£12k for dental treatment?!

[RedCarsGoFaster]

Just seen a private dentist at my NHS practice as they have no NHS dentists working so this was my only option.

My teeth are terrible. I have severe bruxism and most of my teeth are so ground down and broken that the dentine is exposed and the enamel gone. They are also very very short.

This dentist basically said I have three options

1. Do nothing and just keep wearing my night guards. Teeth will crumble and break, and I'll have to have them removed and have a bridge or similar when that happens.
2. Crown the front 14 teeth (8 top, 6 bottom) and wait 3-6 months for my rear molars to push up to the same height (crowns will gain me 5-7mm difference she thinks) - £12,000
3. Crown all my teeth (I have several missing molars) - £21,000

That's it. Those are my options. I'm not suitable for any other treatment. The NHS have long refused to do the crowns.

I'm fucked, aren't I? £12k is an absolutely impossible sum of money to find.

Yes, I saw a consultant about 10yrs ago who specifically told me I'd wasted his time. No TMJ, but I do have an overbite. Just not one severe enough for him to care about.

The botox might last 4-6mths for this specific placement, but it can obviously wear off more quickly. I've had Botox through neurology for chronic migraine (43 injections every 12wks) and it wore off in 9wks on me, so whilst she's hopeful it will last longer, I'll probably burn it up quickly again 😂

Yeah, but if they did that every day for a year, they’d rake in 3 million,

Plenty for overheads, holidays and staff wages in there.

Agree with other that you need to pursue a referral to a dental hospital. Bruxism and not having teeth isn't cosmetic. I've had a visible crown done in white on the NHS, and have been referred to a dental hospital for another issue. Insist, hard.

I used to sit on an IFR panel and I'd be surprised if this succeeds. IFR is designed for cases that are exceptionally unusual - exceptionality is built into their terms of reference - panels have to be very careful that there isn't a cohort of similar patients who could then ask for treatment. It won't be appropriate for your GP to fill in, they won't have the knowledge, it would have to be your dentist or an oral surgeon. Don't get your hopes up on this route.

It's almost certainly a staged procedure in multiple appointments over multiple days

Absolutely do not do this.

I’m sure it is staged.

But they aren’t sitting on their hands the rest of the time.

Your chronic migraine is likely because of your bruxism, but hopefully you already know that?

Thanks, you're super helpful about the travel abroad element and it's all definitely food for thought. I really appreciate it.

Not sure about the stress element though - I've ground my teeth since I was a kid, I've worn night guards since I was 19 with rarely a night off (usually if I've travelled away with work and forgotten to pack it - I have had an emergency spare in my washbag for years now!). I remember one dentist telling me to stop grinding and getting quite angry with me when I asked her how to do that given it happens in my sleep.... Both my parents do it as well.

Yoga, CBT, pilates, swimming, weight loss, weight gain, study, changing jobs, single, married, living with parents, living alone, living with housemates, living with husband - I've done it consistently throughout the life unfortunately.

Yes sorry, I've phoned the dentist surgery not the GP. Out of curiosity, what sort of dental cases might succeed at an IFR panel? I appreciate this is a long shot, but thought I'd ask the dentist whether it's feasible to apply.

No, my chronic migraine is a genetic, complex, incurable and currently intractable disease of my brain. Bruxism may not be helping me, but it's not the underlying cause. The cause of migraine is generally idiopathic and it isn't simple to treat. I'm under neurology for treatment and on anti-CGRP injections just to survive week to week.

https://www.england.nhs.uk/wp-content/uploads/2017/11/ifr-patient-guide.pdf

https://bedfordshirelutonandmiltonkeynes.icb.nhs.uk/our-publications/individual-funding-requests-ifr/ref-2-ifr-guidance-for-clinicians-final-august-2022/?layout=default

Not dental, but some more info. From the 2nd link:

The ICB cannot fund requests that should be fairly applied to other patients who have similar clinical circumstances and who should rightly also be offered the treatment if your patient was to be approved. This would require the ICB to agree a new commissioning policy (or amend an existing one) setting out that the treatment was now available for a new group of patients and setting out how this group had been identified.

Therefore, to meet the definition of ‘clinical exceptionality’ your patient must demonstrate that they are both:

• Significantly different clinically to the group of patients with the condition in question and at the same stage of progression of the condition AND

• Likely to gain significantly more clinical benefit than others in the group of patients with the condition in question and at the same stage of progression of the condition You must show that your patient is very different from others in a group of patients with the same condition/stage of the disease and has clinical features that mean that they will derive much more benefit from the treatment you are requesting.

It's a very very high bar. And I think only NHS clinicians can make an IFR application.

Have you looked at travelling abroad for the same dental treatment? Many Europeans are travelling to Turkey to reputable dental practices for half the price. It's worth researching.

The last request I sent to IFR was for a patient with a very rare clotting disorder who needed multiple extractions , which in the past were done in a specialist haemophilia unit after an infusion of clotting agents. It was turned down twice with the advice I should do it in practice with the advice that when it bled I applied transexamic acid (not available in general practice) and pack her in a car to nearest hospital 40 minutes drive away.
In the end we "arranged " for them to have a dental emergency at the haemophilia unit so they could have treatment that wouldn't kill them .

Look at criteria for dental hospital treatment , you will not get it https://mft.nhs.uk/dental/about/referral-information-for-dental-practitioners/restorative-dentistry/toothwear/

Op I have chronic migraine as well and am also on anti-CGRP injections. It is so annoying when people don't understand!

Chronic pain is almost certainly a contributory cause to bruxing and there is certainly a feedback with migraine, cluster headaches where each feeds the other .
Anything that helps you cope with long term pain will help with bruxing and certainly a pain clinic referral may also help with techniques.

Medication is notoriously ineffective for chronic pain of any type.

Hope the jabs are working for you! Ajovy was great until the enforced 3mth break, then it didn't work so well. I'm on Aimovig now and down to 2 attacks per month!! Last one was yesterday, so I'm utterly exhausted. Still, I'm down from 27 days a month of attacks so I could kiss the scientists who designed these drugs.

Hmm yes, very good points. I might look for a private pain clinic.

Wow that is an incredible reduction in migraines. I take Ajovy which has helped reduce them a lot, especially in severity. Nice to meet another chronic migraine sufferer who understands the pain. Although it's definitely not a nice club to be in!

Ask to be referred to a restorative department at the hospital or a dental school. You sound like a great case study for someone. I'm a hospital dental nurse btw.

Yes this is how I’m getting my treatment.

dentist here - tbh the price sounds fair and normal for that treatment plan.

The NHS does not fund whole mouth rehab for wear cases - too specialist and expensive to treat. The private dentist has probably invested thousands of ££ and lots of extra time on training to tackle this kind of case. Getting it done on the NHS even in a dental hospital is just a fantasy not a reality - with budgets so stretched they have to prioritise other work (e.g. kids GA extractions).

Tbh - a payment plan probably the best option.

To put into context this work in Aus or the USA would cost 4x more! Healthcare is just expensive and us Brits aren’t used to private prices. BUPA announced nearly 100 NHS practice closures this week so this is sadly the new normal.

Once again read the criteria for referral and the priority list . I will append yet a third set of criteria for another hospital.
To put this into context in my area the budget for restorative treatment for the whole department , for a year, will cover the reconstruction for two oral cancer patients. https://www.rlbuht.nhs.uk/media/8334/referral-guidelines-for-restorative-dentistry.pdf

Really research how long the crowns will last. I'm in my 50's now needing implants because of crowns. I have dentures, which make life miserable.

Ignore all the PPs who recommended dentures. Your face shape will change. You will lose a lot of bone and denture wearers have lots of problems with sore spots, breakages etc. They always look like dentures as the gum cannot be replicated to look real. I can always spot dentures in people's mouths, but then I am a dental professional. You are only 41. It's unfortunate that you are not in a major city with a dental school, but you sound like a great case study for students, so worth researching.