Not to go to the dentist for 6 month check ups

[60andsomething]

Well, I am in my 60s now, so it is a bit late if IABU! As children we went every 6 months, but I am not sure why. It was expected back then.

In the last 40 years I have been twice, both times because of side effects of other non-dental treatments.

The dentist I saw last year, to get a clean bill of health before starting on a powerful drug, now wants me to come back, as it is 6 months since I last went, and this is seen as enough justification to try and insist I go again.

I have never had any problems with my teeth, and generally go to the dentist once every 20 years or so.

I am a teacher, when it comes up in lesson, have asked my classes about their experience of dentists - I would say most teenagers these days have never seen a dentist, and don't have toothache.

AIBU to think the need for a six month check up is a myth? And if it aint broke, don't fix it?

I would go it I had a problem, or toothache.

My dentist has said that I don't need to see him every 6 months - he'd be happy every 12-24 months. (I don't have any fillings or problems, and the clean takes less than 10 mins). He's happy that he doesn't need to check my teeth and mouth that regularly and that I would contact him if I had any issues in between check-ups.

But I go every 6 months as my two DC are free when I go (private dentist) and I think it's important that they are seen more regularly, especially as they have braces. And my private dental insurance (provided by work) allows for two check ups per year so I take them up on it.

We all didn't see a dentist for two years during covid but are now back in the habit and seeing the dentist regularly. But I do recognise that not everyone is in the same fortunate position that I am in, and that not can or needs to see a dentist every six months.

I certainly have annual x rays, and both DC have had multiple X-rays - both by the dentist and orthodontist, though given their braces they may not be the most representative of their current teeth (both have had 4 teeth out in the last year). Though I sincerely hope that you wouldn't need to identify any of us from dental records!

I guess I do go because it's under my dental plan
So to me I want to go 6 monthly as I'm paying for it, but I would pay the same cost per month if I went yearly

I quite agree. I'm looking to work abroad as soon as possible.

My father's dentist spotted his mouth cancer. He saw a spot on the roof of his mouth and noticed it was there at the next 6 month appointment. Told my dad to get it checked out and it was cancer. He ended up with facial reconstruction where they removed it and chemotherapy. I genuinely think he saved his life and we will always be immensely grateful

I suspect a lot of teenagers haven't seen a dentist because they are bloody hard to find. Dentists are supposed to see children, but the ones around here aren't anymore because their books for children even are full.

If you want to de-register yourself though, someone will gladly take your place. We moved 2 years ago and can't get an NHS dentist. We are in Exeter. The closest one currently accepting NHS patients is in Wiltshire! Though I hear the other day that there's one on the Isles of Scilly that will take us. If I wanted to fly or get the ferry. I'm currently trying to register myself for and find the funds to travel to one 300 miles away just to get an appt!

I’m shocked that your whole class has never seen a dentist, in fact I don’t believe it! Maybe they were trying to be ‘cool’ by saying they’ve not been. Everyone I know takes their kids to the dentist

Dentist here again. Regarding the "Daylight robbery" claims on this thread. Sorry but for the lift of me I'm witnessing people spending a fortune on their nails, their Botox, their hair colour, their vet bills, their holidays, their homes, and yet they moan about paying £30 or whatever for a dental checkup, that potentially can pick up issues that might save them a world of pain in the future, might pick up oral cancer...
whatever really. You have your priorities.

And it's pretty disgraceful that dentists in the UK are looked upon so poorly. That assumption we must all be Rich.

That's absolutely untrue. Perhaps a handful of successful private practice owners but the vast vast majority of dentists have studied for 5 or 6 years, plus, taken postgraduate courses and qualifications.
We received a proportion of our practice earnings, after the business gets at least half to cover running expenses, . Out of what's left we pay tax, insurances, indemnity, uniforms, pension, accountant, GDC registration, extra insurance for certain procedures, lab costs, dental loupes, and CPD.
Even practice owners are struggling. On top of all that, lab bills have vastly increased costs, as have energy bills, materials, buildings/contents insurance, employers liability, insurance and maintenance of radiology units, compressors, rent, wages, computer systems and service packages, postage, printing, phone lines, staff training and development,

It's really tight. Margins are small. Some practices are still struggling after being forced to shut as a result of Covid.

Dentists are having it really tough just now. The constant abuse, both online and in person, the threat of getting sued, complaints, entitled patients, it's really not a happy place to be currently.

Absolutely, which I why I have retired at 60. Years of underfunding and pointless red tape costing the practice thousands every year. I sold my practice in 2019 and then got out of the NHS treadmill last year. I now get paid to do sod all ( pension) and top it up with 1 day a week private practice.
I still love the job but no amount of money would entice me back to NHS practice. I dedicated my working life to NHS principals and they just shafted us left right and centre for 37 yrs. I feel no shame.

Well I don't work in dentistry or even the NHS so I maybe missing something but I don't think your list of tasks stands up to scrutiny.
clean instruments? Buy several sets sufficient to cover the cycle time of your sterilizer.
write up notes? Isn't that done live by the nurse?
develop X-rays? Never had an X-ray on a check up
Write prescriptions and referrals? as above
restock surgery? with what a new tiny cup of mouthwash?
Decontamination? well I cannot comment on this but hopefully during a check-up most of the blood spit and bones stays in the patient's mouth, and a new roll of paper on the chair keeps everyone happy?

You can tell that you don’t work in healthcare because you obviously don’t know what you’re talking about. If we were practicing the dentistry you describe we would be struck off.

OP, life is all about weighing up risks and benefits. If you’re on bisphosphonates then the risk of not going to the dentist is high. If you develop a problem it can be caught and treated early. If you don’t go it won’t be treated until you have pain. Often once there’s pain it means extraction and you risk osteonecrosis.
The only downside of going is it will cost you money. It depends on how much you value your health I guess.

https://www.yourdentistryguide.com/osteonecrosis/

Well, I am not a dentist either, or a person who visits them, but your post is a bit ridiculous! Clearly the expenses mentioned that you are referring to are realistic and genuine, and your post is wildly out. In fact, I don;t think you can be being serious.

I am too scared to click on the link - but you have convinced me to go annually..... can you please explain if this is a risk only for the course of the treatment? Or forever? Thank you

https://www.sdcep.org.uk/media/hefd1mjp/sdcep-mronj-information-for-osteoporosis-patients.pdf
Non scary fact leaflet

Don’t mean to scare you OP, you should have been told this stuff by the prescriber but doctors are rubbish with teeth 😂

Oral bisphosphonates for osteoporosis are low risk. Weekly alendronic acid or similar.
IV bisphosphonates are higher.

These drugs stay in the bone forever so the risk isn’t mitigated by stopping them- not like anticoagulants for example.

To add- I am a private dentist and see most of my adult patients annually not 6 monthly.
I would see them 6 monthly if I assess them as having high decay or oral cancer risk.
If they have high gum disease risk I advise 3 monthly hygiene but still see them annually myself.

It's changed to annual check ups with NHS Scotland now. Been told no need for 6months unless you have problems with your teeth.

Good old SNP eh

This must be a joke?
If not, I wish the public could understand just how much cross infection and time is spent per patient in dentistry. And, for the environmentally conscious, just how much plastic and waste.
Firstly, all dental surgeries have many sets of instruments. The instrument decontamination process, if done to CQC standards, takes a very long time. You're meant to use an ultrasonic bath first, and/or maybe hand scrub, then check under a light and magnifying glass for and debris, then put in a dishwasher type machine, then put into an autoclave which depending on what model you have takes 20-60+ minutes a cycle. Instruments are then bagged into date stamped bags. (Even if these instruments aren't opened or used by the date on the bag they need re sterilising after that date....). Now not all practices do all of these steps as some for example don't have space for the dishwasher thing.
In the surgery, you are meant to use single use plastic sticky things to cover ever single surface on the chair the dentist might touch. Light handles, buttons etc. Plus plastic sheath covers over any drill/suction tubes. Plastic cover over the headrest or even entire chair. The nurse needs to change these AND wipe with disinfection wipe every surface between every patient.
Charting and some notes can be done live by the nurse. But the clinician is ultimately responsible for them (they are the one at risk of being sued not the nurse) so they need to check they are up to standard how they need them.
If you've never had an xray at a check up then that's strange. Most places do xrays at least every few years.
It would be lovely if during a check up there was no blood and spit. But a check up should involve checking gum health. And trust me people that don't look after their teeth their gums bleed even when blowing air on them. Then if you have a patient who sits up and spits all over the side of the bowl and onto the floor. And wiping their mouth then their hands on the actual chair while ignoring the tissue you're trying to give them. Often while moaning you've "made their gums bleed" and this apparently never happens. Even when their gums are so swollen they've grown over the teeth.

Honestly while some practices may not be doing all they should be when it comes to procedures, overall the days of just changing the instrument set and Mouthwash cup in between patients is long gone. No practice wants to risk getting done by the CQC.

https://www.sdcep.org.uk/media/rq4n5tnn/sdcepcleaninggofdentallinstruments2nddeditionjan2016.pdf

For info, above is a link to part one of a three part series on how we decontaminate our practice. It has 34 pages.

On the same website you can also read guidance for bisphosphonate use and why it's important that these cases are caught early to avoid extractions:

www.sdcep.org.uk/media/xtlp2uqx/sdcep-mronj-guidance-extant-2024.pdf

This publication has 48 pages.

I'm
Hoping this is enlightening and might make folk a little bit more aware of what goes on behind the scene.

We don't just tickle a tooth

I'm mid 40s and hadn't been to the dentist for around five years (part fear/part COVID/part expense). Finally took a deep breath, went and ended up with £400 worth of root canal treatment (on a dental plan). I have to say although I was a ridiculously nervous wreck it was by no means as bad as I thought. Previously I had never had a thing wrong with my teeth at all ever.
My teenagers are still with an NHS dentist and are lucky to get an appointment once a year and if they do it is usually cancelled by the dentist and rebooked months later!
I would however say that dentists also look for any sign of disease, cancer etc. And someone I work with was diagnosed, very early, with oral cancer following a check up. Might be worth the peace of mind!

Thank you for your reply. I think I could still argue with a lot of that, but I won't because I think you have touched on something even more important, possibly the real nub of the problem:
I am feeling a bit of exasperation towards the care quality commission? Might some of the standards be unachievable or counterproductive thereby reducing clinical quality? I have read hospital doctors' and GPs' blogs making complaints along the same lines. You just suggested that cheating was accepted as the norm; "Now not all practices do all of these steps“. If the rules are too tight and cannot be followed it undermines the whole concept of having a standard. I see this in my own industry.
I suppose I am just flying a kite but is there anything in what I am inferring?

Thanks for your input. You have changed my mind. To be fair, I do often skim over the pages of warnings and disclaimers I sign. They are often frightening, and there is nothing I can do about the risks, generally, but you have persuaded me to continue with dental check ups, going forward.

If you are feeling a bit bored tonight you can read through the 86 pages of htm0105 which document the processes a dental surgery has to go through to decontaminate https://www.england.nhs.uk/wp-content/uploads/2021/05/HTM_01-05_2013.pdf

everything from the clensable keyboard to inspection of instruments under light and magnification before sterilisation is covered here. Miss steps and CQC will shut you down before you can blink . All of this has a cost , one high speed and slow speed handpiece will cost £1000 and each surgery, as you said , has multiple hand pieces. Each practice has a decontamination unit with multiple ultrasonic cleaners, autoclaves , oilers etc which cost thousands to buy , have to be inspected every year which costs thousands (the servicing on one autoclave alone is £400 a year ) .

As another poster said the decontamination process takes around one and a half hours for each set of instruments so decontamination goes on all day on top of the processes involved in opening up and shutting down surgeries (flushing and cleansing water lines etc). Here is an excellent overview of the decontamination process https://www.langmansdental.co.uk/behind-the-scenes-in-our-decontamination-room/

In the U.K. you are more likely to be sued ,as a dentist, than anywhere else in the world. Your best defense is a very thorough set of notes , which the nurse starts and you complete . Many young dentists work through lunch and after work to complete notes .

The referral systems for the NHS are Byzantine , people needing braces, wisdom teeth removal, oral medicine , oral cancer , general anaesthetic , sedation , community dentistry all need copious time on referrals on top of gp referrals for blood tests etc .

Antibiotics , fluoride treatments , dry mouth saliva replacements, ulcer treatments such as steroids all require NHS prescriptions .

Finally restocking surgery . To give you an idea this is a minimum of the equipment needed to be brought out for one persons root treatment . All of this needs setting out, putting away and the disposables replacing . https://dental-edu.com/services/tooth-pain-root-canal/endodontic-root-canal-therapy-tray-set-up/

At the other end of the scale the "simple check up" Will need
tray
tray liner
mirror
probe
perio probe
x ray holder
x ray
plastic light handle cover
plastic cover for chair controls
cover for computer keyboard
paper cover or plastic cover head rest
disposable 3 in 1 tip
disposable suction tip
intraoral camera cover
masks
disposable aprons
visors
dental loupes

possibly also
vitality tester
tooth crack tester
Normal camera (for brace referrals)

etc etc etc

Dental practices are held to and have a far higher standard of decontamination than medical practices and many hospital wards . Some of what we do has little scientific basis eg was based on theoretical risks from cjd, but the fact that despite we were the highest risk from covid yet had low infection rates shows our cross infection control works.

Most dentists don't worry overly about CQC, they worry about litigation and the general dental council. When you can be suspended for years , awaiting a hearing , for something as trivial as a light hearted comment when speaking to someone , having no income and working for Amazon to make ends meet and then found not guilty , it is not surprising dentists are terrified.

when you can do your best on a root treatment on the NHS , having made a loss on the treatment , but if the tooth doesn't settle down ( and even in the best hands endodontics is not guaranteed) you can pay out thousands of pounds for a replacement implant and increased indemnity costs.

I help out on a dental helpline , listening to suicidal , stressed colleagues working , unappreciated, in a broken system where everyone thinks they earn ridiculous amounts of money , where most are struggling to keep their heads above the water in an overly regulated and litigious environment. It is breaking many,many people.

@Lollygaggle well said

Im not in Nhs land. I have to pay for checkups and hygienist and treatment.
The surgery is spotless. The staff were excellent through covid.
Keeping up the standard is hard with people wandering in from work to what is a surgical setting.
Compared to the nail bar beside it the prices seem reasonable!

Yes but dentists often catch problems early, that you would not be able to see yourself, so they can be treated before they get worse and become much bigger, more painful and more expensive problems.