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Undervalued

brook2jack wrote: »

Any patient who requires multiple fillings, extractions , crowns, bridges , gum treatment, chrome dentures etc will lose a NHS dentist money.

The laboratory fees also will often be more than the treatment earns.

This is a well known problem and why for at least 10 years the government has been trialling new contracts. The difficulty is the amount spent per patient treated has been falling year on year and how much high quality dentistry can be bought when the average spend per person treated each year is £36? This pays for all the surgery costs,training equipment , etc etc etc

At a cost of £140 an hour to run one room in a practice it is easy to see where NHS Dental maths fails.

I am sure that is all 100% true but it doesn't answer my question!

brook2jack

Even a private dentist will have situations where there is a financial disincentive to some treatments. Dentists are taught to disregard this and plan in a patients best interest.

However there is a difference in the occasional treatment plan losing money and a systemic underfunding of whole tranches of treatment. This has the effect of colleagues cutting down the NHS services they provide or going bankrupt . https://bda.org/news-centre/press-releases/nhs-dentistry-across-uk-running-on-fumes

I am proud of the vast majority of NHS colleagues who many times a day put patients interests beyond their own and ashamed of the tiny minority who rather than get out of a system that is seriously damaged choose to stay and try to game the system.

brook2jack

Undervalued wrote: »

However they will presumably reply claiming it is too complex and the the OP misunderstood what the dentist said!

So unless the OP gets a second opinion staying it is actually straightforward (if indeed that is the case) and then makes a formal complaint this dentist will continue to get away with unprofessional practice.

Actually no. Every NHS dentist has their treatment examined statistically and reported. If their rates of endodontic treatment (root treatment) is lower than expected or their crown treatment lower or extractions (tooth removal) higher they are in breach of contract and their nhs contract can be removed and they can be referred to the GDC with the dentist liable to lose their licence to practice.

Not replying to a complaint , or no satisfactory reply should escalate the replay to the LAT , CCG or appropriate body. This will prompt an investigation and the statistics will tell the story if no root treatment or crowns are done.

Undervalued

brook2jack wrote: »

Actually no. Every NHS dentist has their treatment examined statistically and reported. If their rates of endodontic treatment (root treatment) is lower than expected or their crown treatment lower or extractions (tooth removal) higher they are in breach of contract and their nhs contract can be removed and they can be referred to the GDC with the dentist liable to lose their licence to practice.

Not replying to a complaint , or no satisfactory reply should escalate the replay to the LAT , CCG or appropriate body. This will prompt an investigation and the statistics will tell the story if no root treatment or crowns are done.

Interesting, and reassuring to a point. However the statistics alone won't prove if this particular tooth was genuinely too complex.

brook2jack

But it will demonstrate if a dentist truely will not do crowns or root treatments, in which case then it truly looks as if this tooth is too complicated. The CCG LAT etc employs dental advisors who advise on clinical ldental matters and can confirm complexity or not of treatment.

To give you a view of how sensitive the statistics are the local authority quizzed a colleague because they had provided three more single tooth dentures than expected in a year. They had to prove they were not avoiding providing a clinically necessary bridge.

brook2jack

I am sure you won't want to read all 95 pages but the checks on amount of root treatment done is on page 10 "endodontic treatment" as one of the quality indicators a practice has to hit to keep their contract . https://www.nhsbsa.nhs.uk/sites/default/files/2017-05/Dental%20handbook%20v1.0.pdf

If you read further down that page it also mentions complaints.

Undervalued

brook2jack wrote: »

But it will demonstrate if a dentist truely will not do crowns or root treatments, in which case then it truly looks as if this tooth is too complicated. The CCG LAT etc employs dental advisors who advise on clinical ldental matters and can confirm complexity or not of treatment.

To give you a view of how sensitive the statistics are the local authority quizzed a colleague because they had provided three more single tooth dentures than expected in a year. They had to prove they were not avoiding providing a clinically necessary bridge.

I agree it is very difficult. Even if the OP gets a second opinion that says that the job is relatively straightforward, it is still possible the first dentist was right and the second one was willing to overreach himself? The poor patient can't know who is right and will naturally prefer the opinion he wants to hear.

If the second dentist does the job and it works out OK, was he just very lucky or was the first over cautious or, worse, down right dishonest?

No easy answer but the clear financial disincentive will always raise suspicion even if it is totally unwarranted.

brook2jack

The problem is also litigation. A dentist in the U.K. is more likely to be sued than anywhere else in the world , including the US.

If a dentist attempts , with all the good will in the world , a root treatment that is complex and it fails then they can be held liable as attempting a treatment beyond their competence. That may mean they personally have to pay out many thousands of pounds ,for an implant and it's maintainence, for a treatment that cost them money in the first place on the NHS.

Saffythecat

I’m in Scotland which I know is a bit different, but I needed an upper molar root canal last year, and my NHS dentist was wary that the roots of the tooth were very long and twisty. She gave me the option of her doing it, referring me to a specialist (private), or her doing it on the basis that it might prove impossible for her, in which case I could then be referred, or have the tooth out.

I opted to go straight to the specialist, mainly because I didn’t fancy going through more treatment than I needed if my own dentist ended up not being able to complete the process. I am grateful I was given clear options (my dentist is fab).

My situation is possibly a bit different as I had no infection, but had cracked the filling with previously undiagnosed bruxism, and the tooth just wouldn’t settle down after repair because the nerve was so angry. (It was apparently bleeding inside the tooth. Yikes.) My own dentist crowned the tooth a few months later, and I am now a religious night-guard wearer. The whole saga, not including the night-guard, cost me around £1,000.

welshdent

Undervalued wrote: »

In who's opinion?

We touched on this in another thread. Between the extremes there must presumably be a grey area where different NHS dentists will take different views if they were presented with the same tooth?

Some (hopefully most) will want to do their best for the patient. However I seem to remember you saying in the past that whatever the NHS pay the dentist for doing a root canal is not really adequate for the time and materials involved?

So inevitably it seems to me some such decisions will be made on financial or laziness grounds, which is far from ideal for the patient to say the least!

It is in the dentists opinion if it is too complicated for them

They are the one that have to take the risks if it goes wrong. If they say no matter what, they dont feel able to do the work then while you may find it annoying, they are quite entitled to do that. IF they say they cant on the nhs but suddenly become able to do it privately then you would legitimately have an issue to raise.

To be honest, I would not want anyone doing root canal treatment on me if they were not completely happy to do it. Lets ignore NHS funding. It is a HARD procedure to get right. It is highly technical and highly biological. without microscopes that can cost in excess of £10K you dont know what you cant see. IF you cant see it you can do what you believe is the absolute best job possible and it can still go wrong. By then you may have irretrievably altered the internal anatomy of the tooth meaning someone who DOES know what that can and cant see may find it an impossible job to correct.

These problems do not really happen in countries such as the USA and Australia. Many many MANY general dentists routinely refer out root canal treatment to specialists to make sure the job is done right the first time. In middle east countries such as kuwait, Saudi and oman dentists arent ALLOWED to do them unless they are specialists.
But in the UK we just expect all dentists to be equally competent in everything because the NHS demands it. We arent. There is no reality distortion field. Reality is it is a complex procedure and even single rooted front teeth can be difficult. Many private dentists actually refer them out too. It is not just a "how much are you getting paid" issue. Private dentists set their own fees so it is not an issue. I have a vested interest in root canal treatment. I have an MSc in them and take referrals for them. I truly did not know what I did not know until I did my further studies and I am someone that was actually interested in it!

If you demand something because you feel entitled to it. Fine. But you arent going to make that dentists all of a sudden better at doing it and give you a better job.

When we DO look at fees. Well the NHS doesn't pay badly for root canal treatment. It doesn't pay at all. But when pay outs run to the thousands if it doesn't go wrong is it not unsurprising that dentists aren't prepared to take the risk?? What would you do if you were the one taking on a risky procedure?