national press.

The NHS will claim that he is getting NHS money for private treatments, they will go through his financial records and add up all the times he has done this, then you will see headlines like "Dentist defrauds NHS of £X00,000 (Some very big number) and everybody will get the impression he's the worst villain in the world and 'Typical' of greedy money grabbing crook dentists.

Whether what he's doing is actually 'helpful' or not, it is illegal, and will be manipulated to make dentists look bad if he gets caught, and because of that it makes me really cross when I hear of it going on.

murphydog999

Oh, well as it happens after I made a complaint about my initial treatment at the first practice to my counties PCT, I was passed to the head of dental services, who was extremely helpful. He asked me to keep him informed of the outcome, which I duly have, detailing the 'independent' nature of the treatment.

The only negative comment he made was although the fact that you've had to opt for non-NHS treatment (that's my understanding of "independent") means I'll close your enquiry feeling we (the PCT) still failed, overall....

So to be slightly selfish, whether it's cheaper private or NHS +, doesn't really matter to me, I'm pleased with the treatment I eventually received.

Annonay

murphydog999 wrote: »

Just to qualify this. I didn't go private, that would have cost 3x the amount, this is sort of NHS plus. I wouldn't have got seen for another 6-8 weeks, not just at this practice, at others I spoke to, on the NHS. This was paying a bit extra to be fast tracked really.

My second apt was 45 minutes in total, but I had 2 x-rays one at the start and one at the finish.

I also didn't have a rubber dam, but as brook says, it was one straight root, near the front, so presumably not that difficult.

Are you making this up, or are your teeth movable, or has he treated the wrong tooth??? :huh:

Because initially you claimed

murphydog999 wrote: »

...the tooth is at the back next to a wisdom tooth, a gap would be very visible.

And later posted

murphydog999 wrote: »

The tooth in question is UL5, so top back.

Anyway, I concur with Toothsmith's post (in the main).
There is no NHS+. (or at least shouldn't be)

There is either NHS treatment (where the prices are fixed), or there is private treatment (where you may be able to negotiate a price with the dental surgeon)

AS an MSE'er, you really should be looking for the best price, so if the work was done on the NHS you should only be charged £48 *

However, your later post suggests the PCT say you opted for private work, so it sounds like the NHS didn't fund any of it.

However, if your complaint to the PCT was that you could not get NHS treatment, I can't understand why the PCT would close your complaint because you felt you had no option but to go private, unless they are saying now you have had the work carried out, then there is no point trying to locate an NHS dentist to carry out that work.
However, the fact you felt forced to go private should mean there is still a complaint to be answered by the PCT.

* There is one thing that could legitimately increase the cost slightly (and the part of Toothsmiths post that does not really make this clear)
I remember you said you had agreed to a white filling. This is not normally available for rear teeth on the NHS (unless the dentist could substantiate a clinical need), and so this different material could be provided privately - although the root canal treatment itself can still be done under the NHS.

Normally, the NHS would finally fill the tooth with the traditional amalgam filling which is still the best filling material available in terms of durability, longevity etc. (or possibly even better a crown whereby the cost will be £209 under NHS),
White fillings may look nicer than amalgam ones, but ask yourself do you really want to compromise functionality over vanity, especially in a UL5 tooth where no one will probably ever see it unless they specifically look for it.

brook2jack

Murphydog appears not to have gone to a nhs practice but to a practice which offers nhs style treatment privately (they clearly said they had independant treatment ie not nhs). There are many schemes/practices which offer this ... oasis basics being one. You do not have the choice,range of true private treatment but it is a more affordable way of offering dental care where there is no nhs coverage or long waiting lists. Murphydog was totally informed , there has not been any claim for nhs treatment, they know they have not been treated on the nhsall would appear to be above board .

Annonay once again you are sadly mistaken , the very worst filling you can put into a root filled tooth is amalgam because it acts like a wedge putting force on a weak tooth and is the largest contributing cause to a fractured tooth. A white filling, covering the cusps glues the tooth together, a crown or inlay similarly holds the tooth together. Please refrain from giving clinical advice Murphydog has a dentist who can see them, their x rays and has suggested the most appropriate treatment, a far better option then following internet advice..