UK: NHS vs Private - the REAL differences?

[Maverick T]

Hi Everyone,

I visited a dentist for the first time in over 20 years last week - a combination of fear of future pain and caring, positive encouragement from my wife made me make the appointment.

I lurked here for a few days before the (NHS) appointment - even though I hate my smile (due to a childhood illness, I have crooked teeth), all I needed was a single filling.

Anyway, having read around the forums a bit, I'm just looking for some honest advice from any UK dental health professionals on here. I know that private treatment is going to be better - but how much better?

My NHS dentist was fantastic and when I explained how nervous I was he really put me at ease and I don't for a second doubt his capabilities or ethics. Now, like many others here, I wish I'd gone years ago - though I'll be a basket case when I go for the filling in a week and a half!

However, now I've decided to take the step to getting my teeth and gums properly looked after, what are the real, tangible differences I should be able to expect for the extra investment that private treatment would cost?

I guess what I'm also asking is do you think a longer check-up might find more wrong - would you believe I'm now more scared of dental pain than going to the dentist, so I'd like them to find anything else that might be going wrong before it happens!

Hope all of this makes sense.

Thanks to everyone for all the success stories that actually helped me through the door and into the chair in the first place!

Also thanks in advance for any replies and information.

T

 

[annie778]

I don't think a private checkup makes much difference. The nhs checkup is fairly thorough.

The difference comes when you need treatment and treatment choices and materials become more limited with the nhs. For example you used to be able to have white fillings on only front teeth with the nhs. (Not sure if you can have any now). The materials for crowns were very inferior compared to the private choice, etc.

 

[letsconnect]

I think it may depend on the individual dentist how thorough the nhs check-up is. Some dentists do stay with the NHS because they really believe in a national health system and they may go out of their way to make time for a thorough check-up. I'm not as optimistic as Annie about how thorough the average NHS check-up is nowadays, but that of course doesn't mean that thorough NHS check-ups don't exist.

As Annie said, you're more limited with regards to choice of materials. Also there tends to be less emphasis on preventing and treating gum problems under the NHS.

If your teeth and gums and pretty healthy and you have a kind, ethical and competent NHS dentist, there's probably no reason not to hang onto him. If you need more extensive work or maintenance for gum problems, you may not be able to get up-to-date care on the NHS. However, many NHS dentists also offer private treatment options for things which aren't covered under the NHS.

Looking forward to comments from our dentists on this issue, as they'd be much better informed than us punters !

 

[hdf2]

Welcome to the forum Maverick. And well done on making your first visit to a dentist in 20 years.

I cant really fault my (nhs) dentist . I had 3 fillings done on Tuesday, all white composite, 2 at the front and one at the side towards the back. ( i cant even see where the fillings were done) So, yes, you can get white fillings done under nhs dentists.
The only " downside" for me is the waiting list to have treatment carried out under Iv sedation, the waiting list is longer under nhs run dentists.

Good luck for your appointment.

 

[letsconnect]

I think that's a salaried NHS dentist though (if you're going through the Community Dental Service), and different rules apply.

Oops, I missed the bit about the appointment in a week and a half - best of luck with it !!

 

[Maverick T]

Thanks to everyone for the help and answers so far.

My dentist was very good and he did have a good look around the mouth, taking 2 x-rays.

From what I've read so far, it looks like I'm going to stick with NHS for now. The practice also does private treatments so I would be able to go private for any specific treatment if I needed to - but of course now I've found a good, friendly, convenient dentist on the NHS, I don't want to pay more than necessary - so long as that's not at the expense of treatment.

My filling is at the back so I think it will be silver, but I'm OK with that.

Would you believe that at age 36, I've never had a filling, or LA! Had loads of problems with my teeth in childhood due to an allergic reaction to some medicine so have been scared senseless of the dentist since about age 15. Thanks to a sympathetic dentist and the support/advice on here while I've been lurking, I seem to be gradually realising dental treatment has moved on a LONG way in 20 years

Thanks again for the ongoing help and answers.

 

[brit]

In many many years of regular attendance, I have never had an NHS check-up which lasted more than 15 minutes and that included the 5 minutes of cursory scrape and polish which I'm not even sure they do now. X-rays were rarely taken as an adult - they were more frequent as a child.
In my current location my private 'new patient' check-up was scheduled in for 60 minutes and in reality lasted 45 minutes...yes there were lots of pleasanteries and chat but things such as detailed health questionnaire, my bite, TMJ check, my periodontal health status, full x-rays, oral cancer check, dental health advice were all covered. I see the hygienist every 6 months.

My last UK private dentist also did very thorough check-ups and was the first to get me to see a hygienist every 6 months...my only other UK private dentist before him, had always done the cleaning for me himself..to a much lower level of thoroughness I would now say, although he was right I don't tend to accumulate plaque very much i.e. not much of it turns to tartar. This former dentist was an NHS London one who went private early on, so that might explain the lower care level on cleanings.

I think Letsconnect is right about NHS dental care not really focussing enough on the importance of the health of the gums which are the teeth's support, so if I were you, (and especially if you don't floss daily) I would ensure you get regular cleanings from a hygienist. It's verging on being too late once a problem has been picked up - gum disease is often symptom-free. Even if you do floss daily, it still seems the gums benefit from a regular professional clean.

The other pressure currently on English dentists under the new contract from my understanding of it is that depending on the bands...they only get reimbursed a certain amount, regardless of how much work they diagnose you as needing, so I would say it is possible they would be tempted to spread work out over several check-ups rather than do everything in one big hit for which their reimbursement level would level out once a certain point has been reached. For instance by doing one filling I think you would fall into Band 1, likewise two fillings but if he saves one filling for next time, he gets two payments...how this contract was supposed to incentivise prevention is beyond me! Although actually thinking about it, it could succeed in putting work off so I suppose it does prevent overtreatment a bit which was the major downside of the old free check-up and piece rate per filling.

A minor point for some maybe but many of my NHS fillings were done very competently and comfortably by recently qualified dentists who used to change at the practice I went to as often as every year - the guy you saw and liked today may not still be there this time next year - of course if he is the main dentist then this is not an issue but I do think continuity of care from a dentist you like and trust is important for all patients not just those with dental anxieties. Someone who has examined you every 6 months for years is more likely to notice significant changes....I would suggest.

Many practices are mixed NHS/Private and it could be that you can get a regular clean and check-up included as part of a DENplan type care scheme or similar.....where you pay so much per month. I fall at the high end of their scale so for me it was always cheaper to just do 'pay as you go' .

Other differences are not just in the materials available but also the equipment and treatments....diagnodent and TheWand for painless LA delivery is not very common in the NHS, healozone is not available, implants are not covered, cerec crowns are not available etc etc.

Gosh it sounds like I have a real downer on NHS dentistry....well in its current state I think I probably do....I do believe in universal availability of quality healthcare though...just think reform is needed as dental technology has moved on so much in recent years and what is available on the NHS is rather old-fashioned and cheap and cheerful (CDS and hospital based dentistry excepted).
This is me taking cover......

 

[annie778]

I think it may depend on the individual dentist how thorough the nhs check-up is. Some dentists do stay with the NHS because they really believe in a national health system and they may go out of their way to make time for a thorough check-up. I'm not as optimistic as Annie about how thorough the average NHS check-up is nowadays, but that of course doesn't mean that thorough NHS check-ups don't exist.

I've been lucky in that case because the nhs check ups I've had have always been thorough. The best thing to do is to find a dentist who does both and is accepting to his nhs list. Most nhs dentists do private too these days. It's worth having an nhs checkup and nhs treatment for things like fillings on back teeth, but private cosmetic work for front teeth or any inlays/onlays.

As far as ethical dentists go, I've met more ethical nhs ones recently than private ones. I can recommend two nice and ethical ones in the London area. I've already put one on the recommendations section and at some point must add the nice one who I saw when I needed an urgent appointment a couple of months back.

 

[brit]

As far as ethical dentists go, I've met more ethical nhs ones recently than private ones. I can recommend two nice and ethical ones in the London area. ....

Annie
It sounds like you hang out at dentists' cocktail parties for a hobby!

 

[Snowball]

Sorry, long but I been thinking about this plus I'm putting off going out for a run.

Being an old socialist, I never thought I'd go private for anything. But in the end, also 20 years away from the dentist's chair, my phobia sort of dictated to me that I'd have to go private.

Am in a position to compare NHS and private only in that I have gone along to my kids' NHS appointments. The slots (whether examination or treatment, usually to encompass both if it's say 1 filling) have been 15 minute slots. Knowing what I now know, I suspect there are even fillings that may need longer. One of my sons has special needs and they have booked him in a double slot, before now.

It does upset me that people slag off the NHS - we have had some pretty brilliant things via it, that people in other countries could only gape at in envy. For example, my 15 year old was referred on the NHS for orthodontics. It's a bit of lottery which practice kids get referred to, and the waiting lists are long (around 1 year) but when my son's finally came through it was at the poshest spa-style orthodontist in town, who is very highly rated and I overheard his receptionist on the phone to private patients, quoting prices for braces around the £5000 mark. Cost to me? Zero. My son now has beautiful even teeth, basically Hollywood-style.

So some good stuff happens on the NHS but probably mainly to kids, people with special needs, in community dentistry.

My instincts are if you like the dentist stick with him and give him a try.

I think as ignorant outsiders to the profession, us punters do start to wonder if a dentist is still with the NHS - why? Does that reflect well on them, or the opposite? In my own profession, (teaching), I've worked in some tough inner city sink schools few of my fellow professionals would touch with a bargepole - like an NHS dentist, underfunded, under-resourced, and hated by the general public with the government constantly telling them how rubbish we are at our job. Knowing colleagues in leafy suburbs or village schools got the same pay (or higher) for jobs that are basically money for old rope. But I chose to be there, doing that, making a difference. But you do wonder with the NHS, is it harder for those practices to recruit? Do the private practices get the pick of the new graduates? Would you want to work in an environment where you get a cursory amount of time with your patients, can't remember most of their names let alone build rapport with them, and have equipment from 20 years ago? I just dunno what to think.

All I know is my private dentist saw me for about 55 minutes, my first consult. I saw the hygienist yesterday - who presumably does nothing BUT hygiene all day so must be a specialist, right? - for I dunno 30 minutes at least...

My husband waited the 2 hours last week in my private dentist's waiting room whilst I was worked on and he said there was a marked difference between that and NHS... Far fewer patients. No hurry. Dentists came out personally to meet and greet. People were not stressed, but relaxed and happy and friendly....

Yes you can get great treatment on the NHS but depends what you want, too esp with a filling where you may have options re. materials. A dentist you trust on the NHS is better than a shedload you don't with swanky offices. On the other hand, if you need to combat your fears longterm, I can't see how NHS is the place to do that, right now,despite the brilliant professionals you'll find there : to treat a tooth, 15 mins may be enough but to deal with deeply embedded phobia, it's not going to be enough.

 

[annie778]

Annie
It sounds like you hang out at dentists' cocktail parties for a hobby!

Although dentists are charming companions and the above sounds terribly glamorous, I must shatter you illusions. My extensive experience of the private sector mainly comes from when I had some major problems between 1992 and 94. I've also moved around a bit so I've changed dentists often over the years. I tend to use one dentist for mouthguards and a different one for checkups. I might go to a third if I want cosmetic work done and an endo if I need RCTs. I do the same if I have medical problems. I'd go to a private doctor if I want something specific quicklyetc. And hairdressers too - I am always changing to see if one is better than another. I did houseshare with an australian dentist back in 99/2000 and that was interesting - so I've had barbies with a dentist . He was very nice and we only spoke about dentistry once I think.

 

[brit]

I did houseshare with an australian dentist back in 99/2000 and that was interesting - so I've had barbies with a dentist . He was very nice and we only spoke about dentistry once I think.

See I knew there was a grain of truth in it ....

 

[brit]

Being an old socialist, I never thought I'd go private for anything. But in the end,

Don't beat yourself up about this Poodleoo...I know many 'old socialists' who don't turn down the free BUPA cover when it comes with their job!
Where you choose to work is one thing..it's great to feel you can make a real difference; but just because you may place your vote say (as I do) to retain a 'free at point of use' health service, it doesn't mean you always have to use it yourself all the time. No political principle is more important than your own health.

After all it may not have been your side of the political spectrum who banged the first nail into the coffin...it was actually the Tories - they introduced the first new contract which had London NHS dentists opting out in droves as did mine at the time; as did my OH's corporate dentist, closed dental schools and it has gone on from there....with the current Government continuing to make a pig's ear of the dentistry bit.

My own downer is only on NHS dentistry not the NHS as a whole which when I return to the UK I will mostly be happy to use.

I think the other reality is that the vast majority of NHS dental care is going to be provided by the newly qualified....a bit like those 'old pants' you mentioned on another thread, there comes a time of life when you really don't want your dentist to look as young as your teenage son's best friend.....the inexperience just doesn't inspire confidence.....so having control over who your practitioner actually is, is No1 priority for me...with a GP wouldn't bother me one jot to have a newbie! But then I've NEVER met a scary GP.

 

[brit]

My filling is at the back so I think it will be silver, but I'm OK with that.

But why put a poisonous substance into your mouth (i.e. mercury) if there is none there already...for the sake of a few quid if you don't have to? I have loads of amalgams and would never remove them for cosmetic reasons (they are very durable) but given a clean slate, I think I'd opt for composite.....just in case the scare stuff about mercury leakage has some validity.

You must do what you feel comfortable with but maybe best to be aware of the pros and cons of both types of filling and make an informed decision rather than just go with amalgam because that is what the NHS in its wisdom currently chooses to offer.
.
Amalgam fillings are technically easier to place, cheaper and more long-lasting and therefore also quicker to do....but more tooth structure has to be removed than for a composite filling.

 

[letsconnect]

But why put a poisonous substance into your mouth (i.e. mercury) if there is none there already...

Not sure I would agree with the "poisonous substance". Here's an excerpt from Quackwatch:

"Mercury is a component of the amalgam used for "silver" fillings. The other major ingredients are silver, tin, copper, and zinc. When mixed, these elements bond to form a strong, stable substance. The difference between bound and unbound chemicals can be illustrated by a simple analogy. Elemental hydrogen is an explosive gas. Elemental oxygen is a gas that supports combustion. When combined, however, they form water, which has neither of these effects. Amalgam's ingredients are tightly bonded to each other. Although the types of chemical bonds in water and amalgam differ, saying that amalgam will poison you is just as wrong as saying that drinking water will make you explode and burst into flames.

Very sensitive instruments can detect billionths of a gram of mercury vapor in the mouth of a person with amalgam fillings. However, the minuscule amount of mercury the body absorbs from amalgams is far below the level that exerts any adverse health effect [1-6]. One study found that people with symptoms they related to amalgam fillings did not have significant mercury levels. The study compared ten symptomatic patients and eight patients with no reported health complaints. The symptom group had neither a higher estimated daily uptake of inhaled mercury vapor, nor a higher mercury concentration in blood and urine than in the control group. The amounts of mercury detected by the tests were trivial [6]. Some studies have shown that the problems patients attribute to amalgam restorations are psychosomatic in nature and have been exacerbated greatly by information from the media or from a dentist [7-11]
An extensive review published in 1993 by the U.S. Department of Health and Human Services concluded that "there is scant evidence that the health of the vast majority of people with amalgam is compromised or that removing fillings has a beneficial effect on health." [12] In January 1998, the American Dental Association Council on Scientific Affairs issued a report on dental amalgam safety, with emphasis on studies that had been published since the 1993 review. The report concluded:
Millions of people have amalgam restorations in their mouths, and millions more will receive amalgam for restoring their carious [decayed] teeth. Over the years, amalgam has been used for dental restorations without evidence of major health problems. Newly developed techniques have demonstrated that minute levels of mercury are released from amalgam restorations, but no health consequences from exposure to such low levels of mercury released from amalgam restorations have been demonstrated. Given the available scientific information and considering the demonstrated benefits of dental amalgams, unless new scientific research dictates otherwise, there currently appears to be no justification for discontinuing the use of dental amalgam." (see https://quackwatch.org/related/mercury/)


Composite (white) fillings on back teeth can be difficult to place correctly to achieve a long-lasting result. This problem may regardless of the NHS vs. private issue. Of course, some dentists do achieve very long-lasting white fillings on molars (it depends on how difficult it is to keep the tooth in question dry during the procedure, their choice of materials and technique), but it can be difficult if not impossible for the person on the street to know about their dentist's skill level in this regard beforehand. I would probably base a decision on the dentist's recommendation - they know best what works well in their hands. I'd rather have a well-done amalgam than a cr***y composite...

 

[annie778]

I reckon the mercury in amalgam doesn't have a huge effect on health and is a pretty good long term & cheap solution to tooth problems that would otherwise be far more detrimental to health. It's probably best not to have a mouthful of amalgam, but if you're worried about mercury poisoning you should be more worried about the content in food and from atmospheric pollution. I think the people most at risk are dentists, as they get far more exposure to mercury dust than patients.

I'm surprised that the new composites are not great for back teeth as they seem much stronger than the old ones. I thought gold was supposed to be the best and is also tolerated very well by the body.

 

[brit]

I thought gold was supposed to be the best and is also tolerated very well by the body.

I think gold is the 'gold standard' but it is of course extremely expensive...one poster on here was quoted £1k for a gold filling.....he wanted it for sensory reasons.

 

[letsconnect]

I'm surprised that the new composites are not great for back teeth as they seem much stronger than the old ones. I thought gold was supposed to be the best and is also tolerated very well by the body.

Well, I didn't really say that the new composites aren't great for back teeth, but that they're much more technique-sensitive than amalgam. In the right hands, I'm sure they'd be great. Gold isn't offered that much mainly because of cost.

 

[brit]

Well, I didn't really say that the new composites aren't great for back teeth, but that they're much more technique-sensitive than amalgam. In the right hands, I'm sure they'd be great. Gold isn't offered that much mainly because of cost.

Most people wouldn't want gold at the front these days.....my father has a gold filling so they did used to be available on the NHS on front teeth 'centuries ago' believe it or not in those pre-composite days!

 

[letsconnect]

And before gold prices shot up

Have grillz gone out of fashion already?? Maybe one should study the grillz market to get a grip on those gold prices... doesn't look like it... but they may be a useful indicator.

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