NHS Dentistry. Any Dentists on Board?

[CaroleSinger]

Posting for traffic. I know lots has changed in a short time with NHS Dentistry but AIBU to think some NHS Dentists pick and choose which individual teeth they want to do on the NHS and which ones they want to do privately?

A couple of examples:

I have a really old root canal filling from years ago. This year my NHS Dentist said there was a silent infection under the tooth that I wasn't even aware of as it's never caused me any problems. She said if it did cause a problem in future they won't do it on the NHS and it will be specialists which I will have to pay privately for. All they will do on the NHS is extract the tooth but I must pay privately if I want to keep it.

I always had any root canal treatments done on the NHS before but now it seems some Dentists pick and choose which individual teeth they want to do on the NHS? At the weekend my friend had to call 101 to be referred to an out of hours normal NHS Dental practice who opened a tooth up then removed the nerve. He then had to call around to find another NHS Dentist to finish the root canal treatment. There was no infection and it was a simple process which took a few minutes. When he found another NHS Dentist to finish the treatment they told him they won't do it on the NHS and he has to pay a specialist privately to get it finished. This just makes no sense. How is a normal root canal filling which was started by an NHS Dentist not a specialist job to open up and remove the nerve, but a specialist job to fill it back in?

What am I missing here? To the general observer it does look like some NHS Dentists are picking and choosing which teeth they want to do on the NHS to the point where one NHS Dentist started the treatment as a normal root canal filling and removed the nerve, but the other one won't finish it as a normal root canal filling on the NHS.

How can two different NHS Dentists have such different opinions on the same tooth?

They hardly get paid anything for NHS work. None of them really want to do it and if they do it only make business sense for them to do the easy quick stuff.
In my view it's a massive issue. I'm concerned the GPs will go the same way as they are being run as private businesses for profit now as well.
The only thing we can do is complain to our MPs and vote with it in mind when we can.

By specialist they mean endodontist & root canal treatment can be time consuming, definitely 2 visits but could be more.
Don't want to mention money but unfortunately the fee that the dentist gets, I guess in their eyes, does not warrant them taking the time to

1. Re-do a failed root canal treatment (infection)

1. Complete a root canal treatment.

If you're in pain they'll do what's necessary to get you out of pain & starting root treatment will do that (more often than not) but could take time to finish the treatment and hence, you're referred privately.
Disclaimer: not a dentist, was a dental nurse for some time, prepared to be corrected on the above.

NHS treatment is now basically fill it or pull it. We haven't had dentists for a long time but when we under NHS the treatments they still got funded for were very limited.

If a dentist feels within their capability to do a RCT then they should, if they feel it is beyond their skill set (upper molar 3 roots/curved roots etc) then they are within their rights to refer onwards, be it to a private endodontist or trying to get the patient seen at a teaching hospital.
Other option is obviously to extract. Iv worked with many dentists over the years and I can say a lot that I wouldn't want to have an RCT done by as the failure rate was high. I also know a few NHS dentists who would really try to save teeth no matter what.

Root canal retreatment is a specialist job. It's much more challenging with a lower success rate. The root treatment has already failed once, it makes sense that it's going to be harder to put it right. Years ago I used to 'have a go' for patients that understood the above but couldn't afford the specialist fees. Sometimes it worked, sometimes it didn't. Unfortunately the standards we are held to now that wouldn't be acceptable. It woukd get me sued and a hearing with the GDC with the first question being asked - why did you try this, your not a specialist. Now pay for the patient to have an implant.

The second is more difficult to answer without specifics. In general the further back in your mouth the harder root canal becomes. A lot of dental schools now don't even teach root canal for 7s (2nd molars) as there view is they're so unlikely to be successful without specialist equipment there's no point even trying. Some teeth have quirks (kinks in roots, blockages etc) that mean I can tell from the xray it's going to be a specialist job on that particular patient but equivalent tooth on another will fall within my skill set.

On a different note, we're on our arse in NHS general practice. I cover emergancies and I know of multiple local practices that have no dentist. None. Several who are trying to run on a locum a couple of days a week when they previously had 4 full time because thats all that they can get. We're fire fighting constantly. I'm 20 years in and I've never known it so bad.

Re referring to a teaching hospital. This used to be an option and gave us the confidence that if you did attempt something challenging you had back up. Speaking to the head of department recently he said the referal form might as well say ' is the patient going to die if they don't get this root canal?' as that's literally where the line is now.

I’m on a waiting list of roughly 20 months for the only local dentist with a waitlist list. All other surgeries are not accepting NHS patients.
I have a lot of dental issues, had many dental ops etc in the past and saw an emergency dentist via 111 a fortnight ago for a tooth abscess so large my eye was closing. All they could do was issue a prescription and tell me to see a dentist. My mouth is a total car crash and I hate opening it to speak, I must be one of the only people who loved masks 😷.

Can I self refer to a teaching hospital? I had wisdom teeth removed at Guys many years ago and also visited the dental ER at the Royal London although that was a day long wait and again, cursory treatment.

My concern is that my teeth are deteriorating quickly and if I have to wait nearly two years what sort of state will they be in?

Even if I could stretch to a private initial appointment I could never cover the resulting costs, which will be thousands.

Im
sorry to hijack your thread. I was only planning on reading it but the comment about teaching hospitals inspired me to ask the referral question.

Thank you all so so much for these replies. Sobering and eye open reading. What an insight.

Like others have said root canal treatment is tricky and very time consuming. If it makes you feel better I was referred to a private specialist by my NHS dentist over ten years ago.

NHS dentists are an urban myth.

NHS dentistry is a car crash and the government has no intention to do anything about it. There are so many NHS dentists who have handed their contracts back to the government and only work privately because the amount their are paid does not even cover laboratory fees, let alone their time and skill. Add to that the issue of getting sued the PP above has mentioned and it just isnt worth it for them.

It is too late for many of our generation but can't emphasise enough how much we should be teaching our children to look after their teeth from the outset. I was only taught the basics as a child but have made sure my children know exactly how to care for their teeth and what causes most harm.

I have a great NHS dentist (who also does private) and have been with them for many years, as have my children. We tried to get my DH to join about 6 years ago, after his last emergency appointment elsewhere. He’d only ever used emergency dentists before (irrational fear of dentists) whereas we go for a check up every 6 months but they weren’t taking on any new patients despite us being the same household/married 😢

You used to be able to sit and wait at our local dental hospital, they’d give out numbers in the morning and in the afternoon and you’d be seen by the students. You could also be referred there (I was about 25-30 years ago) to have teeth out under sedation before my brace was fitted!

I think the dentist agenda for change around 15 years ago really impacted the UDA rate for nhs dentists as I distinctly remember friends complaint about it and that’s contributed to the availability of nhs dentists.

The contract we got in 2006 was quickly described as 'temporary ' and 'not fit for purpose ' but we've still got it. There's recently been a huge high court case of a young dentist who got struck off for not following the contract rules, the high court deemed the contract we've been working under for 15years was so unclear she couldn't of broken the rules as it really wasn't clear what the rules were.
I took part in the pilot scheme for the contract, the pilot we ran for a year and ironed all the kinks out of was nothing like what the contract was when issued. The government can't afford/doesn't want NHS dentistry but doesn't have the balls to admit it.

You cannot self refer to a dental hospital. Many have completely closed their waiting lists , those that have open lists it is virtually impossible to get a patient accepted for treatment.
Some dental hospitals may take simple treatment onto a waiting list for students but there is no guarantee when you will be seen.

You are more likely to be sued as a dentist in the U.K. than anywhere else in the world. Moreover if you carry out root treatment on the NHS and it goes wrong you will pay out thousands for it to be put right privately . Worse still you will have lost money providing the treatment in the first place.

As a result any root treatment that looks difficult, eg far back in the mouth or redoing a previous root treatment , is referred because having a go when you know it's difficult is not defensible medico legally. There are virtually no NHS specialist endodontists (root treatment specialists) so,it will have to be private.

Technology is coming on and we can save teeth now that previously would have come out. But that technology costs , a specialist microscope for root treatment costs upwards of £16,000 , specialist cement MDTA for sealing a tooth for one person costs £70, the one use files cost £30 . NHS spends , including patient fees, per person treated per year around £36. How much high quality dentistry will that buy?

NHS dentistry is dead in the water , in thousands of practices what they get paid for treatment is LESS than the patient charge. That's right , they pay the government back from patient charge because what they get in total for treatment is less than the statutory charge. It costs at least £120 an hour to run each room in a practice , and that's in a cheap area. Many,many NHS proceedures cost the dentist to provide . You cannot pay wages and bills on losses because everything part of running and buying the practice is solely on what the dentist earns when you are sat in the chair, they get no other funding.