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NHS or Private? (was:English 'pull own teeth')

Zzzdentist

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This was posted over at www.dentalab.us

Mon Oct 15, 7:19 AM ET

LONDON (AFP) - Falling numbers of state dentists in England has led to some people taking extreme measures, including extracting their own teeth, according to a new study released Monday.



Falling numbers of state dentists in England has led to some people taking extreme measures, including extracting their own teeth, according to a new study released Monday.

Others have used superglue to stick crowns back on, rather than stumping up for private treatment, said the study. One person spoke of carrying out 14 separate extractions on himself with pliers.

More typically, a lack of publicly-funded dentists means that growing numbers go private: 78 percent of private patients said they were there because they could not find a National Health Service (NHS) dentist, and only 15 percent because of better treatment.

"This is an uncomfortable read for all of us, and poses serious questions to politicians from patients," said Sharon Grant of the Commission for Patient and Public Involvement in Health.

Overall, six percent of patients had resorted to self-treatment, according to the survey of 5,000 patients in England, which found that one in five had decided against dental work because of the cost.

One researcher involved in compiling the study -- carried out by members of England's Patient and Public Involvement Forums -- came across three people in one morning who had pulled out teeth themselves.

Dentists are also concerned about the trend.

Fifty-eight percent said new dentists' contracts introduced last year had made the quality of care worse, while 84 percent thought they had failed to make it easier for patients to find care.

Almost half of all dentists -- 45 percent -- said they no longer take NHS patients, while 41 percent said they had an 'excessive' workload. Twenty-nine percent said their clinic had problems recruiting or retaining dentists.

"These findings indicate that the NHS dental system is letting many patients down very badly," said Grant.

"It appears many are being forced to go private because they don't want to lose their current trusted and respected dentist or because they just can't find a local NHS dentist."
 
harper

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Re: English 'pull own teeth' as dental service dec

i wrote several letters last yr including one to our prime minister concerning the welfare of our nhs dentists.
when i had an nhs dentist hes was so busy it was ridiculous. he eventually after several yrs was leaving the practice and i was devastated. i wrote and asked why they were treated so badly and worked so relentlessly. the response was dissapointing but at least i tried. i now have the same dentist but he has his own private practice.
 
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Re: English 'pull own teeth' as dental service dec

I was watching Sky News, and there was Lady who pulled 7 Teeth out - she used her Husbands Pliers !
 
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Lacey

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Re: English 'pull own teeth' as dental service dec

What a terrible shame that people with dental phobia problems have been overlooked in this.  :confused: :confused:
 
brit

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Re: English 'pull own teeth' as dental service dec

QUOTE LACEY: 'What a terrible shame that people with dental phobia problems have been overlooked in this'

I'm not sure they have really....in the UK they can ask for a referral to the Community Dental Service in most areas via their GP...there'll be waiting list but provided they meet the criteria - they will be treated on the NHS by caring salaried dentists with all sedation options available.

No one is supposed to sit around in pain and pull their own teeth...there are emergency units (some posters on here have used them and even liked the dentist they have met) called Dental Access Centres to try to deal with this.

Finally I know it's not true for everyone, but my fellow Brits :p are sometimes a bit slow to prioritise their dental health and get a private dentist who will have more time for them anyway...quite often the same people saying they can't afford to pay for regular check ups which would help avoid more expensive treatment being needed, will be the same ones spending huge amounts on holidays, designer clothes, drinking, smoking, hairdressers, make-up etc etc.........

The line goes 'I've paid my National Insurance/income tax' why should I pay twice? I'll tell you why because it's your health ...why would you jeopardise that because a government years ago closed down dental schools and cut back on the number of students being trained and also failed to take account of the increase in the percentage of female students who at some point may take an extended career break?

I. M.V Dental Insurance is not really the answer...just make a commitment and budget £x per month (get rid of your Skybox if you have to :p) towards your annual dental costs or sign up to Denplan or whatever but just don't sit around letting your teeth rot...they are your teeth.

I actually think we'd all be better off using private dentists with those on low incomes and children getting their costs reimbursed by government...way to go! If you were a newly qualified dentist would you want to work in the NHS system or have more time for your patients to do quality and preventitive work?

I do believe in universal healthcare by the way but I'm not aware of any country where adults get free dental care at point of use.
 
letsconnect

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Re: English 'pull own teeth' as dental service dec

Brit said:
No one is supposed to sit around in pain and pull their own teeth...there are emergency units (some posters on here have used them and even liked the dentist they have met) called Dental Access Centres to try to deal with this.
True, there has been some very positive feedback about Dental Access Centres here. There *are* provisions for emergencies, even if NHS dental provision falls short of 21st century dentistry in many respects.

The line goes 'I've paid my National Insurance/income tax' why should I pay twice?
Not many people are particularly interested in dentistry (let's face it, it's not the most popular subject on the planet). IMO, it's up to the government to inform people that the service provided nowadays is a very basic one. It's probably only a minority of people who are aware of this... and who can blame them?


I actually think we'd all be better off using private dentists with those on low incomes and children getting their costs reimbursed by government...way to go!
Probably true except you'll run into the same problem as in the U.S. where only those on very low or reasonably high incomes can afford dental care. Which leaves a lot of people in a position where they may decide to meet basic needs other than dental care...

Tough one :(!
 
brit

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Re: English 'pull own teeth' as dental service dec

letsconnect said:
Probably true except you'll run into the same problem as in the U.S. where only those on very low or reasonably high incomes can afford dental care. Which leaves a lot of people in a position where they may decide to meet basic needs other than dental care...
Tough one  :(!
I don't think that's such a high risk in Europe where the mindset quite rightly is that the Government has to take some responsibility for their citizens' welfare. We all accept higher tax levels than is the norm in the US to pay for this provision.

The Dutch have compulsory private medical insurance for all (no one can be refused basic cover), under which all kids are covered for basic dental (adults aren't necessarily).....the Government sets top limits for what private dentists can charge for each procedure...preventitive sealant and flouride treatments are included...I don't actually like this approach either as there is little incentive to differentiate the standard of care you offer (hardly anyone in NL offers nitrous for instance) but if you trained enough dentists, this approach could work provided the maximum charges weren't ridiculously low.

Even France so often held up as the EU 'creme de la creme' of healthcare systems doesn't seem to cover adult dental work in full and phobics don't seem to be well catered for there at all.

Our Canadian poster (forgotten her name) on welfare had a terrible job getting her sedation paid for...not sure she ever managed it did she? In the UK through CDS she could have got it relatively easily provided she had a sympathetic GP.

I agree we don't want US style prices in the rest of the world but I still think we could move on to a better system with a bit of imagination and a recognition that what's available on the NHS is not the best out there anymore as Letsconnect has already said.
 
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jools

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Re: English 'pull own teeth' as dental service dec

"Finally I know it's not true for everyone, but my fellow Brits   are sometimes a bit slow to prioritise their dental health and get a private dentist who will have more time for them anyway...quite often the same people saying they can't afford to pay for regular check ups which would help avoid more expensive treatment being needed, will be the same ones spending huge amounts on holidays, designer clothes, drinking, smoking, hairdressers, make-up etc etc......... "

Sorry, I REALLY don't want to get political so I will be brief...I totally disagree..and the idea that everyone on benefits etc should get free treatment while those that work are punished financially, I find quite obscene..

Sorry, but there it is...

Jools
x
 
harper

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Re: English 'pull own teeth' as dental service dec

just thought id give an opinion.
everyone in the uk is entitled to nhs treatment. if they work or not .
 
brit

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Re: English 'pull own teeth' as dental service dec

jools said:
"Finally I know it's not true for everyone, but my fellow Brits   are sometimes a bit slow to prioritise their dental health and get a private dentist who will have more time for them anyway...quite often the same people saying they can't afford to pay for regular check ups which would help avoid more expensive treatment being needed, will be the same ones spending huge amounts on holidays, designer clothes, drinking, smoking, hairdressers, make-up etc etc......... "

Sorry, I REALLY don't want to get political so I will be brief...I totally disagree..and the idea that everyone on benefits etc should get free treatment while those that work are punished financially, I find quite obscene..

Sorry, but there it is...

Jools
x
Jools, I don't really understand your point, but guess you are saying that you feel a large proportion of people on benefits should be working instead and then there'd maybe be more money in the system to subsidise working people's NHS dentistry....as Harper says most everyone living in UK is entitled to NHS treatment whether they work or not but you can upgrade if you choose to.... I don't see that removing that universality of entitlement - is that what you would like?, would help those who really do need help.
It's one thing to discuss on a forum alternative ways of funding dental healthcare but maybe (?) beyond the scope of this Board to encompass who should and shouldn't be entitled to welfare benefits within a particular country.
 
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jools

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Re: English 'pull own teeth' as dental service dec

Hi,

Sorry, maybe I didn't quite phrase it well, I just think its a shame that there are thousands of people just like us, with severe dental phobia, who, working or not , have massive difficulties in finding an NHS dentist, whilst also battling with their phobia. The only 'politcal' point I was trying to make is that, while I neither smoke, drink, or spend 'huge amounts' on designer outfits, or take foreign hoidays, for me personally to pay for private treatment would still be financially difficult.

As to the welfare benefit system, as you say, it is not something either of us should really be commenting on in this forum.


Jools
 
letsconnect

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I found this on a dentist's webpage, it explains the two-tier system of "standard of care" really well.

---
Private v NHS

For 50 years the National Health Service has served us well, improving the dental health of the nation considerably.For the first time in April 2006, the government imposed a new contract based on a fixed budget and targets. This was never tested and there was no mention of quality of work. Almost all dentists were unhappy with the contract. 98% of dentists surveyed said that the new contract had affected their clinical decision making.
This practice did not accept a contract for adult patients, who are now all treated only on a private basis. Patients up to the age of 18 can still be seen on the NHS. Today a number of treatment options are not available on the NHS and our choice of materials is limited. Recent advances in technique have not been included in the NHS fee scales and furthermore, successive governments have imposed rules, which do not relate to good dentistry.

Standards of Care...

The Royal College of Surgeons has defined two acceptable standards of dental treatment.

Standard B is defined as:
"The minimum acceptable standard below which there is a potential for damage to the patient as a result of the treatment or lack of treatment provided."
All NHS treatment is performed to this standard.

Something better…

What if you desire something better?

Standard A is defined as
"A standard of excellence possible where there are no clinical limitations imposed by affordability, time or the patient's wishes."
When private treatment is performed, every attempt is made to reach this standard. Choice of treatment option is widened and each treatment can be characterised more to harmonise with your own oral environment.

How private treatment is different…

Gum Health:
We have the services of a hygienist. Government rules are highly detrimental in the fight against gum disease.

Fillings:
A wide range of quality materials can be used including white fillings in back teeth.

Crowns and Bridges:
With these advanced restorations we are not limited to what material or techniques can be used.

Cosmetic Dentistry:
With new generation bonding materials it is possible to improve the appearance of teeth. We can also change the colour of teeth through the use of home bleaching kits.

This is by no means a comprehensive list of the differences and options. Unfortunately, the NHS has become a question of what can and cannot be done."

---

Because the NHS vs. private dentistry question comes up quite often, I'd also like to add this from a thread that appeared on the dentistry questions board:

---
"As for the private/NHS bit, so far as anything concerning laboratory work is concerned, the private stuff should be made to a much higher standard than the NHS stuff, the NHS is basic, of acceptable quality. The appearance should be OK, but you can't expect a perfect colour match for instance or have high precious metal content in your gold crowns. The NHS also limits the materials you can use, for instance you can't use white porcelain for molar teeth, it has to be non-precious metal. Again acceptable but not the best...

If you go abroad to have work done, don't expect your own dentist to sort it if it goes wrong, at least not very willingly... or cheaply"

---
 
brit

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[broken link removed]

This extract on a Covent Garden (London) Dentist's website is also a good explanation of why their practice is private only. This is just an extract:

"You can't be innovative within NHS dentistry, you can't take the time, you can't incentivise, you can't go that extra mile with your patients. Patients resent rushed treatment. They resent having their cosmetic needs trivialised. They resent having to attend three appointments when one would have sufficed. They can't understand why it takes months to get an appointment, even if they are in pain and they can't understand why their dentist is surly and tense."

"The reasons are obvious.... good dentists won't work under these conditions, forced to provide rushed, compromised dentistry, and being made to spend precious surgery time filling out forms in an ever-changing, politically managed, bureaucracy. That's why it's apparent that so many good dentists have left the NHS, they had sound reason to do so and EVERYBODY is so much better off for that."
 
scaredstiff

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Brit said:
This extract on a Covent Garden (London) Dentist's website is also a good explanation of why their practice is private only. This is just an extract:

"You can't be innovative within NHS dentistry, you can't take the time, you can't incentivise, you can't go that extra mile with your patients.
If I'd written that quote I would have been inclined to change "you can't go that extra mile.." to "you can't go that extra (s)mile".
 
brit

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scaredstiff said:
If I'd written that quote I would have been inclined to change "you can't go that extra mile.." to "you can't go that extra (s)mile".
Good to see you are in creative mode SS!
 
scaredstiff

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I'm always in some sort of mode, presently in blinking mode because the screen is flickering badly. Only hope it's not the sign of bad things to come - this is my main computer. :)
 
brit

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The other thing to bear in mind in the NHS v Private debate, is that if you are paying the dentist a reasonable rate to just check your dental health twice a year i.e. you are paying a significant sum for your check up, there is less incentive to carry out unnecessary work or sell you add-ons such as teeth whitening.
Goodness knows how many teeth were filled unnecessarily under the old drill and fill piece work rate which accompanied the free NHS check up.
 
brit

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http://news.bbc.co.uk/1/hi/wales/7251246.stm

BBC article about how the new contract works in Wales (NB some phobics may find the stock footage photo a bit triggering - typical media photo)
If the new bands really do work like this and it would appear they do...it's very bad news indeed for patients needing a lot of restorative work.
 
scaredstiff

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But then, perhaps luckily though people may not think it at the time, its nearly impossible to get on an NHS list so people have to go privately anyway so therefore are doing themselves a favour possibly without realising it.
 
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Re: English 'pull own teeth' as dental service dec

I actually think we'd all be better off using private dentists with those on low incomes and children getting their costs reimbursed by government...way to go!
That is how the nhs system works already. You go to a private contractor and he or she claims the costs of your treatment back from the government. They don't work for free - the NHS is surprisingly enough not free and is given taxpayers money by the government to commission services on behalf of its resident population.

The problem with a system which uses private contractors (which is what most nhs dentists are), is that they are incentivised by money. If the government introduced more directly employed dentists there would be more flexibility without all the gaming which goes on when you have an externally commissioned service. It would probably also enable the nhs to improve the work it does and reduce the large amount of fraud that goes on.

The community dental service is an example of dentistry services being provided directly by the nhs rather than private contractors.

Yes there is a limit on the materials the nhs will pay for and the work that can be carried out. There is unlimited demand for many things the nhs provides but a limited supply of cash and a cumbersome system. At the end of the day, do you think there should be less money for chemotherapy for cancer patients and neonatal intensive care and more money for nicer looking porcelain crowns? There's an ageing population with high cost complex medical needs. Add to that huge demand for new technologies and high cost drugs e.g. herceptin and you end up with a very different situation to when the nhs was formed in the 40s.

Most of my fillings were done during the pay per piece time of dental heaven when you would walk in to a surgery with a slight toothache and walk out with a mouthful of amalgam. I was not impressed with the old system any more than people are impressed with the current system. Then as now quality of work all depended on the skill and dedication of the dentist be they working privately or under the nhs. The most useful dental experience that happened to me as a teen was a dental visitor to our school who told us how to brush our teeth so that we could avoid decay. (basically using a dental model told us to stop brushing up and down and to brush in circles remembering not to neglect the eye teeth which often decayed). Completely changed my attitude to dental hygiene. All those visits to the dentists I'd had before that had failed to explain this simple concept to me.....it took a public health initiative to get such a simple message through to a classful of students.
 
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