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endodontist, NHS, fees??
Dawn_S
Posts: 5 Forumite
Hi Everyone,
This is my first post and I am looking for a bit of advice about my teeth. I have not been to the dentist for 12 months because of work but previously I had been every 6 months, brush my teeth twice a day and floss.
I went to my NHS dentist for a checkup and stated that I had some pain in my lower and upper jaw. The dentist said I had a cracked filling in 2nd premolar and the rest was referred pain. She also said I would need the white on metal crown I had on my first molar redoing, however, she could not guarantee that it wouldn't need root canal because the x-ray was not conclusive because of the crown. She gave me antibiotics (amoxycillin) and also said some of the pain could be due to teeth clenching of which I had suffered before. She said I would also need a new night guard and since this was no longer available on the NHS it would cost me £125. She made an appointment to redo the filling in two weeks time.
On my return the filling was re-done but I still complained of pain in my lower molar area. She said she could not see anything on the x-ray so blamed it on referred pain. teeth clenching again. She then gave me further antibiotics( metronidazole?) I did not feel completely happy at this point but left and continued with the antibiotics.
After a few days I was in a lot of pain however, I continued with the antibiotics and hoped it would resolve. The pain got worse until I was in absolute agony (and I have a high pain threshold).
To cut a long story short I went for 3 emergency appointments in 3 days.
1st visit: She felt the filling she had done had aggravated the nerve and took the nerve out. She said this should sort it.
2nd visit: Still in absolute agony. Although reluctant to drill because of the x-rays I insisted that there was something wrong on the lower jaw and that it wasn’t referred pain. She hit lower second molar and I nearly leapt out of my chair. She took out the small filling and the smell was horrendous ☹.
3rd visit: The pain had subsided significantly but it was still there. She said that I would have to be referred to save the lower tooth as the RCT was beyond general practice and I would have to go to a private endodontist.
I the following weeks I returned for my root canal of the premolar in my upper jaw. I was under the impression a dam had to be used but this didn’t happen. Also part of the file broke off in my root and I was in the chair for over 2 hours!! She managed to get it out and filled it ready for the crown. And that is where I am up to and don’t know what to do?
With regard to treatment fees I have already paid for the check up and the filling that now has to have RCT and a crown.
-The first molar lower jaw will cost £198 on the NHS or £250 private for a white one. This apparently may also need RCT she hasn’t stated if she will do it or not.
- The second molar will cost the same for the crown but the endodontist will charge £75 for a consultation and £425 for doing it. Is this expensive or about right? I have never had RCT before all this.
Is it possible to get RCT treatment for a lower molar on the NHS even if it may be a tricky procedure? (she said the root was a bit wonky). If so should I change or would I even find one . Could a dental hospital do this procedure for me? Should I just get it extracted? What are the downsides to this? Was I just unlucky that all these problems happened at the same time? What is the maximum I should pay for all these treatments if it was on the NHS? Also my bite has gone weird.
Please, please can someone help/advise/reassure me if I am honest I do feel a little unconfident now. I am going back this Monday (28.4.08) for her to finish the crown on my upper pre-molar and I don’t know what to say with regards everything else.
Also, I am sorry this post is so long but I just needed to put all the facts down.
Thanks in anticipation of a reply
Cheers Dawn
This is my first post and I am looking for a bit of advice about my teeth. I have not been to the dentist for 12 months because of work but previously I had been every 6 months, brush my teeth twice a day and floss.
I went to my NHS dentist for a checkup and stated that I had some pain in my lower and upper jaw. The dentist said I had a cracked filling in 2nd premolar and the rest was referred pain. She also said I would need the white on metal crown I had on my first molar redoing, however, she could not guarantee that it wouldn't need root canal because the x-ray was not conclusive because of the crown. She gave me antibiotics (amoxycillin) and also said some of the pain could be due to teeth clenching of which I had suffered before. She said I would also need a new night guard and since this was no longer available on the NHS it would cost me £125. She made an appointment to redo the filling in two weeks time.
On my return the filling was re-done but I still complained of pain in my lower molar area. She said she could not see anything on the x-ray so blamed it on referred pain. teeth clenching again. She then gave me further antibiotics( metronidazole?) I did not feel completely happy at this point but left and continued with the antibiotics.
After a few days I was in a lot of pain however, I continued with the antibiotics and hoped it would resolve. The pain got worse until I was in absolute agony (and I have a high pain threshold).
To cut a long story short I went for 3 emergency appointments in 3 days.
1st visit: She felt the filling she had done had aggravated the nerve and took the nerve out. She said this should sort it.
2nd visit: Still in absolute agony. Although reluctant to drill because of the x-rays I insisted that there was something wrong on the lower jaw and that it wasn’t referred pain. She hit lower second molar and I nearly leapt out of my chair. She took out the small filling and the smell was horrendous ☹.
3rd visit: The pain had subsided significantly but it was still there. She said that I would have to be referred to save the lower tooth as the RCT was beyond general practice and I would have to go to a private endodontist.
I the following weeks I returned for my root canal of the premolar in my upper jaw. I was under the impression a dam had to be used but this didn’t happen. Also part of the file broke off in my root and I was in the chair for over 2 hours!! She managed to get it out and filled it ready for the crown. And that is where I am up to and don’t know what to do?
With regard to treatment fees I have already paid for the check up and the filling that now has to have RCT and a crown.
-The first molar lower jaw will cost £198 on the NHS or £250 private for a white one. This apparently may also need RCT she hasn’t stated if she will do it or not.
- The second molar will cost the same for the crown but the endodontist will charge £75 for a consultation and £425 for doing it. Is this expensive or about right? I have never had RCT before all this.
Is it possible to get RCT treatment for a lower molar on the NHS even if it may be a tricky procedure? (she said the root was a bit wonky). If so should I change or would I even find one . Could a dental hospital do this procedure for me? Should I just get it extracted? What are the downsides to this? Was I just unlucky that all these problems happened at the same time? What is the maximum I should pay for all these treatments if it was on the NHS? Also my bite has gone weird.
Please, please can someone help/advise/reassure me if I am honest I do feel a little unconfident now. I am going back this Monday (28.4.08) for her to finish the crown on my upper pre-molar and I don’t know what to say with regards everything else.
Also, I am sorry this post is so long but I just needed to put all the facts down.
Thanks in anticipation of a reply
Cheers Dawn
0
Comments
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Nothing apart from 'cosmetic' dentistry is forbidden on the NHS, so bite guards are available. As they're a technician-made thing, if this were the only item you needed on the NHS, it would attract the band 3 £198 charge. As you're already at that level, with the crown, it should be provided on the NHS and cost you no extra.
Root fillings in molars are not beyond the training of an average dentist, but some can be tricky, and a referral to an endodontist is perfectly justifiable. She seems to be happy to do the premolar and first molar, so I think she's doing all right.
If she's not using rubber dam to do root fillings then she's cutting corners - but really, that's par for the course for NHS dental treatment. And if she's broken off a file, then that's cut down the chances of success of that root filling even more. I assume she fully warned you of the dangers of instrument breakage before treatment began? Spending 2 hrs on it is above and beyond the funding available on the NHS, so she is trying hard!
The private endodontist fees sound right, and you could be referred to the dental hospital for the treatment - but it might take a few years before you're seen. They have budget problems too!
Having it extracted probably wouldn't cause you many problems in the long term, but the teeth you've had root filled without rubber dam will also fail more quickly than those done with rubber dam, and the one with the broken file might not last too long either. I wouldn't pay too much extra for a crown on a tooth with a poor prognosis.How to find a dentist.
1. Get recommendations from friends/family/neighbours/etc.
2. Once you have a short-list, VISIT the practices - dont just phone. Go on the pretext of getting a Practice Leaflet.
3. Assess the helpfulness of the staff and the level of the facilities.
4. Only book initial appointment when you find a place you are happy with.0 -
Toothsmith thank so much for all the sound advice. You really are a star on this forum:T . To be honest she did not warn me of instrument breakage and made out that each tooth would be charged individually. She was also very definite that a bite guard would not be covered by the NHS. I have an appointment on Monday and although it sounds silly I feel awkward challenging her pricing! What should I say? I don't want to offend anyone and I realise the dentists job isn't easy. Any suggestions?
Anyway thanks again yo have been such a help:A
Dawn0 -
It is certainly not one price for each tooth.
It is one of the 3 bands for the whole course of treatment depending on what sort of treatments are involved.
As a crown is part of your treatment, then the whole treatment, including any number of other fillings, root fillings, crowns and bite guards will be included in the Band 3 £198 charge.
There should be leaflets and posters in their waiting room explaining this.
If she insists on individual charges, then take it up with the PCT.How to find a dentist.
1. Get recommendations from friends/family/neighbours/etc.
2. Once you have a short-list, VISIT the practices - dont just phone. Go on the pretext of getting a Practice Leaflet.
3. Assess the helpfulness of the staff and the level of the facilities.
4. Only book initial appointment when you find a place you are happy with.0 -
Toothsmith there is nothing wrong with breaking up several treatments into smaller COTs, provided this is in the pts best interest.
Wasn't this the way we were taught in dental school?
1) relieve pain
2) stabalise, OHI, diet, hyg
3) r/v
4) proceed to advanced restorations when hyg is at a good level.
Caries excavation, with GIC,. F- therapy, duraphat toothpaste, once hyg improved GIC to more appropriate restorations if warranted.
Pulp extirpation cleaned, Ca(OH)2 into canal wait for symptoms to subside, then obturate.0 -
Toothsmith there is nothing wrong with breaking up several treatments into smaller COTs, provided this is in the pts best interest.
Wasn't this the way we were taught in dental school?
1) relieve pain
2) stabalise, OHI, diet, hyg
3) r/v
4) proceed to advanced restorations when hyg is at a good level.
Caries excavation, with GIC,. F- therapy, duraphat toothpaste, once hyg improved GIC to more appropriate restorations if warranted.
Pulp extirpation cleaned, Ca(OH)2 into canal wait for symptoms to subside, then obturate.
Exactly right.
We were also taught to use rubber dam for root fillings.
The OPs treatment has not gone on over the several months that your (perfectly correct) treatment plan above would take, but from emergency appointment to finished crown in a few appointments.
This strikes me as more like UDA farming than a properly constructed treatment plan formulated with the patients best interests at heart. Especially when a few porky pies about what is and isn't available on the NHS are being told.How to find a dentist.
1. Get recommendations from friends/family/neighbours/etc.
2. Once you have a short-list, VISIT the practices - dont just phone. Go on the pretext of getting a Practice Leaflet.
3. Assess the helpfulness of the staff and the level of the facilities.
4. Only book initial appointment when you find a place you are happy with.0 -
Indeed,
under nGDS it is possible to ethically meet your UDA targets and provided a high level of patient care. Patient education is key as well , as how long will the restorations we place last without proper maintenace?
Most pts will understand that we have to look at the bigger picture, esp. those that have not been to see a dentist for more than 2 years. You can't please everyone but you will soon quickly form a rapport with your patients and they are more likley to take on board the advice that you are offering.0 -
Indeed,
under nGDS it is possible to ethically meet your UDA targets and provided a high level of patient care. Patient education is key as well , as how long will the restorations we place last without proper maintenace?
Most pts will understand that we have to look at the bigger picture, esp. those that have not been to see a dentist for more than 2 years. You can't please everyone but you will soon quickly form a rapport with your patients and they are more likley to take on board the advice that you are offering.
most of the patients that havent been in for two years at my practice come in for emergency treatment, then either cancel their treatment appointment or fail it altogether.0 -
Toothsmith wrote: »Exactly right.
We were also taught to use rubber dam for root fillings.
The OPs treatment has not gone on over the several months that your (perfectly correct) treatment plan above would take, but from emergency appointment to finished crown in a few appointments.
This strikes me as more like UDA farming than a properly constructed treatment plan formulated with the patients best interests at heart. Especially when a few porky pies about what is and isn't available on the NHS are being told.
Quite interesting read - I'm in scotland myself so have no problem with the banding system down south which seems to be pretty skewered! Anyway, I wanted to ask about ledermix. The other day, we had a case presentation in which one of the VTs said that the person who invented/ have a siginificant development in ledermixsaid that leadermix CAN be used in a vital pulp. My question is, how does ledermix devitalize pulps. It only contains steroids + tetracyline, both surely cannot kill of the pulp in any way but it seems to do that quite effectively. I'm doing the MJDF and am thinking of doing some sort of research/ audit for this but i think this a 3 month timescale wouldn't allow this. But it is interesting - ledermix is a material so widely used but not very well understood i think... certainly wouldn't have my 6 which is pretty close to exposure lined with them ledermix;) In fact, i heard they are trying to rebrand to LEADER mix, - how sad lol :money:
0 -
oh, and out of interest, is a molar rct and a premolar/ incisor rct all in band 2 ? Because that would be pretty ridiculous! £48.50 for a molar RCT + MOD amalgam?? Now that is a loss maker... I bet dentists down south are prob. asking people to XLA instead of RCT! That is clearly understandable... esp. on sclerosed 6s!!!!!0
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oh, and out of interest, is a molar rct and a premolar/ incisor rct all in band 2 ? Because that would be pretty ridiculous! £48.50 for a molar RCT + MOD amalgam?? Now that is a loss maker... I bet dentists down south are prob. asking people to XLA instead of RCT! That is clearly understandable... esp. on sclerosed 6s!!!!!
Your absolutely right all all points!How to find a dentist.
1. Get recommendations from friends/family/neighbours/etc.
2. Once you have a short-list, VISIT the practices - dont just phone. Go on the pretext of getting a Practice Leaflet.
3. Assess the helpfulness of the staff and the level of the facilities.
4. Only book initial appointment when you find a place you are happy with.0
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