• Dental Phobia Support

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Private vrs NHS

T

the fearful one

Junior member
Joined
Feb 17, 2009
Messages
9
when I was a child I went to NHS dentists that really weren't that great, they just wanted me in then out.
When I was a teenager I really didn't want to visit a dentist because I'd started neglecting my teeth but I got forced and bribed to go and see a private dentist that could do my work on the NHS anyway because I was under 16, he however charged more for me to have porcelain fillings (from what I remember and understood at the time). Anyway this private dentist was really nice, and didn't make me look at my teeth, see the damage or bat an eyelid at my teeth even though he would have been able to tell they were neglected. He just wanted to be a "friend". I remember him once asking if I'd ever had an pain from a cavity and I lied and said "no", which I think he believed but found odd... that is all I remember of it - a pleasant experience in general.
I however continued to neglect my teeth and through the years two of the main fillings have dropped out and my teeth got worse. I get tooth aches quite often but I had a high pain threshold and sleep them off - only get real pain when I get an abscess, even then a certain painkiller (I won't encourage people to take rather than see a dentist) works wonders and I get on with my life.
So anyway my brother also neglected his teeth for seemingly different reasons to me - and he started smoking, in his very early 20s all his teeth were black and he had very red gums, - I luckily only have one black tooth (almost hidden, but if you're looking you'd notice it) and my gums bleed only rarely, when I occasionally brush my teeth now (although has got better since my attempts at trying to start looking after my teeth a bit more) - but I know that this is only going to get worse. Is there a reason why my teeth have lasted better than his? purely smoking and better diet?
Anyway going back to his black teeth, he went to an NHS dentist, this dentist told him that all his teeth had to come out, he was like "no way!" so went to see a private dentist, who sorted them all out for him and now his has a lovely set of teeth. He claimed that this is because NHS dentists get paid the same no matter what so they go for the easiest option however a private dentist gets paid per the job, so will do what is best of the patient and hope that he/she will come back, is this true?
Is there much difference in what NHS dentists charge and what private dentist charge? I know that NHS dentists are restricted, but surely private dentists wouldn't want to price themselves too high or everyone would go NHS?
I ask this because I've been looking for a dentist and I've found one or two locally that are private that seem to want to help if you have phobias, but I really can't afford to be ripped off too much as I only take home about £1200 a month - if I'm lucky!
And if a private dentist is out of my budget would an NHS dentist not be as good? There is always the credit card option if private is recommended.
Am I also right in thinking that a private dentist is more likely to take the time out for a consultation pre looking in my mouth, because he/she would be getting paid more for it? Rather than just trying to get through all the treatments they can, I imagine them to be pushed for time like a GP, and just push people through as quickly as possible?
 
He claimed that this is because NHS dentists get paid the same no matter what so they go for the easiest option however a private dentist gets paid per the job, so will do what is best of the patient and hope that he/she will come back, is this true?

Your brother has a point - the UDA (units of dental activity) system in England (but not in Scotland) means that dentists are paid the same within a band of treatment regardless of how much work they do. For example, they would get the same number of UDAs if their patient needed one filling as they would if they needed 10 fillings and 5 root canal treatments (all of which are Band 2 procedures).

This system naturally means that many NHS dentists are not overly keen on high-needs patients, because they have a set target figure of UDAs they have to produce per year and if they don't meet the target, they are financially penalised by their PCT.

Some dentists are able to get around this problem by having a lot of patients without huge dental needs on their books, so this balances out the occasional high-needs patient. Also, they may offer mixed NHS/private services, where the private services to some extent subsidise the loss-making NHS patients. And of course, some people have higher expectations regarding their earnings than others and may be happy to take home less....

Like the general UK population, some dentists love the very concept of the NHS and will try to do their best for everyone :). So there are good NHS dentists around. But it is also true that NHS dentists on average have to see more patients in a shorter period of time, which can in some cases negatively impact on their quality of work (and the amount of time they can dedicate to someone who is very anxious). Having said that, some private dentists also have to work under extreme time pressure because their bosses set crazy targets for them.

Not all dental treatments are available on the NHS. For example, anything which is considered "cosmetic", as well as implants are excluded. Also, there isn't the same choice of materials available (for example, dentists are quite restricted as to the types of materials they can use for crowns or dentures on the NHS). As a result, you can often get better aesthetics privately compared to NHS treatment.

There are good and bad NHS dentists, just like there are good and bad private dentists. Word of mouth can be a good way of finding a good dentist who really cares about their patients.
 
A private dentist will certainly spend more time on you and will be able to offer treatments that the NHS won't pay for. However I don't think it's true that they can't charge too much or everyone will go NHS - there aren't nearly enough NHS dentists to go around, so in many areas private dentists can in fact charge what they like because they have a captive market. It must be very difficult to avoid the temptation to recommend treatments that make the most money for the dentist, and I'm sure there are some that can't. On the other hand, as you say, getting it "right" means repeat business in the future and that's also a big consideration.

My suggestion would be to look a bit deeper into it, i.e. have a consultation, find out what work is needed and then decide if you can afford it. If you decide it's too expensive for you, do you in fact have access to NHS dentistry ? If not then you can start planning how to pay for what you need.

Remember also that many private dentists have websites with full details of their prices, while NHS prices are available from the NHS site - so you can perfom a price comparison from home in order to see what the difference is !

John
 
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