More tooth problems, how can dental bridges cost £650?

mal4mac

justme111 wrote: »

From your posts I can see you have a personal axe to grind with dentists because you were told you need to spend money on your teeth and because average dentist earns more than you do.

I don't mind that dentists earn more than me, I just want to see why dentists only offer expensive private treatments when they are "supposed to" offer the treatments under the NHS. The answer, as far as I can see, is is that they want to earn £60K a year rather than minimum wage. Which, I think, is fair enough!

brook2jack

This is precisely why so many dentists post on this public forum . There is so much bad and ill informed comment not least from the government and department of health.

The public needs to start to make hard choices in health care in general and dentistry in particular. Around £36 a year per person treated is spent on NHS dentistry including patient contributions. At around £160 an hour and rising to run a surgery how much high quality dentistry will that buy?

Dentistry is in a fixed budget , there is no more money unless we have massive tax rises.

Surely it makes sense to provide a basic , core service to get people out of pain eg fillings , extractions , dentures, simple preventative measures and stop pretending that advanced, complicated treatment such as root treatments , bridges etc should be routinely provided on such a budget service?

mal4mac

welshdent wrote: »

Root canal treatment IS a complicated procedure...

We have an NHS saying if it is needed we do it within the course of treatment which ... means we get not funding to provide the root filling.
.
... If something goes wrong such as a broken file or perforation then we could potentially be hit with being struck off or suspended and face massive pay outs relative the low fee it attracted...[but]... a dentist under pressure from a patient to "have a go" which leads to problems

Imagine a system where the NHS expected your GP to do knee or hip replacements because they wouldn't fund the orthopedic surgeons?

If a root canal is too specialised for a general dentist shouldn't he be offering an extraction?

If the patient complains, saying he knows NHS dentists who do root fillings, he can be encouraged to seek them out.

brook2jack

If a patient complains ....................

It takes just one complaint to the GDC , a dentist may be suspended from working for a year or more because it takes so long for the hearings as so many complaints are made.

That is a year or more in which a dentist cannot work. They may lose their business , house , marriage and then be found not guilty. There is no compensation for being off work.

That can and does happen because of one complaint.

A UK dentist is more likely to be sued or subject to disciplinary action than a dentist anywhere else in the world including the US.

A dentist can be sued if they take a tooth out that could be saved by root treatment , a dentist can be sued if they attempt to root fill a tooth that should have been tackled by a specialist, a dentist can be sued if a root treatment doesn't go perfectly.

welshdent

Often thats what does happen. Dentists offers extraction but the patient is the one that doesn't want one so then we end up on this ridiculous situation where there is no referral pathway within the NHS because they won't fund one. Plus. While extraction IS an option. Root canal treatment is a great deal of cases can be and is highly successful ... if done by the right people with the right equipment. But as I said, the dentist feels pressured to do it but they are the ones who carry the can if it goes wrong.

It isn't as simple anymore as finding an NHS dentist that WILL do the root filling either because we aren funded for individual items of treatment. Root canal treatment falls in to band 2. It can be moved in to a band 3 if there is a crown to be done but that is not always the case.

Consequently when we open an NHS course of treatment we agree to do all treatment that will make the patient dentally fit so you legally are not just asking that dentist to do the root filling but to do ALL that is needed. Which puts you back to square one. The patient is not going to be happy paying twice for something the are entitled to all on one course of treatment are they? Often the way to recoup the outlay on the root filling is to adopt a swings and round about approach whereby you accept the loss on the root filling by trying to recoup it with simpler treatments. If you are the dentist that happily does root fillings for other peoples patients on the NHS - it is simply not sustainable. I take around 90 - 120 minutes for a root filling often over 2 appointments. That allows for diagnosis, anaesthesia, access, locating anatomy, cleaning it and disinfecting then filling the root canals and then the filling or crown on top. It is just not sustainable to see other peoples root filling cases at £60 for the whole thing. That's not about me earning money, thats just a simple economic fact. The NHS will not fund a service because they expect it to be done on the existing contract. The existing contract would make is financially prohibitive for someone to just do complicated root fillings for 3 UDAs or around £60. The files to do the shaping alone cost upwards of £15. The nurse usually likes to be paid, the filling materials cost money too. Thats assuming nothing else needs doing too. Because lets not forget they can have the scalings, other fillings and extractions all done too.

But the people that suffer are the patients. It stinks. It is wrong. But it was designed that way by the last labour government.

welshdent

brook2jack wrote: »

If a patient complains ....................

It takes just one complaint to the GDC , a dentist may be suspended from working for a year or more because it takes so long for the hearings as so many complaints are made.

That is a year or more in which a dentist cannot work. They may lose their business , house , marriage and then be found not guilty. There is no compensation for being off work.

That can and does happen because of one complaint.

A UK dentist is more likely to be sued or subject to disciplinary action than a dentist anywhere else in the world including the US.

A dentist can be sued if they take a tooth out that could be saved by root treatment , a dentist can be sued if they attempt to root fill a tooth that should have been tackled by a specialist, a dentist can be sued if a root treatment doesn't go perfectly.

There is also no way to reclaim your legal costs if you are found not guilty.

Damned if we do damned if we don't. The dentist that wants an easy life doing simple treatments gets in trouble for not doing complex work. The dentist that does complex work gets in trouble because the complex work doesn't always work.

In the rest of the world a dentist can quite easily make a living just doing check ups and scale and polishes then referring on to practitioners with an interest in the treatments needed. We seem to be the only place that can not do that because of the systems we have here. Its daft.

justme111

Undervalued , sorry my questions did not make sense to you - that's probably why you have not replied them.
With regards to what you saying on the issue of dentists not providing service if it does not make sense financially I agree. It is impossible to tell though what one has to do under NHS.The trick is that there is no definition of contract conditions, there is no clarity about what should and should not be done. It would be easy to stick to the rules if there were rules. As there none and the less dentist does the more he/she earns it creates conflict of interests and demoralising atmosphere.
With regards to dentists choosing not to work for nhs ' it is not that simple either. Most do not have their own surgeries to be able to chose. Positions in private surgeries are very far and few between. So realistically one would have to commit to buying the surgery and running it which in itself is a big job and a few hundreed thousands loan. So just being a dentist is not enough , one would have to be entrepreneur as well. Many dentists who own the surgery already and have nhs contact are within a few years from retirement. If they hang onto it they would sell it on retirement for a few hundred thousands of pounds. If they give up that contract they would not get that money. They often provide comparatively good service on nhs and they know it .
Malmac , you are right. But there is a little detail - they may be as right at drawing the line at 60 as they are at 30. If there were rules saying "you do this that and that "resulting in dentists earning 30 then I would agree in saying earning 60 is not right. . As it is there are no rules so judging someone for not sticking to them is not logical.

mal4mac

What would you dentists do if offered the following:

"The dentist said today I have an abscess, and said that the only NHS treatment I could get would be an extraction, and also anti-biotics.

He offered private root canal treatment (£290), otherwise a referral to a orthodontist for the same root canal treatment (£600) or to somewhere else for a bridge for £2000 (if I went down the extraction route).

I now see that you can get root canal treatment or a bridge on the NHS."

http://www.mumsnet.com/Talk/general_health/758982-Tooth-abscess-can-I-get-root-canal-treatment-on-the

Note that "jasper the dentist" says:

"an endodontist should do a top class root filling, but your average NHS dentist should do an adequate one.You dont need a microscope to do it properly. In 20 years of practicing in the NHS I have only twice referred patients to an endodontist , and it was more about higher expectations from the patient than thinking I could not do a decent job myself."

And "lolabell the dentist" says:

"After nearly 30 years in dentistry, I am not a fan of root canal and chose to have a side tooth extracted rather than have a root filling myself."

Of course, one wonders if these "dentists" are 14 year olds winding up their mums...

justme111

Sorry what was the question?

mal4mac

Would you let the dentist do the root filling of a top first molar, insist on an endodontist, or seek an extraction?

If you end up having an extraction on a molar would you go for a bridge, denture, an implant, or "leave the gap"?

Is the "ideal" pathway: root canal by endodontist until that fails, then extraction followed by implant by implant specialist?

Of course you will not get that on the nhs so you are talking £3000 pounds per tooth - so if they all go it could be £100 000! (Is "all implants" ideal? Or is it ideal to have, say, six implants and a fixed denture?)

I don't like the idea of "loose dentures". Having something loose & rubbing on the gums seems less than ideal, from my lay viewpoint, which may be based on nothing at all (!)

I wear glasses, don't mind them at all, and never felt like seeking expensive laser surgery. Are dentures any more awkward than glasses, after you get used to them? Is the NHS minimum fine?

If the dentist fails her "have a go" root filling what's the worst that could happen? Extraction now rather than a stable endodontist root filling for ten years, and then extraction? Might it be better to get used to living with one extraction every few years now, rather than several close together when I'm 70+?

I'm seeing the dentist this morning. If I need a root filling, I think I'll judge her confidence. If she's really confident and seems to really want to do the root filling on NHS I'll probably let her have a go. If she seems to lack confidence and really presses for the £800 endodontist I'll probably do that. (Ouch!)

If she's really confident to do the root filling *privately* but insists on extraction on the NHS I guess I would go for her private job. Given what the dentists here have said here, I'm confident that she could only afford to do a cheapest materials/cheapest instruments job on the NHS and might extract in that case.

So I guess it all comes down to "trust the dentist", and don't give her a hard time. Fair enough!