Been going to the Dentist for years, now worried

[Tuffteeth]

Hi, my apologies for not registering earlier, but I think it's a case that I never thought I would need dental support till now. I'll try to keep it short if I can.

Hopefully like a lot of people growing up, teeth really didn't hold a priority in my life. I can't ever recall a time in my life where my parents wanted me to brush my teeth. I recall the fluoride trays at the dentist, cavities on my baby teeth, and what ended up being a few on my adult teeth as well. I think I still have about 8 or 9 cavities currently all located on my back teeth. When I was younger I was rushed to the hospital as my mouth had swollen, next thing I know I wake up missing one of my top K9 teeth, and they moved one of my teeth back to fill the gap a bit. Doesn't really bother me as I've had it my whole life (well almost).

Fast forward to a middle aged man in my 40's, and up till about 5 months ago my teeth really hadn't changed. I haven't had any new cavities since I've been looking after them. I've survived 8 years of US Army Dentistry with about 23 or 24 teeth still intact, not to mention a decade of NHS dentistry in England.

So now about 5 months ago I decided I wanted to eat healthy, so I started to eat carrots raw at work, and some of them were fairly large as I didn't cut them up. A decision I wish I could change. Somewhere between eating them and now my teeth started to feel very rough and my tongue was feeling the pain of it. Went to the dentist and they polished? Or shaved down the rough spots so that my front two teeth are smooth again. One feels like glass to my tongue, not sure why which has me worried as well. I still have about 2 or three on the bottom that are rough, but I'm trying to live with that at the moment. It's hard as my tongue hunts out all of the bits in the mouth all day long.

So here is my issue, now that my front two teeth have been smoothed out, I bite differently, and my bottom K9, and what was my moved tooth where the other K9 should have been impacting each other when I try to eat, or even talk sometimes. When I questioned the dentist, they have set me up with the main man in the Dental practise to look at my teeth. They've mentioned crowns, implants, you name it, and this is without even seeing this main man yet.

So even though I may have had a tough time growing up with my teeth, I've maintained them fairly well, and am proud that I still have all of my own teeth (or what's left of them). I know people out there, or even on here have gone through more with their teeth, but the thought of having a crown, or an implant has really got me worried. Worried to the point I'm not sure I want to see this dentist.

This whole thing has got me buying dental guards to use at night, I bought another electric toothbrush, dental wax, you name it. I don't even want to eat for fear of something happening even worse. If I live till 90 will I still have any of my own teeth left?

How to I get up enough nerve to speak to him? I don't see him till January and each day that goes by makes it worse for me.

 

[carole]

Hi to the forum.

What is it about crown or implants that worries you. I understand you being fearful but I don't really understand what you are asking. It might be me being thick or a bit slow here but if you could ask a few direct questions or tell us what you fear we will be able to offer you some opinions and maybe take some of the fear away.

There is no reason why you shouldn't still have some of your own teeth when you are ninety if you look after them.

Sorry I haven't been of much help so far, but stick with us and we will do our best

 

[Tuffteeth]

Thank you and good point. Not sure if I really did ask anything, but looking around this site you people make my Army days look like fun. I can't imagine going through what everyone here is going through.

I'm starting to feel like my issues in comparison are fairly petty. Should I still see this Head Dentist, or should I ignore my bite issue? Is it an issue? I feel the impact of the two teeth even more when I brush and when I talk, but I haven't narrowed down what sound it happens on.

Also what is the likelihood of a crown coming out? Or should I opt for an implant and lose a tooth?

To be frank I don't have a Scooby Doo what he's going to tell me, but I can't say I trust the NHS after finding out how they are paid. There's just no reason for them to do a top quality job. It explains why they removed a back tooth for the tiniest infection, when they could have drained it, or tried other methods to save it.

 

[Deck2015]

Hi Tuff -- New-ish member here (I've been lurking for a long time, only recently started posting). I'm going to post about my own dental journey soon once I work it up (ugh), but I just wanted to say to you that I'm having issues with my own teeth right now that several dentists and specialists have all agreed are related to or directly caused by my (bad) bite. I never had braces as a child because I feared the extractions that were necessary so I only had a few years of retainers and didn't follow up as an adult like I should have.

I do have several crowns and I dare say that a good percentage of older adults likely have at least one crown/veneer by the end of their lives. If you see a skilled, experienced provider, having a crown shouldn't be a problem. If you're given the option of a crown, I would strongly recommend you *always* try to treat your natural teeth first before opting for extraction and implant. Extraction and specifically the implant surgeries are much more involved and your natural tooth is always best. However, there are situations where you may be unable to save a tooth with a crown for various reasons and extraction and implant are your next best bet. I live in the States, and I assume you do too based on your posts. I just paid $1300 for a lower molar crown (of which insurance paid $350.00). I'm currently scheduled to consult re: have one tooth sadly extracted and bone graft in anticipation of an implant later. Depending on where you are, and more importantly, the provider you see, the extraction/bone graft/temp flipper /implant/temp crown for implant/perm crown for implant can take months to a year to complete and will cost thousands. For example, my current estimate for the entire process is $7,500.00 of which dental insurance will cover $400.00 for the extraction and temp flipper only. I've been quoted higher even for the same process at another clinic. This is for ONE tooth. I've seen clinics run "specials" for implants and it may save you $1,500 or more, but if I'm investing in my appearance and my health, I'm going to pay a bit more to see a specialist who has many years of solid, confirmed experience and consult with prior patients even. Note that my estimate also included IV sedation for the extraction AND IV sedation for the implant surgery months later. No matter how you cut it, implants are expensive. And they have a small failure rate, too.

If I were you, I would keep the appointment and just see what the head Dentist tells you. He's not going to perform any treatment without you agreeing to it, all you're doing is consulting with him. Keep the appointment and go from there. He may recommend a course of treatment and at that time, ask all the questions you have (I keep lists of questions between appointments for my providers ) -- You'll probably come up with more questions after you come home...keep a list and ask by phone/email or at follow up appointments. Some people prefer to know less about the treatment specifics if they're anxious or nervous, some of us like to know ALL of our options and exactly what we're facing to feel more secure.

Some ideas about questions:

1. What is his suggested treatment plan for you?

2. Why is he proposing this treatment? What is the goal of the treatment?

3. What is the success rate of this treatment? Do the majority of patients tolerate it well?

4. What level of pain should be expected, if any, following or during treatment? Options for pain control after treatment? (NOTE : IF AT ANY TIME YOU'RE IN PAIN WHETHER DURING OR AFTER TREATMENT AND SUGGESTED OR PRESCRIBED METHODS OF PAIN RELIEF ARE NOT KEEPING YOU COMFORTABLE, LET YOUR PROVIDER KNOW IMMEDIATELY! This isn't to scare you - but you should never suffer needlessly!!)

5. Should the treatment provide immediate remedy or relief for your diagnosis? If not, how long should you wait to expect improvement in symptoms?

6. Financial Planning - How much will the treatment cost? Are there payment plans offered if you can't pay all at once or does the clinic require 100% payment up front? Most reputable dental clinics in America will accept payments IF you're an established patient and have always kept your account current. If you have insurance, ask the Financial/Office Manager of the clinic to get an estimate of your insurance coverage. Note : In the States, dental insurance is not like Medical insurance. You're lucky if you have a dental plan that covers the standard treatments (fillings, limited xrays, exams) at 80% or even 50% for major (crowns, Endo, veneers as needed) up to an annual max pay out by the insurance of $1,500 (or less). NOTE : An estimate from the Dental clinic about your coverage is an ESTIMATE ONLY and not binding. It's generally best to get the treatment codes and call your insurance company directly, advise them the name of the provider (in case he's a preferred/network provider) and ask exactly what they will pay (if anything) towards your proposed treatment. Unfortunately, even if a Dentist says you need X done, it does NOT guarantee your insurance will pay anything for treatment unless specified in your plan details. For example, they may pay some toward a crown if the dentist can prove (xrays, pictures, narratives) that your tooth needed that crown to treat X problem, but the insurance may only pay for cheaper materials/silver crowns when you want a white, tooth colored crown. If you have insurance, treatment is generally less expensive to you if you use a "Preferred" or "Network" provider. I've had some very good luck with Network providers this year so even though there are less and less participating clinics each year due to the embarrassingly low allowances by the insurance (thanks again, Insurance!), there are still good providers out there who participate in insurance networks.

You'll come up with your own questions, I'm sure. These are just some suggestions. I would recommend you keep the consult appointment, ask questions, do your own research and make a plan. I only allow providers I highly trust to work on my complicated dental problems and strongly recommend everyone else do the same. Remember that the vast majority of Dentists and Dental Specialists are practicing because they care about you and your teeth and they want to help you - most of them want to cure your problem and get you back to excellent dental health. If you go into a treatment with this in mind, it might ease anxiety.

 

[Tuffteeth]

Thank you both for your responses. I'm currently living in England and have an NHS dentist. According to my wife, the NHS dentists are like gold so you don't want to lose one. They are ok if you need fillings or a check-up, but due to past experiences, and my current obsession reading about it, I now have serious doubts.

I guess the NHS are a bit like the Army, which I wish I took more advantage of the free Army care while I was in. They removed 2 back teeth due to a "training" exercise accident, and offered implants, which at the time I didn't think was needed. This was late 90's so that may have been a good thing, as I'm not sure what they were like back then.

The Dentist I'm now due to see is a senior partner at the practise, and I assume is only called in to discuss things that probably won't be covered by the NHS so I would be looking at their private costs, hopefully this would improve the service, but shopping around for prices, they aren't the cheapest.

In case your not aware, the NHS have a band system for payment, so small things are Band 1 (£18 ish), are cheaper than say Band 3 (£220) which are the most expensive. This is the patients contribution to the treatment. The government than pays based on UDA's or something like that. A UDA is worth up to £35 each. The dentist gets paid 1 UDA for band 1 treatment up to 12 UDA's for Band 3. The problem is the fact the Dentist is paid a maximum of about £420 for a treatment (£220 from me, the rest is covered by the government). If I needed 5 crowns, or 1 crown, they would get paid the same amount. This leads to substandard care if a lot of treatment is required.

In theory (as I have never had these done), the Dentist would need to find the cheapest method to sort out the issue. Why drain an infection and save the tooth, when they can pull it, why recommend more than 1 crown, when it would end up costing them money to do 2 of them. Even the fillings I've had redone have been horrible. The material they now use is gritty, and not as smooth as my old ones I had in the US. I assume this is due to costs.

To add to my worries, I've heard that due to being paid by UDA's, technically they can use up all of the allocated treatments they have forecasted for the year. If they do this they won't get paid for any further NHS treatments until the next year. I don't see how they can do it. I'm just not used to the social aspect of the health care here. If your are unemployed you receive free treatment, under 16's as well. Some dentist get involved in so called gaming where they tell you that the NHS service would be substandard or inadequate so they try to sell their private services. From what I can see, the NHS treatment could include everything including an implant if deemed required, but I can't imagine a Dentist doing this for £420.

Another problem lies in the fact my wife has used the NHS all of her life, and it's all she knows. She see's it as a cost which would be less if dealt with by the NHS rather than go private and receive better care. I managed to convince her that my kids need private care, but the costs are minimal so far as they are kids, and better believe I make sure they brush their teeth twice a day, with an electric brush.

For my wife it's second nature to use the NHS, she has crowns, fillings, you name it. For me I've only ever had fillings for the last 35 plus years so it's been fine so far. The thought of having anything other than a filling in my mouth scares me to death.

Since my recent issue with the rough teeth, my brain has been going into overdrive. How much enamel do I have on my teeth? Did they smooth it all off? can my metal fillings be replaced with composite as I hear you don't have to remove the filling to "top" it back up? If this is true, I wouldn't need the hole made larger every time they replace the metal filling? I've stopped drinking my can of diet soda everyday, and slowly weaning myself off of coffee, I got some over the counter night guards coming in the post. I'm constantly licking my teeth making sure they are still ok with no further sharp edges and such. It's really taking over my life. I've been looking at Denture videos seeing what it would be like if I needed those. Even at work, I go down to the bathroom to look at my teeth and see if they are still ok. Can I wear the night guard all day?

Can I go to both a private and NHS for treatment? It's really crazy that one event has driven me mad like this.

 

[carole]

I will answer the easy question first for you, yes you can mix nhs and private care. It depends what the treatment is. I have always been nhs and have good and bad treatment. Over the last three to four years I have had excellent treatment and am now lucky enough to have a really good nhs dentist. I think the chain dental practices are ones to try to avoid but I suppose even they will have good and bad dentists in them. The practice I attend is an owner/dentist and he does private and a couple of ladies that do mainly nhs but also some private as well. The owner wants all patients to get the best possible treatment and will subsidise where the nhs fails in some cases. From what I understand it can be in the materials used that can be the most different.

I have bridges, crowns fillings and a partial denture with just one tooth on it until the extraction site is healed enough for my dentist to put a bridge in to fill the gap.

It is up to us do decide who we trust with our care and if you feel that your nhs dentist is giving you a good service and putting your needs first then they will be fine but things like rct are usually best done by a endodontist for the best results. I have a 30 year old bridge and a crown that is also about the same age so the nhs has served me well in that respect.

I think you will need to listen to the senior dentist you are going to be seeing and make your mind up from there. Just remember if you aren't sure then get a second and even a third opinion until you are sure. See what treatment they are telling you that you need.

You don't have to agree to anything there and then and also remember this 'YOU ARE IN CHARGE' and you have to give informed consent for any and all treatment so make sure you are aware of all the facts before you agree to anything.

Good luck and all the best to you

 

[gentledental]

As a dentist who has worked in both Scotland and England. NHS dentistry in Scotland is light years ahead of the English system and I see far more substandard work in England than I did in Scotland. The Scottish system you pay per item therefore if I needed 6 fillings, the dentist would get paid for 6 fillings. However in the English system, 6 fillings would cost the same as 1 filling so how is that fair?

What I have noticed more in the English system are: more extractions and less root canal treatments, root canal treatments are poorly performed and also a lot of gum problems because dentists are not obliged to do the routine scale and polishes. Not trying to bad mouth all NHS dentists but this is what I normally see.

Dentists are not encouraged to perform scale and polishes because this is classed as band I and they would get paid exactly the same if they did the checkup only.

The English UDA system is completely flawed and needs some reorganising.

 

[Tuffteeth]

Thank you once again to everyone, your advice is invaluable.

For peace of mind, I've decided to register with a private dentist (the same one my kids go to) who will charge about £12 per month, but this includes 2 check ups and 2 hygienist visits through the year FOC including free xrays, 20% off all treatments, etc.. So the £12 should be worth it in the end, and it's not enough that I will notice coming out each month either.

On 23/12 I'm going for an initial check up with them, and I can ask a few questions. Hopefully they will be able to give me an unbiased opinion of what I need doing (if anything). My other NHS dentist also does private which in my mind opens them up to corruption of the system (recommending private treatment over NHS, etc..). I hear a lot of questionable tactics happen to help the Dentist up sell their private products.

I've also looked at the price list for the private dentist, and things like cosmetic fillings are actually cheaper private than they are NHS (private is about £38 compared to £50+ NHS). I may be looking at replacing some of my fillings with composite resin. I hear you don't have to drill them out every time they have an issue, just top them back up? This means I don't get progressively larger holes in my teeth every time a filling is renewed. It may save some teeth in the long run, not to mention costs. I'll pay £38 twice a year compared to £50 once a year if it means I don't need more expensive treatment down the line.

Thank you all again.

 

[Torrentula81]

And I thought us Americans had it bad. I was curious how nhs worked. I always thought must be nice to get partials or other major work done for under £220. I knew it wasn't all roses because someone on here said their dentist said to them "If I knew you were this bad I wouldn't have accepted you." All these years I thought how nice it must be to live in a country that has health care. When you said they get paid the same for doing 1 crown and doing 5. I thought no that can't be true . Then gentledentle makes their post confirming it and I am speechless.

America is a mess. The comments sections on CNBC's "Obamacare penalty will be bigger than you think" thread shows it's short comings. Add salt to the wound it doesn't even require dental to be included. You guys maybe getting substandard care but we have to pay for care that is overpriced. The high rates charged by dentists, hospitals, and drug companies are out of control. Insurance monthly costs vs deductible before they pay anything and annual maximums make them nearly useless. We're at the point of buying insurance to avoid a fee vs buying it for the coverage it provides. You can either afford healthcare through insurance, the of use credit, or like many do without.

Is substandard care better then overpriced. Either potentially shoddy vs having to do without.

 

[Tuffteeth]

Being an American veteran living in England, I've had the fortune or misfortune of a number of different dental systems. For me, having lived under insurance based health systems, and Government controlled ones (Army), I am not a fan of the social health care system in England.


So I guess that would make me a fan of insurance based systems (the lesser of two known evils), and only ever accepted a job in the US that offered these as part of my employment. I paid a small $10 deductible to see the doctor, $20 or so for the Dentist. I've always had about 1 week per year of extra time to use for appointments and such that wasn't counted as holidays. Also I know when I lived there you could get a plan for about $170 per month if your job didn't offer it which was ok to me. I really don't know what it would be like if you didn't have medical/Dental coverage so can't comment on that side of it, nor do I know a lot about Obamacare, though my Mom absolutely loathes it. There were always Medicaid, AARP plans and such for my grandparents, and was always told they will provide life saving treatment before asking for your insurance details. Sounds fairly reasonable of them.

The NHS relies solely on the working class to provide funds for these systems, and it gives it to everyone regardless if they pay into it or not. The Dental care is extremely limited and not completely free, though free if unemployed/pregnant up to 1 year after birth/ under 16?. Not to get into a debate on whether or not this is good or bad ( guess it would depend on your outlook, or what you're used to), but...

I for one feel the NHS system is open to abuse from the patients. In the USA it would cost you to see a Doctor/Dentist, so you are more likely to wait it out to see if things improve (within reason of course), and generally only go if you feel it is needed? I know that's what I used to do. You have a cold or the flu, take a sickie and try to get better taking Dayquil/Nyquil. Toothache? Give it a day to see if it improves. On the NHS it's free for a lot of people. Healthcare for everyone (including EU nationals), and Dentist for those who meet the criteria as mentioned before (again EU nationals as well). Maybe I'm just jelious, but I'm not able to see the Dentist every week or the Doctor. Working hours for Dentists and Doctors are almost the same as my working hours (8am-5pm), and me being allowed to attend an appointment is at the discretion of my employer. Most of the time I have to take a holiday to attend an appointment and as the system is so overcrowded it's difficult to get an appointment.

So now I am in a position where I will be paying for the NHS dental system through taxes as I work, but won't see any benefit to the system. Can I get a tax deduction?

The Dental system on the NHS is Basic dental care, not aesthetics. Because of how the system changed in 2006 there is no incentive for Dentists to use the best equipment, nor the best materials. they aren't bothered if it means you lose your smile, or your bright white teeth. Minimal care for minimal costs. until my investigations I thought the Private and NHS were equal. The NHS just made the public pay a portion and covered the rest. I didn't know they will only pay to a certain amount then stop and force the ethics of the Dentist in question to continue at their cost if they felt it was deemed necessary. That whole saying about doing it poorly means doing it twice comes to mind.

I am now actually looking forward to my appointment in January to highlight the differences in the two systems. Within 2 weeks, I will not only see a private Dentist, but then also a dentist who is supposed to recommend treatments from the NHS as well as private. If both of them are ethically sound both opinions should match, and treatment plans should be similar.

I take fairly good care of my teeth, brush twice per day (Morning/Night), no contact sports, and I'm not a accident prone person. Before my 2 teeth were smoothed out, I didn't have any other mouth issues, and I was on a once a year treatment plan on the NHS, now I have a bite issue or at least now two teeth that meet earlier than they used to (not a matching set, canine to lateral Incisor) which would seem a simple fix in my mind, but am being referred to the Head Dentist. I guess it's above the capability of my normal NHS Dentist?

I'm in a better frame of mind knowing that I have that appointment on the 23rd. It's restored my faith, and hopefully my teeth.

Sorry I know I like to rant, just imagine what my wife puts up with!