/ Health

It’s time for dentists to sit in their own examination chair

More than half the NHS and private dentists we visited in our undercover investigation were rated poor by our experts. Some even neglected to offer basic treatment. Sound familiar, or do you love your dentist?

I don’t know about you, but I think my dentist is pretty fabulous. She’s clear about what she’s going to do, and I can honestly say she’s been a godsend for my poor, much-ground teeth. But I’m no clinician, and I’m relying on her to do a good job – if I’m honest, I’m not sure I’d be able to tell if she didn’t.

So it’s worrying to think that our undercover dentistry investigation might be any sort of reflection on the general state of UK dental practice.

Our dentistry diagnosis

Out of 20 visits across England rated by our panel of experts, 11 were rated poor, with evidence of poor case history-taking, clinical examination and a hotch-potch of inappropriate treatment offered to our undercover researchers.

All of our researchers had dental problems – from gum disease to decay and orthodontic need – and all should have been offered x-rays. So it was a real disappointment to see this didn’t happen in five out of 20 visits. Moreover, five visits lasted less than ten minutes, with two at just a shocking five minutes!

So what’s going wrong in an industry that has two regulators? Is it the NHS contract that’s the problem? Not necessarily – we also saw some poor private dentist visits. Are the standards dentists are working to too broad and woolly? Perhaps – these standards are currently under review by the General Dental Council (GDC).

Our four experts – who work at general dentist and consultant level, as well as having expertise in standard-setting and performance management – were surprised and disappointed by the picture they saw, with only three of the 20 visits rated good.

Improving NHS and private dentists

Sadly, it looks like some patients have been failed, which might leave them with a lifetime of dental problems that could have been prevented.

We want our findings to bring about positive change, so we’ve already shared our results with the British Dental Association (BDA) and the GDC. The latter is studying our findings closely to consider further action and told us:

‘We’re extremely concerned by any evidence of poor standards in the delivery of dental care. All dentists and dental care professionals are required to observe standards, and the findings of the Which? undercover research raise questions about adherence by some dentists.’

Do our dire dentistry findings strike a chord with you, or do you love your dentist?

Comments
Guest
Ray Steggles says:
8 November 2011

Responding to Greg’s comments

You will get a range of fees, because the cost profile of practices differ. At one end you will have highly qualified staff, undertaking regular training, the most modern fully maintained equipment , wonderful surroundings, work guaranteed for several years, and so on. At the other you could have inexperienced staff, undertaking the minimum of training, basic equipment, no investment in the future, rapid throughput of patients.

To maintain these types of practices produces a very different hourly rate that they need to earn.

Which type of practice would you feel more confident of receiving a high quality crown? There are different types of crown, usually involving laboratory work, which is a cost additional to the required rate for the practice, or very expensive computer and milling equipment (Mine cost me £70,000.). There are other factors, which I won’t go into here, which are to do with treatment planning, which can have a significant effect on cost.

I think that should give you some idea of the background to the variation between practices. Of course the majority of practices come somewhere in between those ends of the spectrum, having to establish their costs by local market conditions. I think it becomes extortionate when a practice charges slightly below the local average rate, and at the same time offers a much lower quality of service, and cutting back by employing inexperienced staff, for example. To a patient this may seem like a bargain, because they think one crown is the same as any other.

People can have treatment abroad, because of the differentials in the cost of living. A person travelling from here to Poland pays very much less for treatment, but the dentist in Poland is receiving a fee which is high in their terms, and could be described as being extortionate, because it may be way above their normal earning level. It is also depriving local people of a service, by pricing them out of their local market, as ‘greedy’ dentists makes money from health tourists.

Guest
Greg says:
9 December 2011

Mine cost me £70,000? You are a dentist of course, so you can afford it.

Guest
A worker says:
9 December 2011

Daft comment Greg, he was explaining the high cost of equipment. This is to help you understand why dental charges are seen as high by you.

Guest

Yes sorry I misunderstood.

Guest
Donna Jackson says:
8 November 2011

Dentistry in the uk is roughly 30 times more regulated than anywhere else in Europe. Our property , taxes, cost of living are higher than virtually the whole of Europe. The costs of this are reflected in how much it costs to employ people and how much it costs to run a business.

In eg Hungary the average wage is a third of the uk. So the technician who makes the crown, the nurse who assists the dentist, the receptionist, the cleaners , the decontamination nurse, the dentist are all paid less, the premises cost less , but do you think the price of a Hungarian crown will appear cheap to the average hungarian? No.

It will cost a uk dentist between £120 to over £200 or more an hour to run each surgery in a practice and that figure goes up at around 10% a year (far above inflation rate) and alot of that is to comply with uk regulations.

The uk technician that makes the crown has also seen a massive increase in overheads also partly due to having to be registered with the gdc. Many UK dental labs have gone to the wall because they cannot make a living in the current climate and introducing registration for some was the final straw.

Over 70% of dentists do not own a practice and these dentists average 72% of their earnings going in expenses. Private dentists have a higher percentage of their earnings go in expenses than nhs as private practices are so much more expensive to run.

Guest
Greg says:
9 December 2011

It would be good to have a Which report on your view and others posted here, to demystify this situation with dentistry in the UK. I cannot understand why dentistry fees have gone so high, or why there can’t be reasonable competition, unless the government is involved mucking things up as usual. Which please do this report, it is a major concern amongst at least older people in this country, but it is a concern for the younger generation too and also for dentists in terms of their livelihood and credibility.

Witness myself, reasonably affluent at 47 but struggling, no way I can go to the dentist for any more than an NHS filling, while I have other broken teeth requiring bridges or removal/implant as recommended by my dentist. But I won’t go because I can’t afford it and I certainly won’t pay for someone to remove a broken/decayed tooth that isn’t bothering me only to give me a huge quote to replace it.

Also, I suspect that when I was a child and young adult, dentists did unnecessary procedures on my teeth in order to get money from the NHS. Why is it that my daughters, who devour chocolate and sweets, have not had a single filling in their young teeth or for that matter in their adult replacements, while my juvenile teeth were drilled to bits and filled to the hilt with fillings? Was that because I was undernourished as a child? What is the explanation?

I had one episode when the government introduced a £15 fee for initial consultation, in my early twenties I think (i.e. the 1980s) when my usual dentist was replaced because he was ill by a stand-in irritable dentist, where when I complained when she said I had to have the initial consultation and return a week later despite me having a bad tooth ache, she then proceeded to drill with a vengeance through the tooth to remove most of it and replace it with a filling that fell out on the same day.

I’ve never trusted dentists since then, alas.

Guest
Ray Steggles says:
9 December 2011

Responding to Greg.
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Demystifying dentistry would be a good idea from the point of view of patients and dentists alike. It would not sit well with the DOH because they prefer to obscure the situation and blame dentists for the mess they have created. For many, dentistry hasn’t been the best experience. Given knowledge, equipment, materials and the massive demand because of disease rates, dentists of the time were doing their best. Those who found their experiences unpleasant are easy targets to propagate perceptions of dentistry and pass them on to their children, friends, work colleagues and so on. The ‘Press’ play on these fears and create or repeat stories pandering and perpetuating these anxieties. As we can see, many are keen to add their negative perceptions on discussion boards. Modern dentistry is more to do with prevention and catching disease at its earlier stages. If people avoid us they only appear when disease is bad and treatment options limited. This feeds through to cost. Unlike older generations, many don’t want dentures, and the other options are expensive. The NHS will not cover more than basic, traditional types of treatment. There isn’t sufficient money in the system, even though everyones been paying ‘their stamp’ and feels entitled to any treatment they feel they need.

Do people really want to know about dentistry or are they happier to view it on the basis of their preconceptions?

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We can all choose how we spend our money. I have some patients, who elect to have private treatment, even though they could qualify for free NHS treatment. We all know there is a range of ability to pay and a range of desires to pay. What people would really like is to separate the desire from the payment. We all like a bargain. Bargain dentistry and other health care is not a good way to go. At what point does it change from being a bargain to dangerous or a rip off?

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35 years ago, when I qualified, there was so much disease we really couldn’t cope, and we didn’t need to do unnecessary fillings to earn a living. So if I had seen a 12 year old Greg, I would have been very pleased not to have to do any fillings. In all likelihood you were over nourished with the wrong things. What has changed is the use of fluoride containing toothpastes. Those who use them slow down the rate of decay, even if their diet isn’t particularly good. They still get holes, but later in life, when they can cope more easily with dental treatment.
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Does one poor experience make all dentists bad?
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That’s a shame.

Guest

The bottom line with NHS dentistry is that the “service” is expected to be provided on a quarter of the European market value of dentistry. This was bad enough when the contract was fee per item but is far worse under the new contract. At least before if someone came in needing a full mouth reconstruction you got paid for what you did; a pittance admittedly but not a loss.

Another legacy of the NHS is the perception among the general public that dentistry is a cheap activity, leading to belief systems as instanced in one of the posts above where £400 was considered expensive for a root canal treatment and crown! The NHS has created a populace that expects to receive a very complex and very expensive service for next to nothing.

When the new contract was being formulated the main problem with fee per item was the money, which had led to whole new methods of providing high tech treatment on the cheap at high speed. In typical government fashion the new contract changed everything except the money. Now we have a situation where the same payment is received for ten fillings as for one, or for a root canal treatment taking, say, ninety minutes and an extraction taking ten minutes.

When I first arrived here from Australia I saw the fee levels and thought that someone was joking. Sadly it was not a joke. It was known that the drop from ivory tower academic standards to those of NHS practice was a big one but it was only this year, when I had the chance to speak to an undergraduate, that I realised that the university course content has now been corrupted by the need to provide NHS cannon fodder.

Dentists have differing opinions on what should be done about the NHS. My own feeling is that anyone who can pay should be private. The remainder in the benefit system should get First World treatment at private fee levels. What is happening, though, is that this situation is being arrived at by default, with dentists moving paying patients out of the NHS, but the fees for work on exempt groups remain at Third World levels.

All this is overseen by the GDC, a body which is supposed to look after the interests of patients, and which does indeed crack down hard on dentists who may have been faced with the choice between cutting corners and bankruptcy, but which cannot or will not address a system that makes it all but impossible to carry out First World dentistry. The GDC has always been politicised but, in recent times has become virtually a government quango. The ever increasing lay membership, imposed from above, is heavily stacked with lawyers; yes, the profession that is now making fortunes out of no win, no fee litigation, an activity whose worst manifestations border on fraud.

Which could have written a scarifying expose on the above but instead chose the tired old mystery patient routine, the first resort of junior journalists looking to make a name. Still, a proper treatment of all that is wrong at the heart of UK dentistry would have required some research and hard work.