Dentists refusing to do costly treatments?

WTF. An advert for Ocean Village dental practice has popped up.

When I needed a root canal there was no NHS dentist at all at my dental practice. There were no dental practices who would register me, even as an emergency.

I went twice to a ‘sit and wait’ dental hospital an hour away and didn’t get seen as there were so many people there and everyone was triaged. I was in a lot of pain but there were elderly people who had fallen down stairs and knocked all their teeth out and teenagers who had been punched in the mouth.

I went private and I can’t remember what the root canal cost as it paled into significance when compared to the three thousand pounds for the implant.

YANBU. I thought I struck gold when I finally got an NHS dentist.
I am in and out of the chair in less than 8 minutes. I have a hole in one tooth. was told it was due to a breakage, and not a cavity. I was told I can have it extracted when it causes me pain. No other fix in the meantime.
I also have a missing tooth (top and in smile line). That is cosmetic, so I will have to go private.... even for a denture.
I am on benefits so don't even pay for the NHS rates. I am convinced that is why I don't actually get any treatment. This is the second practice this has happened with too.

Whether you contribute to the NHS fee or not the practice gets paid exactly the same amount , the government just pays 100% of it instead of around 10% .

It has always been that way. Many low income families have bad teeth. My DD needs one out and a filling with sedation, sedation is only available privately, there is no way she could have it removed without sedation, even a teeth cleaning procedure causes her to get in a state, we’re on the waiting lists for private sedation.

Sedation treatment is available on the NHS with the community service , but will need referral and in most areas the waiting list is years .

Going without teeth because one cannot afford private care or because it’s not available on the NHS is disgusting. It’s physically and mentally damaging for someone to endure the pain, embarrassment and misery of bad/ missing teeth. It’s not luxury or cosmetic to have decent teeth, it’s part of your whole well being, and it’s time the Government sorted out the NHS contract with their dentists.

I know.. but I get treated differently.

It's been this way for years, surely? I had a middle tooth removed twenty years ago and my only option (back when I had an NHS dentist) was to have it pulled, and I'm sure the only treatments available generally were filling or extraction. Like most I've had to go private now, but I would never be able to justify the cost of cosmetic treatment, other than something simple like a white filling. My teeth are structurally fine, cosmetically am absolute mess, but would be a ball park figure of 7k to put right so it'll never happen! I pay £20 a month for the basics, 2 check ups and hygienest a year.

I agree with all Lollygaggle’s comments on this ( fellow dentist). Amalgam is just that- an amalgam of metals that in the mouth are very stable and don’t leak mercury. I have patients with amalgam restorations in their mouth that have lasted over 30 years. Composites don’t have anywhere near the same longevity. On balance, they are cost effective, work well, easy to place compared to alternatives, cheaper and have low evidence that they cause harm in the mouth.

the issue is that when an amalgam is removed, the mercury vapour is the issue. We use high volume aspiration/rubber dam, ventilation and other measures to try and minimise the effects.

the environment concerns are huge though. See the Minimata conventions. Amalgam has now been banned in EU, and is being phased out in the UK. The question is what is a safe, Cost effective and easy to use alternative?

watch this space!!

A good friend of mine is a dentist, who has always done NHS work as a sort of moral duty. But practice policy has changed- she says dentists are de-skilled by the system, they just do basic checks, monitoring and simple treatments if the practice is mainly NHS. So equipment, training and expertise may be lacking to do those specialised treatments that you mentioned. The NHS won’t pay so your dentist will be working for free and spending his salary on tools to do the work for you.

I’ve been with an NHS practice located in the same site for 28 years - but that’s changed hands around 5 times in the last 10 years, previously been owned by a very stable and all encompassing husband and wife dental team.
The treatment offered has seriously declined since Covid. Now we have junior dentists, quite often from the Middle East with heavy gutteral accents (no problem with their origin but try understanding what they’re saying whilst in the chair!). Check up and the odd easy filling only. My DH recently had a four hour wait to get a prescription to treat an abscess, having to wait for someone qualified enough to sign it off.
I have the back upper right tooth needing extraction after half of it fell away, apparently having a long standing bad crack but one never mentioned at check up. The practice declined to do it and have referred me to a hospital dentist. I find out yesterday that there’s a minimum 6-9 months wait. Luckily I have no pain at the moment but is this really the way to go??

Have they said the root canal would have to be private or just that the bridge or implants would be private?

They have already seen a private specialist who has said the tooth is too badly damaged to be saved.

Any replacement will be private , unless they have other teeth missing, in which case they will be offered a denture on the NHS.

I understand a bridge or implant would be private but I wonders if the NHS dentist had said removal or root canal would be NHS or private then realised I’d missed the last update where root canal not possible

Is it a front tooth or at the back?

YABU. I used to work for Health Education England so know the ins and outs of the dental contract, it’s one of the worst ones. Dentists are really struggling to cover their overheads and can’t justify undertaking costly work like that for an NHS payment. Be grateful that there’s an opportunity for some of it to be at a cheaper rate because at some point dentistry will all be private, I’ve got no doubt about that.

The government has a limited pot of money so they have to pick and choose where they spend it. They don’t always choose well but unfortunately, dentistry is one of the things they have chosen not to spend it on.

UK Dentistry is no worse than another country - you just need to pay for it

It is sad and frightening to see another poorly educated dentist. It is established fact that amalgams leak mercury. Even the FDA finally acknowledged this a few years ago.

Dental Amalgam Fillings | FDA

In fact professor Alfred Stock showed this almost a century ago along with a series of elegant experiments showing that mercury bioaccumulates in the body including sensitive organs like the brain. He was ignored by the dental community.

Feel free to explore the myriad of links below to the research.

https://iaomt.org/wp-content/uploads/article_ZiffBibliography.pdf

But if you want an easier visual showing mercury released from amalgam, see below.

001 SMOKING TEETH - YouTube

Mercury Dental Fillings Raise Blood Mercury to Dangerous Levels in 100+ Million Americans - YouTube

Boyd Haley PhD measures mercury vapor from amalgams - YouTube

Boyd Haley PhD funny amalgam product story - YouTube

I’m sorry but YouTube videos are not peer reviewed research and have no place in making educated clinical decisions and all dentists undergo years of materials science education.

Materials which have health problems like formocreosol , endomethasone , beechwood’s creosote etc have been stopped in clinical use because proper research indicates the risk benefit ratio weighted against their use. Materials science in dentistry is a busy discipline.

Cochrane reports which collate research to provide a scientific consensus and other reports such as that collated by the EU , again using peer reviewed research , all consider , in the right clinical circumstances, amalgam to be a material of choice . Long term collated studies of dental staff who are exposed to amalgam and mercury vapour daily for decades , shows no increase in morbidity and mortality .

Amalgam is being discontinued because dental research is continually improving materials being used , although for many dentists the very best material to use in the mouth , gold , has been used for centuries back to Etruscan times and beyond.

For a properly research overview of the use of amalgam with multiple , peer reviewed papers see https://ec.europa.eu/health/scientific_committees/emerging/docs/scenihr_o_046.pdf

You must have missed my link to the myriad of peer reviewed articles showing that amalgams leak mercury which is detrimental to human health.

https://iaomt.org/wp-content/uploads/article_ZiffBibliography.pdf

You also are not familiar with Professor Alfred Stock who published his experimental findings showing that mercury leaks from amalgams and gets incorporated into human tissues.

Why do the FDA & BDA now acknowledge that amalgams off gas mercury vapour?

But you have not explained how amalgams are toxic enough for the environment to be disposed off as biohazard waste but safe in a human mouth?

Your link also clearly states that amalgams leak mercury and that this is toxic. One can argue about levels and at what point that turns into disease but the facts are amalgams leak mercury and mercury is toxic to human health.

Again, look at the cochrane review which states “Overall, the evidence suggests that amalgam restorations are effective, enduring, and safe, while composite resin restorations are more likely to fail and lead to secondary caries. However, the studies in this review were quite old, and composite resin materials have likely improved since the included studies were conducted. Patients and dental providers can discuss together which material they want to use when permanent teeth in the back of the mouth require fillings in the dental clinic. Governments around the world are trying to reduce the use of dental amalgam (according to the Minamata Convention on Mercury), and so each local area will have their own regulations and guidance. “ www.cochrane.org/evidence/CD005620_tooth-colored-resin-fillings-compared-amalgam-fillings-permanent-teeth-back-mouth

and the EU report on amalgam use posted above.

You are quite right we are exposed to mercury in both the placing of and removal of amalgams . However extensive peer reviewed analysis of multiple studies , not just one or two , has revealed no link between amalgam and increased morbidity or mortality. Tellingly in the populations most exposed to amalgam , in both their own mouths and in their everyday working life , ie dental staff there is no increase in morbidity or mortality when all well researched and reviewed papers are considered.

With any research there will always be papers that differ from the consensus. That is why reviews such as Cochrane are so important as they look at all papers, how well the research is put together , any bias, the number of subjects and methodology . They then collate them and provide a balanced view.

This has become increasingly important as people can make life changing decisions based on a flawed research paper eg Andrew Wakefield and MMR which has resulted in multiple fatalities and injuries because people didn’t not vaccinate their children based on a paper which, when reviewed properly, revealed serious flaws.

It is also why people should not confuse serious research that is peer reviewed and balanced against other papers with you tube videos and single group or opinion papers .

Oh so something does need to go in its place really (if you’re conscious about that). I had one from the back and dentist recommended bridge or implants but as you can’t see it I had neither but obviously if it’s at the front your in a different position