Difference between private dentistry and PHI

silvercar

I wonder if any of the dentists on here can guide me.

I have a upper tooth that has decayed below the gum line. It was root filled and crowned many years ago. My (private) dentist warned me that it could snap at some point and also that it was slightly loose. He also said that it would need a surgical extraction and he has a visiting dentist who specialises in this.

The inevitable has happened and it has now snapped off. There is little above the gum line. Obviously I could go back to the dental surgery and have it removed by this visiting dentist. I'm not sure what the cost would be, but I would guess £2-300.

Whereas I don't have private dental insurance or denplan, I do have private health insurance. I am wondering if I could ask my dentist to refer me instead to a private hospital. The specific clause on my PHI is:

"Teeth and dental conditions
The plan does not cover treating dental problems or any routine dental care including treatment of cysts in the jaw that are tooth related or are of a dental nature. This also means we will not pay any fees for dental specialists, such as orthodontists, periodontists, endodontists or prosthodontists. We will cover the following types of oral surgery when you are referred for treatment by a dentist:
 • reinserting your own teeth after an injury
 • removing impacted teeth, buried teeth and complicated buried roots
 • removal of cysts of the jaw (sometimes called enucleation)."

Given that it needs a specialist visiting dentist (though I do wonder why my own dentist can't do an extraction) would this count as a buried or complicated root tooth?

brook2jack2

You might get it covered , although mostly this is used for wisdom teeth extraction or impacted teeth (ones growing in the wrong place) and I wouldn't bet on it being covered. Phone up your insurers. 

Extractions can be very difficult and given the extreme litigious nature of practicing in the U.K. a dentist will often refer rather than "give it a go" because of the risk of being sued when it had been assessed as being difficult . 

This defensive dentistry is no good for anyone because it is very difficult to get expertise and experience without "giving it a go". Many dentists of my generation have a much broader wealth of experience because early in our careers we did many proceedures which today would be referred because of defensive dentistry. 

Defensive dentistry is also partly why NHS dentistry is down the pan , because a dentist doing say endodontics (root treatment ) actually loses money doing it but is held to the same standards , in many cases , as a specialist . Not only that but if someone sues you the pay out could be a multiple of hundreds of what the treatment earned you .  So anything remotely challenging will get referred. As you are more likely to be sued as a dentist in the U.K. than anywhere lease in the world your indemnity (insurance) rates , registration etc are so high that most dentist in The NHS work from January to April just to pay the bills to be a dentist , before they actually earn anything. 

silvercar

Thank you @brook2jack2 that makes sense.

What would happen on the NHS? Presumably an NHS dentist would also be reluctant to remove the offending tooth himself, but there wouldn’t be an option of a visiting specialist dentist. (Just thinking that now the tooth is a goner, it doesn’t really need private care).

brook2jack2

In my area you would be referred and would wait 12 to 18 months for initial specialist appointment and up to another year to have tooth out. 

Other areas may have shorter waiting lists particularly if they have tier two providers (not a hospital but dentists who have skills in surgical extractions ) . 

silvercar

To update. The visiting specialist has now cancelled their clinic twice. I asked to be referred to another clinic that could carry out the extraction as I'm fed up of waiting with a sore gum etc. The dentist has now decided that he can do the removal himself. I am guessing that it was fairly marginal whether to refer or not and rather than choosing to leave an unhappy patient waiting much longer or to refer outside the practice it sis worth him having a go.