Paying for NHS root canal treatment

bird~brain

Thank you so much for your support. I will contact pct tomorrow.

Annonay

bird~brain wrote: »

In reference to my earlier post. I sent the dentist a message asking if perhaps there had been a mistake and they had not realised that I have a tax exemption certificate. He replied that because of difficulty of job I have to pay up £340 or lose tooth, or go to endodontist privately. I have said I am going to Citizens advice about this tomorrow, he has offered to refund payment and remove the tooth. Don't know what to do.

It really depends on the availability of NHS dentists in your area.

Fortunately where I live, we have quite a few options. I would urge you, if possible, to seek another NHS dentist.

Root Canal Treatment (apart from some very specialist treatment) should be available on the NHS where there is a clinical need.
There is clearly a chance to save your tooth (your dentist has said so if you cross his palms with silver!) and it's almost aways preferable to save a tooth if possible rather than extract it.
Whilst RCT is never 100% guaranteed, it is usually 90-95% successful. (especially if then crowned)

Hunt round to see if you can find another NHS dentist who will do the work necessary.
The CAB may be able to provide you with a list of all local NHS dentists.

brook2jack

Actually root treatment is alot more complex than you think. A specialist , with a tooth that has no complicating factors , has a success rate of around 90%.

A tooth with no complicating factors in a general dentists hands will have about a 80 to 85 % success rate.

Complicating factors are numerous and not at all rare, e.g. tooth has been root filled before , has curved roots etc.

Even then a tooth may be root filled successfully but if there is not enough left to put something on it may be pointless to root fill.

Finally a root filled tooth is a tooth that has a limited lifespan , particularly in certain situations and again it may be better to take the tooth out and do something else.

This is also not taking into account a patient's medical history and medications where again extraction may be the better alternative.

All this is to say nothing in dentistry is as straight forward or as cut and dried as the internet would have you think.

Annonay

brook2jack wrote: »

Actually root treatment is alot more complex than you think. A specialist , with a tooth that has no complicating factors , has a success rate of around 90%.

A tooth with no complicating factors in a general dentists hands will have about a 80 to 85 % success rate.

Complicating factors are numerous and not at all rare, e.g. tooth has been root filled before , has curved roots etc.

Even then a tooth may be root filled successfully but if there is not enough left to put something on it may be pointless to root fill.

Finally a root filled tooth is a tooth that has a limited lifespan , particularly in certain situations and again it may be better to take the tooth out and do something else.

This is also not taking into account a patient's medical history and medications where again extraction may be the better alternative.

All this is to say nothing in dentistry is as straight forward or as cut and dried as the internet would have you think.

You are sounding like the sort of dentist I quickly lost faith in.

Any tooth has a limited lifespan. An untreated tooth can lead to further complications.

An extraction should always be considered the last option as it results in more stress on the neighbouring teeth.

The tooth I had RCT on had a curved root. I asked about this too as I know drills cannot go around corners, but was informed it was a risk ... but better to have risked it and failed rather than not to have risked it at all.
The final option, extraction, is always available if RCT fails.
As you say, a curbed root is not uncommon.
Neither indeed is a filling in the tooth. In fact some of the the main causes of requiring RCT is because a previously filled tooth has leaked around the filling or the tooth was damaged by repeated fillings having been applied to the tooth

Look on the NHS website for what they claim the success rate of RCT is. Success does not depend on how much silver you grease the dentist's palms with... and you'd think the NHS would quote success rates they achieve.
And remember, you've probably paid 10s of £1000s in tax/NI - it's National Insurance as opposed to Private Insurance (where they have to make a profit too) and chances are it'll be the same person doing the treatment no matter how it is funded ... as the OP has discovered.

brook2jack

The problem is in this litigious age if a dentist sees a tooth has a complication and will be difficult to root fill they have to advise a referral for a higher chance of success. If they then attempt to root fill the tooth and have a suboptimal result and then a patient attends a specialist a 're root treatment is much less likely to be successful.

It would be very difficult for a dentist to be defended even though they might have had a go to save the patient the expense of seeing a specialist.

Most endodontists would say that a root filling on a top molar particularly right at the back is impossible to do without a microscope. For most nhs dentists unless they are thinking of getting a qualification to go private, a microscope is unaffordable for nhs dentistry.

As we have already said to the op it is not allowed for the same dentist to do the treatment privately . However it is acceptable to refer to a specialist. They will have access to a microscope (£15,000) ,specialist materials such as mda cement £50 a use, specialist one use equipment, and time (typically two hours plus for a molar tooth), and training costing thousands of pounds none of this is affordable for a nhs dentist.

Yes any dentist should be able to root fill a straight forward tooth,but specialists do have better success rates, particularly for difficult teeth.

Extraction is often not the worst option, for many people, for some Extraction is a better option .

Annonay

An NHS dentist should not be referring a patient to a specialist, just so they can get some private fees.

By the way, there are specialist endodontic surgeons happy to offer their services on the NHS.

Unless there are specific reasons, you should not be referred to a specialist anyway; any dentist should be able to undertake routine Root Canal Treatment - and any NHS dentists who says they can't should be kicked out oif the NHS system.

If you think extraction is the best and first course of action, then you definitely are the sort of dentist I lost faith in.

Remember, the OP's dentist has already confirmed there is a good chance to save the tooth (RCT is never 100% successful no matter who does it) and that he could do it ... if he is paid enough money. That is against the NHS guidelines! :mad:

brook2jack

I personally do not know of any pct/lhb that pays for a specialist endodontist and I'm almost certain none of the other dental posters do. In these days of severe budget constraints where even cancer treatments can be rationed then you can see why a pct would not want to fund £400 to save one tooth. You cannot refer to any of our local dental hospitals for endodontic treatment.

The problem is as technology has improved more teeth could potentially be root filled than in the past but only with the right equipment and expertise. This is not available in standard nhs practices. So an every increasing number of teeth could potentially be saved but need specialist treatment, which in the vast majority of areas will be private.

It is also illegal for a dentist to accept a fee from a specialist for referring patients. At best they would be struck off. So a nhs dentist will not benefit from referring to a specialist.

Finally there are many reasons why extraction might be better for SOME people or SOME teeth. From medical (e.g. patient about to start intravenous bisphosphonates,immunosuppressants where extractions once they start treatment could be disastrous if the root treatment failed, to practical e.g. not enough tooth left to be able to get a good crown on, to local reasons e.g. patient has a jaw disorder so staying open for the length of time a root filling may take will cause long-lasting or permanent jaw pain, to patient choice e.g. root fill and crown a tooth with an uncertain lifespan or have an implant instead.

I suggest you read my replies to op as to how he was advised to proceed.

welshdent

I think you are getting the wrong end of things. If a dentists be they private or nhs, refers to a specialist they get zero money back. There is no financial incentive and if there WERE they could get in serious trouble. Endo is really complex and most people do not realise just how complex until they get the chance to look down an operative microscope. I did one 2 day ago that to all intents and purposes had 3 canals but when I looked under high mag at one of them it actially had 2 side canals that went half way down to make a trident shape. Impossible to see without the scope but could mean the difference between success and failure. Not one dentist on here has said it is right to say they can't do it on the nhs but chuck in some extra cash and it can be done. But saying it is beyond you and referring to someone better IS right. It's not the dentists fault there is no specialist nhs endodontics provisions. It is the pct and department of health

sebastianj

I wouldn't bother with root canal treatment, at the most it will last 8 months or so and then you pay to have it taken out. If there is an infection below the gum line, then use some mouth wash to control it then have it capped. The cost will be less and it will last 20 years+
Speaking from experience.
sebastian

brook2jack

If you cap a tooth that has a tooth abcess under it no amount of mouthwash will sort it out it will cause infection and pain.

If a tooth has a gum abscess then careful cleaning will keep that under control.

Tooth abscesses and gum abscesses have different causes and treatments.