Root canal question

jfozz81

I have been told that I need a root canal re-treatment in my upper right 2 incisor. I moved to a new area and dentist and my new NHS dentist wants to refer me to their in house private endodontist at a cost of nearly £600. I've been in this situation before when I was told by a previous dentist that they don't do root canal work and again referred me to private. I changed dentists on that occasion and did have it done on the NHS.
I'm just weary that this just a bit of a money making exercise by dentists as it more profitable to refer to private rather than do it through the NHS?? 
Any dentists that can give me some honest advice about this please?

brook2jack2

The economic facts are a dentist loses money doing root treatment on the NHS , the equipment and time costs more than the procedure brings in. Just the files alone cost £35 per person per visit . 

The other problem is a dentist faces litigation if they attempt treatment that is not in their scope of practice. 

Difficult root treatments fall into this category yet almost universally the NHS does not provide specialist endodontists so root treatments requiring specialist treatment almost always need a private referral. Specialists use equipment such as operating microscopes (£18,000) and cements such as mdta which by itself costs £50 a capsule. 

What a dentist cannot do is say I cannot do this on the NHS but I can do this myself privately. However they can refer privately to another dentist ,even within the same practice. There is no financial reward for doing this. 

One of the criteria for referring to a specialist can be redoing a root treatment. The success rates for a root treatment are much less second time around . Things like an existing post crown, bent root , difficult anatomy , resorption , cyst etc can make it even more difficult. 

Undervalued

jfozz81 said:

I have been told that I need a root canal re-treatment in my upper right 2 incisor. I moved to a new area and dentist and my new NHS dentist wants to refer me to their in house private endodontist at a cost of nearly £600. I've been in this situation before when I was told by a previous dentist that they don't do root canal work and again referred me to private. I changed dentists on that occasion and did have it done on the NHS.
I'm just  as it more profitable to refer to private rather than do it through the NHS?? 
Any dentists that can give me some honest advice about this please?

An NHS dentist simply saying they "don't do root canal work" is not acceptable as it is a breach of the rules under which they operate.

As Brook has indicated, they are allowed to decline to do more complex root canal work but they are expected to have the equipment and skills necessary to carry out reasonably straightforward treatments. Where the line is drawn is of course a difficult grey area.

As Brook also indicates the peculiar NHS funding arrangements provides a great incentive for an NHS dentist to try and avoid doing this work but that is not the patient's problem.

So you are, indirectly, right to be "weary that this just a bit of a money making exercise by dentists". Whilst they may not (hopefully) be getting a backhander for the referral, they would be losing money if they honour their obligations! Obviously that assumes your tooth is within the range that a non specialist could reasonably be expected to treat, which it may or may not be.

jfozz81

brook2jack2, thanks for you reply. 
So I read from what you say that there is a financial benefit in so far as the dentist loses money if the do the work through the NHS but not if they do it privately?
I guess what I need to know is, will I get a better standard of work and as such a better chance of success if the work is done privately? Or will I get the same if I pushed for it to be done on the NHS, or looked for another dentist that would do it on NHS?
£600 is a lot of money, however I will spend it if it is worth it.

brook2jack2

It is illegal to accept a "back hander" for a referral and would rapidly involve a visit to the GDC and the loss of registration , job etc https://standards.gdc-uk.org/pages/principle1/principle1.aspx

elsien

That is the question you  need to ask.
My dentist told me - I can do it on the NHS - my success rate generally over 5 years is...... or I can refer you privately. It will cost x but with their equipment and knowledge the success rate is ...   (which was higher.) 
Then the decision was mine. 

brook2jack2

A specialist endodontist or a dentist with an interest in endodontics (root treatment) has advanced training (Very often a msc which takes over a year to obtain) and equipment ranging from an operating microscope , to materials and techniques which are prohibitively expensive for a non specialist . Their appointments will be longer anything up to two hours l 

Because of this the specialists success rate is always higher than a non specialist even for non complicated procedures. For complex procedures their success rates are much higher but no procedure has 100% success rate particularly if you are redoing a failed root treatment . 

Root treatment is really complex microsurgery , you are cleaning out and filling root canals a fraction of a millimetre in size , that can be bent , twisted , or mutiple deltas fanning out at the base of a tooth. This gives you a small clue as to how complex the task is https://academy.dentsplysirona.com/content/dam/master/education/documents/upload/I/Irrigation%20White%20Paper.pdf

jfozz81

So I have an appointment with the specialist on Wednesday, its £49 for this appointment, chargeable if I don't agree to go through with the treatment. Which again puts pressure on me to go ahead so as to not lose more money!

brook2jack2

The expenses involved in running a practice is enormous . Time has to be paid for somehow and charging for consultations , I think, is fairer than loading the cost of treatment for those who proceed to pay for the cost of "free" consultations. 

elsien

jfozz81 said:

So I have an appointment with the specialist on Wednesday, its £49 for this appointment, chargeable if I don't agree to go through with the treatment. Which again puts pressure on me to go ahead so as to not lose more money!

It is a small amount to pay to help with the decision making, compared with what you could be paying if you go ahead.
And you do not have to make a decision on the day of the appointment, you can go away and think about it. It sounds like you've already decided they're ripping you off, which isn't a good basis for any professional/treatment relationship if you don't trust the people who are doing it. 

jfozz81

Elsien, I've not decided they are ripping me off. In some repects I don't blame them for avoiding NHS work if it would be done at a loss for them, so I'm more annoyed at the way its funded! 
I suppose thats the problem, it encourages dentists to refer when perhaps it is not necessary. Regardless, root canal work is included on the NHS so i just need reassurance im not wasting my money. I'll go ahead with the appointment on Wednesday and ask lots of questions to see it confirms in my mind that its the right way to go. 
Thanks for all you advice.