Root Canal needed but my NHS dentist won't do them

Roy1234

This post is not a request for medical advice, rather it's about how best to obtain the dental work I do need.

It looks like I'll need a root canal in a molar tooth.  I've known my NHS dentist for over 20 years and thoroughly trust him, he's minimized extra work/cost in the past.  But he just won't do root canals, considering them fiddly (microscope work; dental dams; single-use tools) and time-consuming. It doesn't help that the NHS classify root canals as only mid-range (£73.50), like a simple filling.

A few years ago, when I last needed one, he sent me to a private dentist in a posh area who wanted £650 for this work, then another £650 for the crown afterwards.  Googling prices, suggests this was the top end of that private price bracket especially then.

So I'm expecting to be referred privately again.  It narks me that friends have had this work done by NHS dentists in the past, whilst I am back in the hands of private dentistry.  I am guessing you can't just find another random NHS dentist and ask them to do a root canal?  I'm reluctant to leave a good dentist who I trust in order to get the work done on NHS.

Just wondering what others experiences have been of getting root canals via NHS dentist or the costs if private?

beckstar1975

I have given up on them as they've always failed in the end and needed extracting - so round here we're told either to find a private dentist to do them or are referred to the specialist dentist for an extraction on the NHS. Years ago we could be referred to Kings dental hospital for them but that hasn't been offered to DH or me for several years now

Voyager2002

I went to Poland for a specialist in this kind of dentistry. Standards are very high, and the total cost (including transport and accommodation) much less than a private dentist in England.

Undervalued

Roy1234 said:

This post is not a request for medical advice, rather it's about how best to obtain the dental work I do need.

It looks like I'll need a root canal in a molar tooth.  I've known my NHS dentist for over 20 years and thoroughly trust him, he's minimized extra work/cost in the past.  But he just won't do root canals, considering them fiddly (microscope work; dental dams; single-use tools) and time-consuming. It doesn't help that the NHS classify root canals as only mid-range (£73.50), like a simple filling.

A few years ago, when I last needed one, he sent me to a private dentist in a posh area who wanted £650 for this work, then another £650 for the crown afterwards.  Googling prices, suggests this was the top end of that private price bracket especially then.

So I'm expecting to be referred privately again.  It narks me that friends have had this work done by NHS dentists in the past, whilst I am back in the hands of private dentistry.  I am guessing you can't just find another random NHS dentist and ask them to do a root canal?  I'm reluctant to leave a good dentist who I trust in order to get the work done on NHS.

Just wondering what others experiences have been of getting root canals via NHS dentist or the costs if private?

A NHS general dentist is supposed to do "straightforward" root canals as necessary as part of a band 2 treatment. They are allowed to decline any that are "complex" and / or require more specialised skills and equipment than would reasonably be expected of a general NHS dentist.

The problem is two fold. Both straightforward and complex are relative terms with huge grey areas in between. Also, the amount they are paid by the NHS (quite different to the fees they collect from the patient) falls well below the real cost of the time and materials. So there is an obvious incentive for them to decline. It is not easy to challenge.

What they cannot do is decline to do it on the NHS but offer to do it privately. They can however refer the patient to another dentist, even in the same practice!

Although I have some sympathy for their position that doesn't excuse the rule bending that clearly happens is some instances.

Roy1234

Undervalued said:

Roy1234 said:

This post is not a request for medical advice, rather it's about how best to obtain the dental work I do need.

It looks like I'll need a root canal in a molar tooth.  I've known my NHS dentist for over 20 years and thoroughly trust him, he's minimized extra work/cost in the past.  But he just won't do root canals, considering them fiddly (microscope work; dental dams; single-use tools) and time-consuming. It doesn't help that the NHS classify root canals as only mid-range (£73.50), like a simple filling.

A few years ago, when I last needed one, he sent me to a private dentist in a posh area who wanted £650 for this work, then another £650 for the crown afterwards.  Googling prices, suggests this was the top end of that private price bracket especially then.

So I'm expecting to be referred privately again.  It narks me that friends have had this work done by NHS dentists in the past, whilst I am back in the hands of private dentistry.  I am guessing you can't just find another random NHS dentist and ask them to do a root canal?  I'm reluctant to leave a good dentist who I trust in order to get the work done on NHS.

Just wondering what others experiences have been of getting root canals via NHS dentist or the costs if private?

A NHS general dentist is supposed to do "straightforward" root canals as necessary as part of a band 2 treatment. They are allowed to decline any that are "complex" and / or require more specialised skills and equipment than would reasonably be expected of a general NHS dentist.

The problem is two fold. Both straightforward and complex are relative terms with huge grey areas in between. Also, the amount they are paid by the NHS (quite different to the fees they collect from the patient) falls well below the real cost of the time and materials. So there is an obvious incentive for them to decline. It is not easy to challenge.

What they cannot do is decline to do it on the NHS but offer to do it privately. They can however refer the patient to another dentist, even in the same practice!

Although I have some sympathy for their position that doesn't excuse the rule bending that clearly happens is some instances.

Yes my dentist uses the word complex, as you rightly say this is impossible for a patient to argue.  My private root canal was painstakingly careful, lots of X-rays, three or four visits.  All that makes a mockery of a £73.50 fee.  I realise (having a slight work related connection with dentistry) that 'drill & fill' is the model they follow, all about bums on seats & throughput, one patient numbing-up in the waiting room whilst someone else gets their scale & polish.  Hours of fiddling with microscopes doesn't really fit that model, especially at that price.  What perplexes me is that any NHS dentists will do root canals.

He is likely to send me elsewhere privately, so not breaking that rule, although I have a friend whose NHS dentist did precisely that to her and took a private fee for some of her work.

Does anyone have a sense of a reasonable private fee for this?  When my private dentist back then hit me with the £1,300 estimate with only a 90% success rate, I instinctively said 'but that's almost the cost of an implant, whereas your root canal isn't even guaranteed to work?'.  He seemed quite wrongfooted by that remark, and he agreed I had a fair point, but it was an idle comment from me, I was in his chair, and we went ahead with the root canal. 

Toothsmith

Roy1234 said:

Does anyone have a sense of a reasonable private fee for this?  When my private dentist back then hit me with the £1,300 estimate with only a 90% success rate, I instinctively said 'but that's almost the cost of an implant, whereas your root canal isn't even guaranteed to work?'.  He seemed quite wrongfooted by that remark, and he agreed I had a fair point, but it was an idle comment from me, I was in his chair, and we went ahead with the root canal. 

90% isn't bad! I cannot think of any medical procedure that can give 100% success rate.

You can see from Beckstar's post above that they have given up on them, as 'they all fail in the end' - which I'm presuming is their experience of NHS ones? An NHS one, and indeed a private one done by a non-specialist would certainly have a lower success rate than one done by a specialist. 

Even if 'successful' - a root filled tooth would then almost certainly need crowning, and even with that - it would be a very foolish dentist who would tell you that that would do you for the rest of your life! (Unless you were 96 and on death's door!). All dentistry has a life span. The more complex the procedure, the less predictable that life span is.

Even implants don't come with 100% guarantees. Their 10 & 15 year survival times aren't bad (can be up to 95%) but as more are placed - and especially as more are placed in unsuitable people (Often, but not exclusively, by the 'dental tourism' clinics who just do what the patient wants without regard for their ability to care for the end result) A condition known as periimplantitis is being seen more and more often - a gum disease specific to poorly cleaned implants.

If you get a root filling done, then the average time a 'successful' one will last will be about 15 yrs, possibly more if well looked after and in a gentle mouth. 

Implants can then follow - and the chances of one of those lasting 10 - 15+ years are also pretty good, but again, they do need a good level of patient care.

brook2jack2

The other big problem is litigation. You are more likely to be sued as a dentist in the U.K. than anywhere else in the world. 

Dentists , private or NHS , are much less likely to take on a root treatment as specialists have microscopes , different materials etc and hence have a higher success rate . 

If the root treatment fails , even if the dentist has done their best , there is a good chance litigation will follow and it will be very difficult to defend not sending it to a specialist . The £73.50 fee looks even more of a joke if the dentist ends up funding an implant as well , despite trying their best . 

This highly litigious working environment means dentists are more and more likely to refer out treatment to a specialist , not only because the NHS fees don’t even cover costs , but mostly because it can end up costing the dentist a fortune and an enormous amount of stress. 

When I started dentistry root treatment was a fairly straightforward proceedure , but as technology and materials have improved more and more teeth can , in theory be saved and root treated , hence  it becomes more and more difficult for a general dentist to defend trying to do a root treatment themselves. 

Roy1234

Toothsmith said:

Roy1234 said:

Does anyone have a sense of a reasonable private fee for this?  When my private dentist back then hit me with the £1,300 estimate with only a 90% success rate, I instinctively said 'but that's almost the cost of an implant, whereas your root canal isn't even guaranteed to work?'.  He seemed quite wrongfooted by that remark, and he agreed I had a fair point, but it was an idle comment from me, I was in his chair, and we went ahead with the root canal. 

90% isn't bad! I cannot think of any medical procedure that can give 100% success rate.

You can see from Beckstar's post above that they have given up on them, as 'they all fail in the end' - which I'm presuming is their experience of NHS ones? An NHS one, and indeed a private one done by a non-specialist would certainly have a lower success rate than one done by a specialist. 

Even if 'successful' - a root filled tooth would then almost certainly need crowning, and even with that - it would be a very foolish dentist who would tell you that that would do you for the rest of your life! (Unless you were 96 and on death's door!). All dentistry has a life span. The more complex the procedure, the less predictable that life span is.

Even implants don't come with 100% guarantees. Their 10 & 15 year survival times aren't bad (can be up to 95%) but as more are placed - and especially as more are placed in unsuitable people (Often, but not exclusively, by the 'dental tourism' clinics who just do what the patient wants without regard for their ability to care for the end result) A condition known as periimplantitis is being seen more and more often - a gum disease specific to poorly cleaned implants.

If you get a root filling done, then the average time a 'successful' one will last will be about 15 yrs, possibly more if well looked after and in a gentle mouth. 

Implants can then follow - and the chances of one of those lasting 10 - 15+ years are also pretty good, but again, they do need a good level of patient care.

Toothsmith - thanks for that useful info, you are obviously in the trade.  I hadn't realised that implants were as short lived as that, nor that people are getting problems with them.  I guess what you are saying is that in terms of useful life, nothing lasts forever and you get what you pay for, and that a cheapo NHS root canal (when available) is at the shorter end of the life spectrum.  But that an implant may not outlast a good root canal anyway.

If/when I do go down the implant root, is it just the above ground part that needs replacement, the metal root/screw presumably staying forever?  If so, does that make any top part replacement easier/cheaper?

brook2jack2 - hadn't heard of dentists getting sued for something like a root canal, I can't imagine how anything is ever legally 'proven' in that context?

brook2jack2

The most common reason for an implant to be lost is perimplantitis which is gum disease of implants. That means the whole of the implant needs to be replaced, including the bit in the gum. Smoking , diabetes and gum disease elsewhere in the mouth are risk factors and for that reason meticulous cleaning is required . 

The top part (superstructure) will possible need redoing and/or replacing during the lifespan of the implant. 

Dentists are sued more in the U.K. than anywhere else in the world , in this ten year study there were 1500 ish claims and that rate has rocketed upwards since. https://ddujournal.theddu.com/issue-archive/issue-3/pulp-fact---looking-inside-endodontic-claims It is this massive rate of litigation that makes U.K. dentistry so stressful , particularly when , on the NHS , the dentist is loosing money already on a root treatment. The chance of being sued with the money and stress makes it more and more unlikely that a non specialised dentist will attempt one, private or NHS. 

Roy1234

brook2jack2 said:

The most common reason for an implant to be lost is perimplantitis which is gum disease of implants. That means the whole of the implant needs to be replaced, including the bit in the gum. Smoking , diabetes and gum disease elsewhere in the mouth are risk factors and for that reason meticulous cleaning is required . 

The top part (superstructure) will possible need redoing and/or replacing during the lifespan of the implant. 

Dentists are sued more in the U.K. than anywhere else in the world , in this ten year study there were 1500 ish claims and that rate has rocketed upwards since. https://ddujournal.theddu.com/issue-archive/issue-3/pulp-fact---looking-inside-endodontic-claims It is this massive rate of litigation that makes U.K. dentistry so stressful , particularly when , on the NHS , the dentist is loosing money already on a root treatment. The chance of being sued with the money and stress makes it more and more unlikely that a non specialised dentist will attempt one, private or NHS. 

Very interesting.  I always thought the (titanium?) metal root effectively bonded forever in the jaw; obviously not.  I've never thought of suing a dentist, I cross my fingers and take my knocks, but then I come from an era when suing rarely happened.  Your average Joe could afford lawyers even less than private dentists.  Now I suppose its No Win/No Fee, so open season.

Is the meticulous cleaning you say is needed, during the dental work only, or ever after?  The pricing of NHS root canals as band 2 seems, even as an outsider to the industry, the weirdest thing.  Tantamount to saying 'Not available on NHS' or else not done very well if they are.

brook2jack2

The meticulous cleaning is forever after. You are more likely to lose an implant than your own tooth. 

The whole of NHS pricing is ridiculous when it costs a minimum of £140 an hour to run one room in a dental practice . Most practices subsidise , to one extent or another , NHS from private work. 

Two of my acquaintances have given up their NHS contracts in the last few months as they were losing 6 figure sums a year on the practices NHs contracts.