Dental checkup/hygienist

alwaysbrassic

NHS patients who see a hygienist need to be referred by the dentist. A patient could see their dentist for basic treatment, but the dentist will only do basic treatment which is needed for dental health. A dentist is not obliged to remove staining on the NHS, and in circumstances such as this a private scale and polish may be done.
A patient with one short visit to the hygienist should be charged the NHS band 1 charge of £17.50. For a longer appointment or 2 appointments the band 2 charge will be £48. Private appointments will be charged depending on length of time.
Hygienists are basically loss leaders for dentists which is why most dentists do the work. They most probably however do not have the time to spend discussing dietary habits etc with patients as hygienists do.

londonTiger

a lot of nhs dentists are snake oil salespeople so be careful.

I had braces done via private treatment, I then had a routine checkup with the nhs dentist, and twice in a row the dentist told me that I should get "extra cleaning" because I was on braces. I normally have a basic scale and polish and I did not see anything extra that was done on the "extra cleaning".

What's more I was sold this extra cleaning while I was in the dentists chair.

This practice really needs to stop - I feel like doing undercover filming or something and reportin them to trading standards. I don't want to be put on the spot by the dentist - worrying that he/she will be spiteful towards me for not opting for the esxtra private treatment and taking some "revenge" against me.

That's how I feel about them when the try tocon you into buying extra treatments like that. They're not like medical professionals, they're like double glazing salesman.

brook2jack

Most of the orthodontists I know will want adult patients to see a hygienist etc at least a couple of times during treatment because it is notoriously difficult to keep teeth clean whilst wearing braces and notoriously both decay and gum problems can easily start around braces.

Unfortunately the nhs is not set up to provide preventative treatment, just to treat existing disease , so this extra brace care is only provided privately.

That being said if you do not trust your dentists advice or even worse suspect they would be so unprofessional as to penalise you for not taking that advice , you need to change dentists.

There is a whole gamut of dental options that are not available on the nhs. The dentist can be found clinically negligent if they do not inform you of all the options available , even if they are not available on the nhs. e.g. implants can be a viable option for some people but have never been available as a rule on the nhs. Many people want the option of choosing white/composite fillings for back teeth and in general these have to be a private option.

londonTiger

brook2jack wrote: »

Most of the orthodontists I know will want adult patients to see a hygienist etc at least a couple of times during treatment because it is notoriously difficult to keep teeth clean whilst wearing braces and notoriously both decay and gum problems can easily start around braces.

Unfortunately the nhs is not set up to provide preventative treatment, just to treat existing disease , so this extra brace care is only provided privately.

That being said if you do not trust your dentists advice or even worse suspect they would be so unprofessional as to penalise you for not taking that advice , you need to change dentists.

There is a whole gamut of dental options that are not available on the nhs. The dentist can be found clinically negligent if they do not inform you of all the options available , even if they are not available on the nhs. e.g. implants can be a viable option for some people but have never been available as a rule on the nhs. Many people want the option of choosing white/composite fillings for back teeth and in general these have to be a private option.

Thanks for the reply. I think what you said is true for the majority of dentists. But there are some that are unscrupulous. We know from a recent investigation that NHS dentists were just getting filling work on borderline teeth willy nilly. I experience that first had - I had 4 fillings done in one go and then 6 weeks later another dentist just put another filling in there - I didn't have any sensitivity what so ever - she just put it in as a "preventative" measure it seems. Then the NHS rules on fillings changes and I haven't had any put in, not any relaced. I have a white filling on mine which is a bit sensitive if I poke it in a certain way - but the dentist wouldn't change it.

So there ARE unscrupulous dentists.

Also with regards to my earlier post - I feel that I should clarify. I have had routine hygiene appointments with the dentist while I was on braces. This paticular incident of dentist selling me "extra cleaning services" was actually done after having the braces taken off. The orthodondist would have polished and scaled the surface of of where the brackets were glued on so I see now reason why it would need extra work done. .

brook2jack

perhaps after spending all that money on private braces, seeing a hygienist regularly and investing time on your teeth, you have changed your diet and hygiene and that is the reason you have not had fillings recently?

If you do not trust your dentist then you need to change dentists. In the UK between 83% and 93% (depending on area) of patients are very satisfied with their nhs dental treatment. As you say there are bad in every walk of life but surprisingly dentists come much higher in satisfaction surveys than virtually any other health care provider e.g. doctors,hospitals,opticians etc.

So yes there are unscrupulous dentists , they are very much in the minority and all indications, statistics and checks would seem to say , despite the chronic shambles in nhs funding the vast majority of nhs dentists do an honest job. If you feel you don't trust your dentist , move as trust is the biggest factor in taking your dentists advice to getting good oral health.

athomick

[FONT=Arial, sans-serif][FONT=Arial, sans-serif]I am in dispute with my dentist. He claims that there are 2 levels of scale and polish available under the NHS. Band 1 (£17.50) gets you a cursery clean while band 2 (£48) gets you a thorough clean including under the gums. My teeth and gums are perfectly healthy but he insists that I need a regular band 2 cleans and refuses to do band 1 cleaning. This is standard practice at his surgery for everyone.The NHS say this:[/FONT][/FONT]
[FONT=Arial, sans-serif]
[FONT=Arial, sans-serif]"If your dentist recommends a scale and polish, it should be provided under the NHS (Band 1, £17.50), whether it is done by a dentist or a hygienist.If your dentist says a scale and polish is not clinically necessary but you want one anyway, you will have to pay to have it privately. An NHS scale and polish should be carried out as thoroughly as a private one".[/FONT]


[/FONT]

mo786uk

My dentist normally does my scale and polish and it does nto take that long - maybe 20 minutes.

Does/can a hygeniest do a deeper clean or do they just do a more through scale and polish?


there seems to be conflicintg info online but a standard scale and polish does go beneathe the gumline doesnt it?

brook2jack

athomick wrote: »

[FONT=Arial, sans-serif][FONT=Arial, sans-serif]I am in dispute with my dentist. He claims that there are 2 levels of scale and polish available under the NHS. Band 1 (£17.50) gets you a cursery clean while band 2 (£48) gets you a thorough clean including under the gums. My teeth and gums are perfectly healthy but he insists that I need a regular band 2 cleans and refuses to do band 1 cleaning. This is standard practice at his surgery for everyone.The NHS say this:[/FONT][/FONT]
[FONT=Arial, sans-serif]
[FONT=Arial, sans-serif]"If your dentist recommends a scale and polish, it should be provided under the NHS (Band 1, £17.50), whether it is done by a dentist or a hygienist.If your dentist says a scale and polish is not clinically necessary but you want one anyway, you will have to pay to have it privately. An NHS scale and polish should be carried out as thoroughly as a private one".[/FONT]


[/FONT]

The nhs information is incomplete. Indeed there is a band two charge for periodontal treatment (including scaling and polishing). If a cleaning can be done as part of a check up appointment, then this is probably a band one treatment. If the condition of the gum is such that more intensive treatment is needed at a further appointment then a band two charge is normally charged.

Most people are unaware they have gum problems as there is usually no pain until late on. It is normally diagnosed with x rays and by measuring pocket depth (gap under gum line where gum has detached from tooth) at check up.

If your gums are perfectly healthy you are not entitled to a band one or two treatment. If you have bone loss or pocket formation, both of which you would only be aware of via x rays and pocket charting, then band two treatment is indicated.

You are , of course, entitled to refuse any treatment but then you alone take the consequences of this and considering gum disease is the number one cause if tooth loss in the UK you may want to think of this.

The biggest issue here is the dentist has advised a course of treatment, you do not trust their advice, therefore perhaps you should be looking for a new dentist whose clinical judgement you do trust. Dentistry done in an atmosphere of distrust does not provide the best result for anyone.

Toothsmith

athomick wrote: »

[FONT=Arial, sans-serif][FONT=Arial, sans-serif]I am in dispute with my dentist. He claims that there are 2 levels of scale and polish available under the NHS. Band 1 (£17.50) gets you a cursery clean while band 2 (£48) gets you a thorough clean including under the gums. My teeth and gums are perfectly healthy but he insists that I need a regular band 2 cleans and refuses to do band 1 cleaning. This is standard practice at his surgery for everyone.The NHS say this:[/FONT][/FONT]
[FONT=Arial, sans-serif]
[FONT=Arial, sans-serif]"If your dentist recommends a scale and polish, it should be provided under the NHS (Band 1, £17.50), whether it is done by a dentist or a hygienist.If your dentist says a scale and polish is not clinically necessary but you want one anyway, you will have to pay to have it privately. An NHS scale and polish should be carried out as thoroughly as a private one".[/FONT]


[/FONT]

He is right in that it is allowable to claim a band 2 for a 'thorough' clean.

What is meant by this isn't very well defined though, and it would be pretty tricky to argue against unless you were seen by somebody before being seen by your dentist, who could give you a 'second opinion' before you'd had your first! (IYSWIM), as once the crud has been cleaned off, it's impossible for anyone to say whether it was appropriate to charge band 2 or not!

If it really is the standard thing that this dentist is claiming on every one of his cleans, then this would show up on his prescribing profile, and sure as eggs is eggs - they'd come down on him and penalise him financially! (He won't be making any more money by charging more, as patient payments only come off his monthly regular, fixed NHS cheque anyway.)

If you really think he's on the game, then either complain to the PCT to see if they are investigating him for over-prescription, or go and see another dentist.

athomick

I'm grateful for the last 2 replies.

These things I am certain of:

1) My Teeth and gums are perfectly healthy

2) My partners teeth and gums are perfectly healthy

3) Both of us have been (seemingly) “required” to have band 2 clean and polished at least once a year but often more lately when we are plucked out of the waiting room by a hygienist before our check-up and told we are having a clean and polish and charged an additional £48 on top of our band one fee. Once I was done twice in 2 months – this was after the first hygienist complemented me on how clean and healthy my gums were.

These are the things I strongly suspect:

1) All or nearly all clean and polishes for NHS patients are charged under band 2

2) They are used as a devise to reach treatment targets

3) Patients are advised that treatments which should be available on the NHS are only available privately. This has happenned to myself and my partner

I think the biggest issue here is not whether I should change dentists but whether there is wrongdoing herewhich needs investigating.

Toothsmith:

(He won't be making any more money by charging more, as patient payments only come off his monthly regular, fixed NHS cheque anyway.)

Thanks, that is interesting. What is his motivation for always (I believe) charging at band 2 rather than band 1 then? I repeat, my gums are healthy and he refused to clean them under band 1. Surely it must be to increase his treatments (do you get 3 treatments for band 2 and just 1 for band 1?).