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

brook2jack

What isn't right is virtually any root canal done on the nhs is done at a loss. Nhs dentists are not paid a salary they are paid piecemeal. There is in general practice no such thing as a nhs dentist merely a dentist who has a contract to provide so many pieces of treatment.

A dentist who takes you on for a course of treatment has to provide it if they are competent to do so. The dentist who spends thousands of pounds going on courses and buying equipment would rapidly go bust unless he used that skill and equipment to provide private treatment . To put this into context just to buy a microscope for endodontist a dentist would have to do the complete treatment for approx 700 nhs patients including all their fillings root fillings check ups x rays etc for no pay in fact at a loss because other materials, overheads have to be paid as well.

Some people are very lucky that their dentist has additional skills and equipment they use on the nhs. However as welshdent will tell you they get these skills to facilitate a way out of the nhs which does not in any way provide any incentive to develop additional skills.

welshdent

in principle yes root canal treatment is available on the NHS however that does not take in to account some teeth are significantly more complicated than others - molar teeth for example are a lot more complex with their anatomy. FWIW I dont think a general practitioner should be obliged to do molar root fillings ( I DO think alternatives should be in place) because its not fair to them or patients due to the complexity and inability to get hold of the necessary (IMO) equipment. As already touched on, some dentists are better at some things than others. For example I am the last person I Would want making a denture for me! Dont get me wrong, they are ok but other people have much more of a flair for them than I.
As already explained, we are not direct NHS employees and can not just jointly carry treatments out on a single course of NHS treatment. When we can not do a procedure we are obliged to refer. There is a limited scope for referral to hospital which leaves referral to a competent colleague. It may not seem right but we do not have at this stage a way to refer to a colleague for NHS care like this. Options are a) the dentist does it for free which isnt going to happen or you have to pay them independently.

V26

Annonay wrote: »

Having just had (or rather in the course of having) root canal treatment, and not having had anything I would call a 'rubber dam' used, I thought I would find out more.

This seems the latest must-have, but in fact is not essential at all. It all depends on what the dental surgeon is most happy to work with.

Although its been mentioned before I just had to add my opinion to this, as a current UK undergrad dental student I cannot believe people actually think a rubber dam isn't essential. We have it drilled into us how important a rubber dam and after reading all the studies done on the effectiveness of rubber dam and the longevity of restorations I am convinced on its usefulness.

I would much rather work with a dam, have the tooth isolated and have my patient safe than not work with it to save a bit of time. Yes I've had it done of myself and its not the most pleasant feeling, but its most definitely an essential piece for root canal treatment.

Troutwrestler

Absolute rubbish!
I have just had a second root canal done of the same tooth, it was complicated and involved around 6 appts and god knows how many hours, my first root canal on the tooth was done privately and failed within 3 months. The NHS dentist I know see was stunned by how awful the treatment was. He made no mention of NHS being second best.
Personally I would find another dentist

watchingthepennies_2

I was offered root canal as an option for a back tooth and was discouraged by my NHS dentist as would need 2 separate appointments....or he could do the same job privately at considerably more cost in one appointment. I decided to have the tooth out and very quickly moved to another NHS dentist, very happy with new dentist, just amazed at how much the service varies.

welshdent

V26 wrote: »

Although its been mentioned before I just had to add my opinion to this, as a current UK undergrad dental student I cannot believe people actually think a rubber dam isn't essential. We have it drilled into us how important a rubber dam and after reading all the studies done on the effectiveness of rubber dam and the longevity of restorations I am convinced on its usefulness.

I would much rather work with a dam, have the tooth isolated and have my patient safe than not work with it to save a bit of time. Yes I've had it done of myself and its not the most pleasant feeling, but its most definitely an essential piece for root canal treatment.

Not using it does not in reality save any time because any time savings are lost by having to continually move the tongue or ask the patient to open back up again!
My lecturer's favourite phrase was "rubber dam is your friend"

welshdent

Troutwrestler wrote: »

Absolute rubbish!
I have just had a second root canal done of the same tooth, it was complicated and involved around 6 appts and god knows how many hours, my first root canal on the tooth was done privately and failed within 3 months. The NHS dentist I know see was stunned by how awful the treatment was. He made no mention of NHS being second best.
Personally I would find another dentist

Personally I can not see a way you can justify deliberately doing a worse job on the NHS. I CAN however see a justification for someone saying they can not themselves do the necessary treatment as it is beyond their abilities. Referral to someone privately is a reasonable alternative to offer especially if there is no sufficient NHS referral service. I would rather someone tell me they are not capable of a procedure and offer me a chance to see someone better than to have a go a balls it up just becuase I am "entitled" to it.

welshdent

Troutwrestler wrote: »

Absolute rubbish!
I have just had a second root canal done of the same tooth, it was complicated and involved around 6 appts and god knows how many hours, my first root canal on the tooth was done privately and failed within 3 months. The NHS dentist I know see was stunned by how awful the treatment was. He made no mention of NHS being second best.
Personally I would find another dentist

Paying for something privately doesnt automatically make it better. What is important is IF you are seeing someone privately (or on the NHS!) then they are capable and equipped to do the work in the first place. Funding does not make someone better (or at least it shouldnt) I do not alter WHAT I do for a private or an NHS patient. I am fortunately able to allocate significantly more time for a private treatment and offer a wider choice of materials but my actual dentistry is the same.

kboss2010

My (private) dentist informed me that the only difference between NHS and private treatment is the quality of materials. NHS treatment is cheaper therefore the materials they use for fillings/crowns etc is of poorer quality as it's the basic stuff. It's cheaper initially but may not last as long. At my practice, the NHS dentist is usually the most recently qualified/least experienced staff member.

All NHS-registered dentists can (and should) perform ALL work, the price just depends what banding it falls into.

Your dentist doesn't want to do it on the NHS because it loses them money. Report them to NHS England (if you live in England)

Here's what the NHS website says:
Can a dentist decide what treatment is done on the NHS or privately:

"No. You can have all treatment on the NHS that your dentist feels is clinically necessary to keep your mouth, teeth and gums healthy. If your dentist says you need a particular type of treatment, you should not be asked to pay for it privately. The exception is cosmetic treatment, such as teeth whitening, which is not covered by the NHS.
If you're ever offered any private treatment as part of your NHS treatment plan, your dentist should always tell you that it's optional. Separate details of private treatment and charges – usually on the same form as your NHS treatment plan – should always be given in writing before you commit to it. If it is not, query this immediately with the dentist or seek advice from the commissioning board, NHS England. "

brook2jack

The technology and expertise for root treatment has advanced enormously in the last few years and teeth can now be saved that previously would be taken out because the root canals are too small, too curved etc.

A dentist has an obligation to assess work and refer if it is beyond their competence. Any molar tooth has the potential to be difficult and a specialist will have a much better chance of success than a general dentist.

Unfortunately there are no nhs funded specialist endodontists generally available. So if a tooth is difficult to root fill the options are refer to a specialist who will be private or attempt a root filling with no microscope and with a decreased chance of success and possibly lay yourself open to litigation.

There are other differences in nhs and private treatment but time is a major one , a nhs dentist will see about twice as many people in a day. Also there are many treatments that are not available on the nhs from implants to mouthguards for sport!