Dental checkup/hygienist

athomick

Do you believe that it is against the rules to routinely charge patients under band 2 for a prophylactic scale and polish i.e. patients with perfectly healthy teeth and gums?

Toothsmith

athomick wrote: »

Do you believe that it is against the rules to routinely charge patients under band 2 for a prophylactic scale and polish i.e. patients with perfectly healthy teeth and gums?

Someone with 'perfectly healthy teeth and gums' wouldn't need a clean at all.

It's a known fact that 98% of the population have 'gum disease' to some extent or another - be it just a bit of bleeding here and there to full blown wobbly teeth about to fall out end stage periodontal disease.

So - to start with, there will be very few patients who go to the dentist with perfectly healthy teeth and gums.

Given that, is it right that most of a particular dentists patients would need a band 2 Cleaning?

My answer to that would be 'No'. - but a proportion of them probably would.

In all honesty, how large is your sample size?

This dentist will probably have 2-3000 patients that he's looking after.

If you have spoken to 5 - 10 then it's perfectly possible that every one you've spoken to regularly needs a band 2, and it wouldn't be beyond the realms of probability.

But to move that up to what's happening amongst the 2-3000 is quite a big leap.

athomick

I take your point about gum disease. What is the difference between band 1 and 2 cleans exactly? A band 1 clean is supposed to be as thorough as a private clean so I assume a band 2 clean has some additional procedures. Is there anywhere on the internet where I can read dentists guidance on this?

Toothsmith

I run a private practice.

I stopped doing NHS stuff for adults years ago, and I stopped completely when this 'Band' crap came in in 2006.

By a 'private clean' I assume you mean what you are charged privately for at your practice, because there is no way that a 2 min tickle round by the dentist at the end of your check-up is 'the same' as a 30 min session with one of my hygienists - which is what I would call a 'private clean'.

There are no clear definitions of what is a Band 1 and Band 2 clean, but the idea is that the dentist, being a registered heathcare professional, is bound to use his clinical judgement and provide the most appropriate treatment.

I would say that to put it simply, a band 1 clean up is what the dentist could reasonably clean off in the 2-3 minutes at the end of a check up.

A band 2 would be a clean up, probably at a seperate appointment, or maybe even with a hygienist, that basically requires more time. Either because the patient has more tartar, is a bit more sensitive so needs numbing up, or because they fuss and flounce around a bit needing a break every 5 seconds and a rinse out every 10! which ever it is, it should be recorded n the notes so that the dentist can justify the claim should he need to.

athomick

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]

Is this just ignored by NHS dentists?

brook2jack

This is nonsensical.
There is no such thing as a private scale and polish.

Most private practices will have a twenty to thirty minute hygiene visit. For most of my patients little of that is actually scaling and polishing, mostly it is education, taking intra oral photos and demonstrating to people where they are missing out on cleaning, demonstrating different brushes,techniques to try. That is because they have been attending so long and been nagged at so long by myself and the hygienist that they are controlling their dental disease really well and need little physical scaling. However any staining will be removed, in contrast a nhs "scaling" is just to get rid of tartar, staining is a cosmetic issue and Will not be removed under the nhs.

If people have active gum disease they will come for an initial five or six visits to get their oral hygiene up to scratch and then be assessed as to what further treatment may be necessary.

Most private dentists will want their patients to see a hygienist at least twice a year just because prevention is so much better than trying to treat disease.

So you are talking about apples and pears. A nhs scale which you are defining as a purely physical exercise in getting tartar off and a private hygiene appointment which should be more about education and stain removal.

athomick

I'm not clear what you are saying about this:

"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".

It's directly from the NHS. Are you saying that this is nonsensical? Is this something that dentists have decided since the contract was formed some years ago? Do the NHS agree that it is nonsensical?

Toothsmith

That paragraph really refers to a scale and polish.

The band 2 clean is there to treat a gum problem.

When a band 1 becomes a band 2 is a matter of clinical judgement for the dentist, and really can't be written down in a snappy little paragraph which will explain all possible situations, but the dentist should be able to explain to you why, in your case, he feels a band 2 is the appropriate charge.

You can then either accept this and get on with it, or not accept it and look for another dentist who can either:-

1. Explain it better to you

2. Only charge you a band 1 treatment and do a basic clean which will be all you really need anyway

3. Only charge you for a basic clean, only do a basic clean, and you only find out it a few years time that dentist one was correct, but by that time you've developed quite a nasty gum problem that with either cost a lot of money to fix, or you lose some teeth.

We here can have no idea whether your dentist is right or not. The feeling I get is that you think he's overcharging. This might or might not be he case, I don't know.

It IS allowable to charge Band 2 for a more intensive clean. Whether its appropriate in your case, I can't say.

athomick

I've kept the issue simple as it's easy to get sidetracked on forums but I'll give a fuller explanation of my situation.

There is no dispute between myself, my dentist(s) and the hygienists I've seen over the past few years at this practice regarding the health of my teeth. We all agree that my teeth and gums are in good condition (bar a couple of small chips). The hygienists agree that my teeth are brushed well and flossed regularly. I have never had any problems with my teeth and have no fillings. My partners teeth are similar although she has a few fillings.

The dentist agrees that my teeth are healthy but insists that patients at his surgery (all the NHS ones I know of and he implied all of them) undergo regular Prophylactic band 2 cleans. He refuses to carry out a repair of my chipped teeth under the NHS until I have my next scheduled band 2 clean.

There is also an issue with the chipped teeth. I have had them for 2 decades following an accident and had them repaired privately at this surgery when the dentist insisted that chipped teeth could not be repaired on the NHS. The repairs have since failed and I asked him about it again recently. He said that they could be repaired under band 2 (forgetting that I had already had them done privately at his surgery a couple of years previously) but only after undergoing my band 2 clean. I pointed out that I had been told that they could only be done privately so why could they now be done on the NHS. He quickly spluttered that the chips had recently got worse and now qualify. This is utter nonsense.

Do chips qualify or not for repair under the NHS? The NHS say this to patients, although I am starting to think that what the NHS tell patients and what dentists think they are allowed to do under the NHS are not the same thing:

"If you have just chipped the edge of one of the front teeth, your dentist will probably smooth the uneven edge and replace the missing bit with a tooth-coloured filling....
these treatments can be provided on the NHS."

brook2jack

Again it depends. Some people are very critical about their front teeth and want them to look perfect, evening out every imperfection. Small chips here and there may have no bearing on dental health but cosmetically the patient wants perfectly even teeth, this would be a private treatment.

If the chips are bigger and cause sensitivity or other problems then a solution is appropriate on the nhs which may be one of many solutions depending on what caused the chips in the first place.

Interestingly in the new nhs pilot being carried out at the moment patients are graded by computer red, Amber,green according to their dental health. Treatments will be limited according to how well peoples oral hygiene is kept. The pilots indicate most people will be in the red or Amber group.

The difficulty with dentistry is it is not cut and dried. You give the same patient to three dentists and you will get four different treatment plans equally valid, none "wrong". It depends on the individual patient and the experience , expertise and treatment philosophy of the dentist. Some may want to fill a tooth, others monitor it ,others may want to crown it and all these options could be justified.

You will not find a black and white regulation saying in case x you must do y because there are so many variations in individual patients, their dental and medical history and in dentists.

It goes to what I originally said , a question of trust is most important between dentist and patient. If you do not trust the dentist then you are best off looking for someone else as treatment in an atmosphere of distrust is never a good idea for patient or dentist.