I’m an NHS dentist…

[Booyahh]

First time posting… AIBU to think that NHS dentistry is absolutely on its arse? I’ve been in the industry since 2011 and it’s getting so much worse. I’m constantly hearing bad things about dentists or the ability to see a dentist, which makes me so sad. (I’ve started this thread on the back of another post recently just to hear some views)
I’d love to hear people feedback. Also, happy to answer any questions anyone may have

They are paid a wage , they don’t have to run a business on fees which don’t even cover the expenses . Dentists are not paid a wage .

I am aware of this. I said ‘can request’ that would then be dependent on the dentist and how they would feel about it? Not that they would automatically be accepted. I am merely suggesting ALL outcomes to someone who has asked a valid question 🙄

What was the price? You can ask if you’re registered as nhs or private

I’m extremely lucky and have an excellent NHS dentist, although my surgery is a mix and I dip in and out of private treatment - eg Air Flow polish a couple of times a year. I had a terrible time in 2017 where I was in the surgery every week pretty much, and my dentist was so kind and patient despite not finding any reason for my pain which was shifting around my mouth. I was eventually referred to Max-Fac and after a lot of testing, including an MRI, was diagnosed with atypical facial pain. I now get a checkup every three months in case it is actually a tooth, not nerves. I am so grateful to her - and even in that dark period where I was honestly insane with pain and worry, I never once doubted we would get to the bottom of it.

Seeing a GP is a different story, and I would be more likely to have a one to one with Princess Diana than get an appointment there.

Do you ever wonder if a lot of dentists overtreat due to the payment structures in dentistry, in the private sector especially? If people look after their teeth well and have a good diet, how much dentistry is actually needed?

I was raised seeing a dentist who was honest with my mum that I had good teeth, diet and oral hygiene and didn't need seeing often. He told my mum her teeth had been "overfilled" in the 70s with probably unnecessary small fillings that had weakened the teeth and then needed constantly replacing with bigger ones.

I didn't bother going for 20 years and had no problems when i did. I never saw the hygienist, had fluoride paint or had a scale and polish.

During that time DH (who'd also grown up with good teeth) saw various dentists. One private dentist said he needed 3 small fillings... he decided to wait, was able to see an nhs dentist later on who laughed and said he just needed to use duraphat toothpaste for a bit. He took the toothpaste, never had the fillings done, and a third dentist he's seen has never said they need doing.

He's started concluding that the more you see the dentist the more they do but long term it doesn't seem to lead to better teeth!! It seems to lead to recurring work... fillings that fall out and need bigger ones, clumsy scale & polish that leaves gums sore & teeth sensitive.

Less is more

DH is a dentist and has always said that the downfall started with the 2003 contact changes. Within the next 5-10 years, NHS dentistry won’t exist anymore. Everywhere will be private and no one but the government is to blame.

I've recently moved from an NHS to private dentist and the difference is night and day. I very much wish I'd moved sooner.

Like a PP my appointments with the NHS dentist were less than 5 min, and included no scale and polish in the 10 years I was there, and no prodding of the teeth, just a quick look. In contrast the private dentist spent a lot of time explaining everything to me and showing me the photos and x-rays.

Tbh I might as well be at a private practice anyway as I was planning to pay for private treatment at the old practice for white fillings and hygienist appointments, and those things are actually cheaper at the new dentist!

Nearest dentist actually taking nhs patients near me is over a 3 1/2 hour round trip

Count yourself lucky. For me, the nearest dentist taking private patients is a 7 hour round trip.

Sigh.
No one can look at someone’s mouth and tell them that a filling done in the past wasn’t necessary , it’s impossible. Fluoride toothpaste was only introduced in the early 1970s so people needed many more fillings then . Also technology has moved on so decay would be treated in a different way to then .

There is absolutely no motivation for a NHS dentistry to overprescribe , they lose money on multiple fillings .

Dentistry is not an exact science and give one patient to two dentists and you will get three different treatment plans, all equally valid , particularly if decay is in its early stages.

The most important thing for dental health is what you do at home , ie the frequency of sugary/starchy foods, how well you clean your teeth and if you smoke , have diabetes etc .

98% of all dental treatment is preventable.

My NHS dentist is excellent, as is my daughters.

I think I’m in a little bubble because I still have an NHS dentist who is absolutely amazing however I’m pretty sure he’s going to retire in the next few years and I have literally no idea what I will do then because I don’t think the practice will recruit another NHSdentist

Every dentist around here (within a 30 mile radius) that is NHS work has stopped and gone totally private. Except for one, which luckily for me I'm still seeing. Every time I do, I'm expecting to be told they too are stopping NHS work.

I don't know the industry well enough to know what the fix is. Is it just as simple as the govt throwing more money at NHS dentistry? Is it possible that many dentists have realised that they can charge whatever they like for private work, and that if they all stop doing NHS work then it forces people to pay privately at whatever cost? It's basically a cartel?

Yeah I think there are some private dentists who over treat. In the same way that nhs dentists (on the old contact) used to do the same. It’s a difficult situation and I really feel for people. Also, I remember when I was training (way back when!) that I was told ‘if you ask 10 dentists for a diagnosis, you’ll get 10 different opinions. Which doesn’t help I’m sure,

what I do, which I think is important, is show and explain the X-rays (if applicable) and give all options of what could happen if we intervene and what could happen if we don’t. Basically trying to explaim everything in lamens terms and let them decide on what they want to do. Rather then telling ‘you need this’

Is it just as simple as the govt throwing more money at NHS dentistry? Is it possible that many dentists have realised that they can charge whatever they like for private work, and that if they all stop doing NHS work then it forces people to pay privately at whatever cost?

The biggest issue in dentistry is payment based on treatment type. It means certain types of complex dentistry are more profitable to deliver and therefore are pushed. Dentists love to send you to hygienists for scale and polish because they are cheaper staff so the profit made on it is higher. If you are paid for more for treatments, you aren't going to want patients with lovely healthy teeth who never need treatments!

Dentistry should based on NHS owned clinics with fixed salaried dentists who simply get salaries based on experience & specialisms, with bonuses if you work in areas with deprived populations who have more teeth problems.

The government can certainly throw more money at the nhs. But then it’s also up to each individual practice to pass that onto its dentists. Which doesn’t always happen. We had had the occasional uplift in recent years but speaking from personal experience (not everyone’s of course) the practice takes that as their money because bills are higher etc.

I think it’s important to note that dentists don’t get the full money. They’ll get paid a percentage. The remainder goes to the practice to pay for running costs and staff fees and lab bill. The practice gets any ‘pay rise’ and often they don’t pass it back down, claiming they need the money to cover other costs

It costs , in a cheap area , a minimum of £140 an hour to run one room in a practice that does mostly NHS treatment .

The only money a practice gets is from the treatment it does and in many cases the amount it gets is only a pound or two more than the patient charge .

Given that it will take a minimum of twenty minutes to set up , do a check up , write up the notes , sterilise etc which will earn around £28 total you can see the practice is already running at a loss. That loss gets worse when there are multiple fillings or work that needs laboratory work .

Dental inflation is running around 10% ie the cost of providing dentistry . The fee rise this year is 3.5% , so for at least the past 15 years the amount paid to run a practice has gone down year on year. Private work subsidises NHS but that can’t continue .

NHS dentistry is the only health car where practitioners pay for patients care . In many cases dentists would be better off giving a patient £20 to go find a dentist elsewhere. https://www.bda.org/media-centre/nhs-dentistry-treasury-now-no1-roadblock-to-saving-service/

Im blessed to have an nhs dentist i think its the only one left where I live most people have to use private or don't go. My dentist is amazing really funny nice bloke and they will get you in quick in an emergency

No nhs dentists in my area taking on patients. I had to go private for an extraction recently. Cannot afford private check ups so me and DH just don’t go to the dentist.

This has been tried before .
The average cost of a course of treatment for a NHS patient in the U.K., including patient fees is £36 to £45 . That pays for everything , wages, buildings, equipment etc

Over a decade ago when dental access centres were set up so the government paid everything from clinic costs to wages the average cost of a course of treatment was £450 !

NHS dentistry has been pared to the bone there is nothing more to give and solutions are based on zero funding increase ie do more on the same money .

I was always taken to the dentist as a child/teen and have so many fillings I seemed to have them all the time. Now I’m older they are going bad an are too deep to replace I often wonder if I really needed them all as I’ve not really had new ones as an adult. I feel they did them as preventative

Practice expenses are running at over 10% inflation per annum. I’ve just had two colleagues hand back their contracts because last year the NHS side lost a 6 figure sum at both practices . The 3.5% increase won’t even touch the sides particularly with the NI increases on top of everything else this year.

Why would student loans take half their pay? Im
Plan 2 and mine, even with an MA, only takes 12% of my income above the threshold of £28k.

Students pay tuition fees for 5 years and with maintenance loans may come out of dental school owing £100000. They are trained and work in the NHS but it’s not free. It used to be and most new dentist spent time in NHS practices building up skills. It was a much fairer system where you were paid for what you did and many paid back their training fees by serving in the NHS. But with the student loan system they may enter the workforce feeling no loyalty to a failing system. The cost of indemnity and registration can be £5k a year after the first year and with the current pay system you have to work rapidly but pay can be limited by the contract budget available.

Im very grateful for my NHS dentist.

What happened to the community dental services that treated school children and disabled adults?.

I have a filling that was placed in a nhs clinic when i was 10 im 45 now.

That narrative is EXACTLY what the government want the general public to think.
Dentists have the right to a decent living, not be out of pocket when they provide NHS care. It’s not a charity. The government need to fund NHS dentistry properly. This is incredibly expensive, they won’t do it. The only reason they’ve not totally axed NHS dentistry totally, is that the party who do this know they will be un- electable again for a lifetime!