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

brook2jack

A dentist cannot say I can't do the root treatment on the NHS but I can do it privately.

They can say I cannot do the root treatment but I can refer you (normally privately as NHS endodontists are generally non existant) privately. Even if that referral is within the same practice.

20 years ago there were many teeth you wouldn't attempt to root fill that could be root filled today with the advent of operating microscopes, MDA cements and rotary instrumentation. Very few dentists will have an operating microscope that is essential to find some of the complex canal anatomy.

brook2jack

You cannot say what the ideal path or treatment plan is. It depends on the patient (can they stay open long, are they nervous, does a gap bother them etc), their medical and dental history (bisphosphonates , chemo therapy, dry mouth,decay rate, gum disease etc) , the tooth (anatomy,access, how much tooth is left) , patient expectations etc.

welshdent

mal4mac wrote: »

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."

do you want adequate or top class? Seriously. As a patient what would you want?

I didnt think you needed a microscope. Until I got one and saw just how much more complicated a root canal system can be. Finding sclerosed canals, canals that split, extra canals that dont show up on x rays.

Undervalued

brook2jack wrote: »

A dentist cannot say I can't do the root treatment on the NHS but I can do it privately.

They can say I cannot do the root treatment but I can refer you (normally privately as NHS endodontists are generally non existant) privately. Even if that referral is within the same practice.

But anecdotally at least it seems quite a few do say that although some wrap it up more subtly than others!

Referring within the same practice is bound to be misunderstood by many patients even if it is within the rules.

Clearly the whole business is a mess. Yes I sympathise with the dentists' position based on what has been explained here. However, as I said before the vast majority of patients aren't going to understand any of that and why should they?

welshdent

Which brings us right back square one to the rubbish contract that was imposed on the profession. Junior Doctors beware!

We do have a second class dental system (not dentists) in my opinion. We have a rapidly advancing knowledge and technologies that allow much more advanced treatments to keep or replace teeth. It has come on so much even in the last 10 years. But we have a poorly funded NHS that passes costs on to the dentist so it doesnt REALLY absorb the costs. Then a government that lies about what it will provide knowing that it is up to the dentist to make these things happen in ever restricted budgets or suffer the consequences. understandably people want "NHS" care but as has been alluded to, no one really is aware of what it is. It is a viscous circle with the patient suffering.

The original contracts were based on for example providing amalgam fillings not composite ones. Composite fillings cost SIGNIFICANTLY more to provide than amalgam. When the government decide one day we can not use it, guarantee they will NOT increase funding to compensate. they decided a few years ago we could not use root canal files more than once due to a worry there may be a risk of vCJD transmission. No evidence. We are the only country in the world that does this. So immediately these files that the cost could be spread over a few patients treatments are good for only one. They would not give any more funding just expected us to absorb the costs. That probably increased the anecdotal experiences of people being "encouraged" to pay privately/.

silvercar

brook2jack wrote: »

A dentist cannot say I can't do the root treatment on the NHS but I can do it privately.

They say this all the time.

Or to use the phrasing of my ex- dentist (who was good), I can push most of your treatment through the NHS but not the root canal.

mal4mac

What about extraction followed by implant? As the root filled tooth might only last ten years, why not go straight to implant?

brook2jack

An implant doesn't last forever either. All dental treatment has a lifespan. Nothing is as strong as the original tooth.

An implant requires maintainance and can be lost due to eg gum disease as easily as a tooth.

You need the right quality and quantity of bone so implants are not for everyone and most implantologists will not place implants on smokers or people with ill controlled diabetes for instance.

justme111

I see. It depends what you value your teeth at. And your relationship with your dentist. I would not see dentist under nhs contract full stop.

mal4mac

Well I just had an NHS check up for £18.50 and it went fairly well, I think, certainly as regards "money saving". The dentist showed me with mirrors and X rays exactly what had gone wrong with my three problem teeth, and then referred me to the dental hospital for two extractions at £0. She showed how the teeth had decayed so much that they were beyond root canal work and simple extraction.

The dentist did push the hygienist at £64 a pop. I'll maybe see if I can argue that cost down after the surgery! Shouldn't it be £0 as there is a definite clinical need to get on top of my gum disease?

Implants weren't mentioned, a plate, or "just leave it", seemed to be the options she favoured, but that discussion is going to happen in depth after surgery, and after my gums get some semblance of health.