NHS Dental charges

Undervalued

AliceBanned wrote: »

The NHS dentist I went to said it needed root canal and outlined the costs NHS, private with her, private with a specialist. I asked her the difference between NHS and private treatment and she said it was 'the materials used'. Seemed a bit vague and it has calmed down for now but if it returns I will need to go ahead with some kind of treatment and still have no idea of the best option as I don't like the idea of root canal at all. It is a molar.

I am not a dentist but my limited understanding is as follows.

Root canal treated teeth generally need to be crowned. A NHS crown for a back tooth is metal, not tooth coloured ceramic. Metal is strong and may involve removing less of the tooth but doesn't look as nice. If you want a nice looking tooth coloured ceramic crown it is quite legitimate for the NHS dentist to offer that as chargeable private job.

However, the root canal part of the job should be done by the NHS dentist if it is within their capabilities. If it is not they can refer you elsewhere for private treatment but what they cannot do is suddenly find the capability to do it themselves if you are willing to pay!

One of the dentists will have to answer the question about whether she can legitimately charge for doing it herself using materials that the NHS wouldn't pay for (like the crown). As far as I know that is not allowed.

Toothsmith

AliceBanned wrote: »

Slightly hijacking this thread but it was of interest to me because recently I had an abscess and took no action - it cleared up on antibiotics from my GP.

It won't have 'cleared up' - the antibiotics may have settled down this flare-up - but the cause is a dead infected nerve in the middle of the tooth - and either that dead tissue needs removing and the space filling up (Root filling) or the whole tooth needs extracting.

Until one or the other is done, that tooth is a time-bomb. It will flare up again. It might be a few weeks, a few months or a few years. But Sod's law says it will not be at a convenient time. Just before an important family member's wedding, or as you're about to go on holiday would be my guess!

Undervalued wrote: »

I am not a dentist but my limited understanding is as follows.

Root canal treated teeth generally need to be crowned. A NHS crown for a back tooth is metal, not tooth coloured ceramic. Metal is strong and may involve removing less of the tooth but doesn't look as nice. If you want a nice looking tooth coloured ceramic crown it is quite legitimate for the NHS dentist to offer that as chargeable private job.

However, the root canal part of the job should be done by the NHS dentist if it is within their capabilities. If it is not they can refer you elsewhere for private treatment but what they cannot do is suddenly find the capability to do it themselves if you are willing to pay!

One of the dentists will have to answer the question about whether she can legitimately charge for doing it herself using materials that the NHS wouldn't pay for (like the crown). As far as I know that is not allowed.

That pretty much sums it up.

But the NHS doesn't actually say what it will or won't pay for. There are no 'banned' materials or procedures.

What the NHS 'allows' though, is for the dentist to do the treatment that will achieve dental health for the patient in the most 'cost effective' way.

So - the dentist doesn't have a list of 'banned' items. It's just all very ambiguous and non-committal from the NHS side, until a patient complains!

Some things can be quite black & white with the conditions as they are most often the most cost effective treatment and in the best interests of the patient.

But then there are things like root fillings, which are much greyer! How necessary is the tooth? Does the general dental health of the patient and their level of self-care warrant providing more advanced treatments? This is very subjective, and one of those things where no two dentists would probably agree!

But - what is wrong is for a dentist to say they won't do it on the NHS, but the would do it privately.

Saying they couldn't do it privately, as it is too complex for them is perfectly valid - and in that case the options are to go and see a specialist (Who all happen to be private) or have it out on the NHS is fair enough.

AliceBanned

Thanks Undervalued and Toothsmith. Understood that it will flare up again, the dentist said the same and I am trying to work out what is best way forward.


The NHS dentist I go to gave me the option of NHS or private treatment both by her, or private by someone more experienced. What I was trying to find out is what is the difference between NHS and private root canal (not including crown as obviously this would be higher cost depending on materials chosen) both by her? She said something about materials. Maybe the procedure would be more comfortable with private treatment, at £300 higher cost than NHS. NHS for root canal only was around £50 from memory, plus the crown at around £400.


As it settled (temporarily I know) I am not sure when to go ahead or what to do. I am scared of root canal as so invasive. Never had anything like that before. Also concerned if I leave it could the abscess cause other problems?


When she showed me the abscess on an xray I wasn't too convinced as the tooth didn't look much different to the others, but I guess the level of pain (excruciating) across my ear and jaw and especially when I tried to eat or drink anything hot) would indicate it definitely is an abscess?

Undervalued

AliceBanned wrote: »

Thanks Undervalued and Toothsmith. Understood that it will flare up again, the dentist said the same and I am trying to work out what is best way forward.


The NHS dentist I go to gave me the option of NHS or private treatment both by her, or private by someone more experienced. What I was trying to find out is what is the difference between NHS and private root canal (not including crown as obviously this would be higher cost depending on materials chosen) both by her? She said something about materials. Maybe the procedure would be more comfortable with private treatment, at £300 higher cost than NHS. NHS for root canal only was around £50 from memory, plus the crown at around £400.


As it settled (temporarily I know) I am not sure when to go ahead or what to do. I am scared of root canal as so invasive. Never had anything like that before. Also concerned if I leave it could the abscess cause other problems?


When she showed me the abscess on an xray I wasn't too convinced as the tooth didn't look much different to the others, but I guess the level of pain (excruciating) across my ear and jaw and especially when I tried to eat or drink anything hot) would indicate it definitely is an abscess?

That is the bit that is questionable to say the least. She should not be offering to do it privately herself. If she is capable of doing it as an NHS treatment that is what she should do.

Obviously you could opt to pay for a specialist to do it privately. That person would (hopefully!) be more experienced and may well have access to more elaborate equipment. However if, in her judgement, that degree of specialism and equipment is needed to do a satisfactory job then she shouldn't be offering to do it at all!

She most certainly shouldn't be saying (in effect) pay me privately and I will take more care and do a better job!!

She is entitled to offer you a more cosmetically pleasing crown privately. or you can have a functional and strong metal one at NHS rates.

It is not for me to comment on the medical aspects but from my own personal experience, apart from the time it took, a root canal was not in any way more unpleasant than any other filling. Mine, done on the NHS and with a metal crown is fine five years on.

AliceBanned

Yes I thought it a bit confusing. I am concerned about materials used to fill in where the nerve was and in terms of fillings paying for private treatment means you can avoid amalgam which I prefer to do. But I couldn't get clear information from her on the NHS treatment and what would be used in my mouth for the root canal itself.


I think I may go to her and get the NHS treatment but will mull it over a bit. Generally the practice has been very good. I am put off getting it done as it will cost me £800 privately.

Undervalued

AliceBanned wrote: »

Yes I thought it a bit confusing. I am concerned about materials used to fill in where the nerve was and in terms of fillings paying for private treatment means you can avoid amalgam which I prefer to do. But I couldn't get clear information from her on the NHS treatment and what would be used in my mouth for the root canal itself.


I think I may go to her and get the NHS treatment but will mull it over a bit. Generally the practice has been very good. I am put off getting it done as it will cost me £800 privately.

My limited non medical understanding is that filling replacing the nerves will not be amalgam either way as it has to be some kind of special material.

AliceBanned

Just thought I'd feed back that I didn't go ahead with any treatment. Had no pain at all, and I had a check up yesterday. The dentist was surprised but says that nothing needs to be done and it seems to have cleared up on its own.


When she initially showed me the xray of the nerve I couldn't see anything wrong with it, it looked similar to the others so I wasn't convinced.


There is a hairline fracture which she says may have caused it. Doing nothing saved me around £800. Of course it may flare up, who knows, but at least then I will know to take action.

Undervalued

AliceBanned wrote: »

Just thought I'd feed back that I didn't go ahead with any treatment. Had no pain at all, and I had a check up yesterday. The dentist was surprised but says that nothing needs to be done and it seems to have cleared up on its own.


When she initially showed me the xray of the nerve I couldn't see anything wrong with it, it looked similar to the others so I wasn't convinced.


There is a hairline fracture which she says may have caused it. Doing nothing saved me around £800. Of course it may flare up, who knows, but at least then I will know to take action.

Well that is good news. However, it would have cost you a lot less than £800 on the NHS, had it needed to have been treated (as indeed it still might at some point in the future).

Straightbat

I have read that root canal treatment includes a crown and this can be done as band 2 NHS treatment.

So why is a crown or onlay only charged as band 3? Is this correct?

Toothsmith

Straightbat wrote: »

I have read that root canal treatment includes a crown and this can be done as band 2 NHS treatment.

So why is a crown or onlay only charged as band 3? Is this correct?

I think you've just got a bit mixed up.

If you have an RCT followed immediately by a crown, then because the treatment involves a crown, the whole lot is considered a Band 3 treatment. But yes - the RCT is included in this charge.

If just an RCT is done, and for clinical reasons it is considered best to wait a while (More that 8 weeks) before doing the crown, then the RCT is a Band 2 treatment, and the crown would be a separate Band 3 treatment

There are many good reasons why waiting 6 - 12 months after an RCT before crowning it can be considered a sensible thing to do clinically.