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

I live abroad and have private health insurance

I've just had a gingival graft: would this be a standard procedure with the NHS?

Insurance paid 80%

Unlikely as it’s primarily for cosmetic purposes?

@coxesorangepippin no it wouldn’t

@FlubandSlub oh absolutely, I know it is based on fear. That’s why I always go along with how they’re feeling whether it’s to laugh cos better giving off banter vibes, or the be empathetic because they’re giving off terrified vibes. I don’t judge the patient at all for how they are feeling and I’m fully aware the majority of people are scared of the dentist.

however it is still hard to hear regularly how much people hate coming. I, and a lot of dentists, do our absolute best for patients and we want them to be comfortable and happy and be treated well! Sometimes, even after a period of time and good experienced, they will still attend with ‘you know how much I hate dentists’ and it’s makes your heart ache. If you’ve not been if that situation, you wouldn’t understand

@CookingFatCat its true that a scale and polish is only a part of a band 1 if clinically necessary. Also it is true what @Lollygaggle is saying. New evidence shows that there isn’t a huge benefit to a scale and polish. Tarter itself poses no threat to teeth (apart from being a plaque retentive factor) gingivitis alone is usually caused by lack of correct brushing or lack of flossing. At the end of the day, we see a patient 1-4 times a year at most (if we don’t do any treatment) that’s nothing compared to the 365 days a year that a patient should be taking care of their own teeth. A lot of the time, there will be complaints that someone has an issue because they can’t see a dentist, however I’ve had new patients come to me after 8/9 years of no dentist and have no issues because they brush correctly twice a day and floss every day

@Sammyspurs I’m sorry you feel this way after your dental experience.

’deep cleans’ or perio treatment, involves getting below the gum line to remove bacteria and tartar which you can’t otherwise reach. If you have a lot of tartar preset, sometimes it can initially make teeth more loose on removal. It does all depend on the amount of bone you have remaining. However, if it is a good clean, and providing you still have some bone, you should be able to keep the teeth. Leaving alone, may cause the disease to spread much quicker and result in you losing teeth anyway. If you can afford it, seek help from a specialist periodontist who will give you a treatment plan and provide surgical treatment if possible

I’m sorry for this. However, in my practice, if you paid privately it would have cost more than that. NHS of course would have been cheaper but sadly, it’s just nowhere near as available as we’d like

Yes some countries offer cheaper rates. Partly due to our private having to subsidies the nhs. Partly due to their guidelines being less strict. I will be honest I have seen the occasional good work come from Turkey. However I have also seen many bad things. Including a patient of mine who went to Turkey for implants which failed, and was told ‘we’ll try and sue me, you won’t get very far’

In this country we are registered and regulated much more closely than other countries. I appreciate it can be more expensive than other places however, as a PP has mentioned, it’s because nhs treatment is so cheap, we generally make a loss. Practice includes, which still have to pay for nurses and bills etc. So private fees make up for the loss of nhs fees

@OSTMusTisNT second what PP has said. Legally we have to offer all options

@outofdate I agree without a clinical exam and X-rays , it really is impossible to day, but often as I have seen (not always) but yes, I decay is under a crown and goes below the bone level, it’s generally not salvageable. Sometimes the only way it is, is with crown lengthening which is a private only treatment. And that would need to be assessed by a specialist

For me, I think I would feel happier if it wasn't pushed on me while I was flat on my back with the dentist hovering over my face. I feel in a very vulnerable position and would agree to anything that gets me out the door ASAP!

I'm the same at the hair salon when they rinse my hair and offer all sorts of extra silly priced conditioning treatments while being 2 inches away from my face.

Must be something about being trapped as I'm the first to tell charity chuggers or sales people to bugger off when I'm standing up!

I can't fault my dentist who serves several large and very deprived areas on the outskirts of our city as one of three dental practices accepting NHS patients.

She will move mountains to get one of her dentists to see you in an emergency. She's been amazing with my disabled and very anxious child. She and her team are kind, inclusive and professional at all times. I've just written her a thank you note for today's visit.

@OSTMusTisNT I actually fully agree with you. I do my exams and then sit the patient back up and discuss the options face to face. It’s demeaning to do it with them lying down in my opinion. Also if I have a suitable X-ray to help explain the situation then I will show it to them (we have large screens at our practice) and explain why a private option is being offered.

No one should be lying down and talked to about any options. I’m sorry you’ve experienced that

I am so glad you’ve had a good experience

I have been to the NHS dental clinic for years and they are lovely and are so patient with disabled people.

A friend of mine could not find an NHS dentist so went privately, but actually had one tooth filled which cost less than the minimum NHS cost, and he was quite surprised. Perhaps the complaints come from people who don't realise that if you have to pay for NHS treatment - which I do, because disability is not means tested - you don't always get it cheaper.

I also have to count in the carer and mileage!

Don't leave it, we really do appreciate you.

Thank you for your reply.
Is it dangerous to leave decay under a crown?

Yes, turkey can be hit and miss, i have seen good work and some awful work, the lady i saw refuses to do the awful smile make overs you see on tik tok etc, but she said some people just insist so she sends them away to other clinics who will crown everything !

@outofdate if you leave decay under a crown it will only progress. Eventually you would have to have the tooth removed

@bumblebee1000 you’re quite right. In this country, we’re very much of the opinion that if it will harm you, we won’t do it. Obviously we want people to be happy in their smile and it’s a great feeling when somebody is. However, sometimes just because someone wants a nice smile, doesn’t mean they’re suitable. If a uk dentist is refusing to do cosmetic treatment, more often than not it is justified. And going abroad may get you what you want, but may cause much more serious problems down the line. It’s also important to note that if anyone is an nhs patient and went abroad for work, it most likely wouldn’t be corrected on the nhs here if it went wrong

I have gum disease and have had it for quite a number of years. My gums bleed sometimes when brushing or using Tepe sticks. I have been regularly seeing my NHS dentist and (private) hygienist every six months. I have been questioned about my brushing technique, whether I use floss, Tepe sticks and each time I state that I floss every day, Tepe sticks after meals, a water Pik to flush teeth as well as brushing with Corsodyl toothpaste with an electric toothbrush morning and night. I don't know what else I can do to improve my dental hygiene. All I know is that my gum disease is being maintained but doesn't seem to get better. I eat very few sugary snacks and I don't have sugary drinks. I agree that my dental hygiene is my responsibility, but I honestly don't know what I can do to improve on what I already do. Even my dentist says my dental hygiene is good. I am so upset that I am unable to improve the gum disease and extremely nervous about losing my teeth as I age - in my sixties now. What on earth can I do?

Hi @Nerdippy
If you have active gum disease, it is recommended to see a hygienist every 3 months. It really depends on the level of gum disease you have and if it is stable or not. Gum disease is not reversible, it can only be stabilised. Once it progresses to the bone, there is no going back, you can only try and prevent it worsening.

if your gum disease is unstable, 3 monthly hygienist visits or a referral to a specialist periodontist is needed. If it is stable, I wouldn’t worry too much if you have regular hygiene visits and good OH. It is unlikely to progress to the point of losing teeth. I would speak to your dentist and find out if it is stable or not and go from there.

What I find odd is that when I was an NHS patient a check up only ever involved an xray if they thought there was a problem. My dentist moved to private only (for adults - children can be NHS patients there if their adult is private) and suddenly they want to do X-rays at every single appointment. I now say no. Each visit was costing around £500 and I just don’t have that.

To see if anything has changed since last time. Also, if you don’t go regularly they take you off their books. Which means you can’t make it more affordable by spreading out visits. It all feels like a bit of a racket.

@Booyahh Thank you for your response, much appreciated.

I have been trying my utmost to keep my teeth clean to the best of my ability. Unfortunately, while it has been stable for a number of years, it does seem to have progressed this year. I have been seeing the hygienist every three months for about a year now, but having had X rays done recently, it appears there is detritus above the tooth, which is impossible to remove by brushing/tepe sticks etc and above the remit of a hygienist. I am now booked into to have a subgingival PMPR - deep clean to get this bacteria out. How do I stop bacteria from getting back in?

This is what the dentist noted on my file:

 Generalised periodontitis stage 4 grade c, currently unstable, risk factors poor OH
 The prognosis of the UL8 was deemed to be poor in the long term in view of severe attachment loss and mobility
 The prognosis of the UL37, UR17, LL4 were deemed to be fair in the medium term in view of attachment loss and mobility, depending on patient’s compliance with recommended oral hygiene regimen and treatment plan.
 The prognosis of the remaining teeth as deemed to be good

What this mainly says is your home cleaning is not effective , your oral hygiene is poor.

Have you tried using disclosing tablets to see where you are missing? Do you clean the gums more than the tooth? Do you use interdental brushes every day? Has your hygienist checked what you are actually doing when you brush? Do you wear reading glasses and if so do you wear them when brushing so you can see where plaque has built up?

It all comes down to effective cleaning

@Lollygaggle Thanks, but the x-rays have proved (as stated in my post above) that the detritus is not reachable by toothbrush or tepe sticks. The dentist has said my oral hygiene is good but I cannot brush in places that are unreachable and that is where the gum disease has originated from and likely been there for quite some time. I will be having a deep clean, but how do I prevent detritus from entering this space in the future?