Do kids need to pay privately for a hygienist?

[namechange8621]

DD is about to have braces fitted. Apparently, there is a small issue with a baby tooth and I have been told that the dentist can deal with it or I will have to pay private rates for a hygienist at the same practice who would be more knowledgeable about how to deal with it. Is this normal or are they having it on because I pay for my exams?

Is the airflow clean literally where the assistant is holding the airjet and the dentist is ploughing away tooth by tooth? Do only hygienists do scale and polishes? I am confused because I have had a scale and polish at the regular dentist myself?

DD was advised to see a hygienist separately before she had her braces fitted so her teeth would be as clean as possible before they went on. This seemed to make sense to me as they are obviously harder to clean when they are on.

She has very crowded teeth though, so struggles with getting them 100% clean at times.

@saffy9876 The rule I believe is the 12 year old molar has to have erupted. Any baby teeth leftover after that are probably a problem that needs an ortho anyway.

For 90% of the population hygienists visits are purely cosmetic. For the 10% who have periodontal disease they are a clinical necessity.
A scale and polish is entirely unnecessary. But hygienists also impart much information and advice on how to maintain your teeth yourself to help prevent dental decay, non destructive periodontal disease or halitosis. So if you’re doing a crap job cleaning your teeth, hygienists can teeth you how to look after them and save yourself a fortune in dental charges. However, this is where the supposed scam starts, hygienists are often self employed and are paid per scale and polish, it is easy work when your patients need minimal treatment. This may change soon since HMRC are looking at removing their self employed status.
As a prescribing dentist I find it frustrating when our hygienist s are booked up for months so I can’t refer a patient who actually needs regular periodontal treatment. I often end up carrying out the treatment myself. It is also frustrating when I see patients with perfect oral hygiene and no problems , who self maintain but after years of being told they need hygiene visits are convinced that they have gum disease and insist they need a hygiene visit.
So while agree that some people do not need hygiene visits, many do need short term courses to improve their own dental hygiene. Only a small percentage actually need and benefit from longterm hygiene treatment, even then, with brilliant self care and regular visits periodontal disease will eventually cause loss of teeth.
Hygienists are the physiotherapists of dentistry. We may need to see one at some time during our lives but some only need a short intervention to help improve oral health, for a small number it’s a lifetime of care.

Ah, thanks. That makes sense. I probably have not seen one as I don’t have problems with my teeth.

My 15yr old has monthly private hygienist appointments as he has braces and the spaces between some teeth are still very tight, so yes they are normal for certain cases, the need for them should reduce as his braces start to work, currently £80 per appointment.

@Angrymum22 That is very interesting. my sister has been told that she has early periodontal disease but wasn't referred on (about two years ago). Does that mean that she will definitely lose her teeth somewhere along the line? I don't think she knows that 😮Is there a laser procedure which can be used to reverse it administered by a hygienist or dentist? I may buy it for her as a birthday present!

I have paid for my dc to see the hygienist, my older ds has braces and struggles to clean between the braces, and my younger ds has SEN and struggles to brush thoroughly. But it would be once or twice a year maximum.

Just to add this is my opinion not all dentists would agree.
Teaching patients to clean their own teeth in a daily basis is far more effective in maintaining oral health than cleaning their teeth for them once every six months.
Explaining to a patient why cleaning effectively every day is the gold standard and results in healthy mouths.

As someone who suffers from gum disease, this issue is very vexing. The NHS covers problems with teeth- and should cover problems with gums. The NICE guidelines say that NHS dentists should offer a scale and polish in case of "clinical necessity", for example in the case of bleeding gums, but you just try holding them to that. They used to, but they certainly don't now.

Instead, we're left to the tender mercies of private hygienists, who love to upsell. I go to a separate hygienists practice- because they're cheaper- but they tried to heavily persuade me into a £250 treatment because they said I had pockets in my gums. I went back to my regular dentist, who X rayed me, and said that I did not have pockets 🙄.

This is just a taste of how privatised medicine works. Imagine what it must be like to be in the USA and never know if the expensive procedures recommended for you and your kids are actually necessary, or if the doctor's trying to squeeze a bit out of you!

The whole situation makes me pretty angry. Apparently gum disease can be related to quite serious stuff like heart problems, so why is its treatment privatised?

Periodontal disease is complex. It is a type of autoimmune disease. For most of us the build up of bacteria and food on our teeth ( plaque) will cause mild inflammation after a week of not brushing.
For those who have perio disease even the smallest amount of plaque build up will cause an over reaction of the immune system leading to a massive inflammatory reaction causing gum and bone loss. Eventually the teeth loosen and will fall out.
There are no quick fixes or magic treatments. The best way to stabilise periodontal disease is to remove every last bit of plaque from your teeth in a daily basis. If there is no plaque your immune system cannot over react.
Your sister may benefit from seeing a hygienist to monitor and record the damage to date and to help her maintain excellent cleaning.
Periodontal disease is linked to diabetes and heart disease, there is currently a lot of research going on in this area. However, you don’t necessarily end up with all the conditions. It worth looking at family health history to see if there is heart disease and diabetes in the family. There does appear to be a strong genetic link but so far it’s not clear exactly how.

There seems to be 2 levels at mine

1. Quick scale and polish by dentist
2. Hygienist appointment, costs more but is 30 mins as opposed to 10 mins and very thorough.

Thank you @Angrymum22 for your brilliant posts.

I had aggressive gum disease 25 years ago, my gums are stable now and I still have all my teeth thankfully, but I need 6 monthly hygienist appts. In lockdown I couldn’t see a hygienist and it flared up, even though my dentist always says my oral hygiene is excellent. It’s a disease that is always at risk of returning, and I have to be scrupulous with cleaning and appointments.

I don’t think many people understand that it’s an autoimmune disease. I also got gum inflammation when I had Covid, which is a new one on me but I guess the innate inflammatory response is just primed to go a bit bonkers to any invader.

So not a rip off from my pov.

When the current NHS Dental contract was introduced provision for periodontal disease was vague to the point that it just didn’t exist. Patients who needed extensive treatment argued that they were being overcharged because the wording in the NHS online advice site was incorrect.
Also dentists were penalised for seeing patients too frequently. Patients who needed to be seen every three months created red flags in the monitoring system so most dentists decided that in order to provide hygiene for these patients the only solution was to charge privately so that the visits didn’t result in a penalty or investigation. Before the pandemic the government were in the process of trying to increase access to NHS dentists by increasing check up intervals. Patients would have been able to have check ups 12-18 monthly.
Interestingly the pandemic provided the perfect model for this and like many areas of medicine we saw a massive increase in the work required after the end of restrictions. So much so that they have altered the contract to accommodate this. Six months does seem to be a good interval between visits to pick up early disease and treat minimally or preventatively.

Thanks @Angrymum22 . I never knew about it being autoimmune and there is some history of heart disease in older family members. I am going to suggest that she look into whether they will give her a scale and polish. I would like to buy her some treatment as she is low income. Could you recommend a brilliant hygienist in London (Pm if you don't want to post name on forum)? Much appreciated

BillStickersIsInnocent that’s interesting about Covid. I lost a patient to Covid in the first wave. It was quite a shock because she was ver fit and healthy but she did have chronic perio disease. Covid itself wasn’t the problem but it was the immune system reaction to Covid in the weeks after infection that seemed to be a factor in the more serious cases. Common predisposing factors were heart disease and diabetes and it would follow that perio would be liked in.
Certainly it was observed that perio disease was present in some of the hospitalised cases after recovery but I don’t think they were screening for perio on admission.
Longterm it will be interesting to see if this gene fault played a part in the serious Covid infections. This would certainly help with preventative treatment going forward.
Again, these are just my observational views. Unfortunately we need proper joined up research involving multidisciplinary providers to see if the gene involved in perio/heart/diabetes may cause increased risk with Covid.

namechange8621 I think it would be a good idea. However, the hygienist is just the cleaner. I would recommend a good periodontist first who can assess and advise first then prescribe treatment. I work in the Midlands so have no idea about London based specialists. We actually have the only NHS periodontal specialist locally who we can refer to if a patient isn’t responding but they also do private work as well.
I will have a look and PM you.

Thanks so much for sharing your wisdom.
The thread definitely took a twist (originally wondered about my DD!)

www.dentalfearcentral.org/faq/scale-and-polish/

www.dentalfearcentral.org/faq/deep-cleaning/