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

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

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.

Yes sorry I misunderstood.

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.

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.

I agree Which should do a proper report on dentistry in the UK, rather than the rather shallow article against dentists that appeared in a recent report. I suppose that’s what I would like to see, and appreciate you and others for your comments here that are educating me out of a two dimensional naive position.

So you are saying, I think, that a dentist has to make another £12,000 per year to cover their costs, and then make a wage on top of that? Once again I ask, where are these costs coming from? Forgive me if I am naive.

Greg, premises costs (rent or mortgage), gas, electric, staff salaries , staff training, Care Quality Commission bureaucracy and registration fee, General Dental Council registration fee, equipment purchases, equipment maintenance, stationery, postage, computer systems, unscientific cross infection measures, scientific cross infection measures, carpets, desks, storage facilities, lab fees, contents insurance, buildings insurance, public liability insurance, dental protection insurance ( for those no win no fee lawyer), council tax, security systems, loans interest and we haven’t even started doing any dentistry with customers yet. Materials needed to do dentistry, time spent with customers, referring customers to other professionals (ie. cancer suspicions), time spent educating customers who know better and do not listen, fees to trade associations, training courses which cost £500+ loss of days earning(£1000) many of which are mandatory. Plastic cups, paper tissues, minty mouth wash tablets, toilet rolls etc.
That’s not all,but I think gives you an idea.

I had a similar experience a while back, where a dentist put in a “temporary dressing” to help with a tooth that seemed all but shot, for nothing, telling me that it had to come out. But months later it is still holding, there’s no pain and the temporary filling is solid. I am confused too, but I think this forum that Which has created is great because we are getting some valuable and considered responses back from dentists that are helping to create a clearer picture of why dentistry is like it is today in the UK.

This sounds like a bloated buorocracy that is incurring expense on dentists, though at £800 a year that doesn’t sound too bad, so is this really the main complaint.

It would be interesting to know more about the cost of regulation, to which you refer. What is this regulation that makes a room in an NHS practice cost £130 per hour to run, and even more in a private practice??? Such figures don’t add up for me, because in my understanding by that account the costs of ordinary dentistry climb to astronomical proportions.

Meantime I have got used to missing some parts of teeth, and the fact I have no money to go to dentists for repairs, extractions, replacements etc. But I will say always that we should push for a better way at least for our children.

Greg

If you want cheap dentistry, we could all go in this direction

http://www.youtube.com/watch?v=WR8tIjTykbE

Whilst you are waiting for the decline of UK dentistry, perhaps you would like to become a ‘health’ tourist.

How would you like us to cut corners to keep prices affordable? Which regulations will HMG cut to help us? Most dental practices are run very efficiently, probably much more so than state run health services.

Greg another analogy for you.
1* hotel £40 a night
3* hotel £100 a night
5* hotel £200 a night
so why the price differences? It’s only a bed for the night.

I think you will find government regulations are strangling the life blood out of every walk of life, just because the public always want to blame if anything goes wrong. We have brought it on ourselves as a society.

This helps put things in perspective, Ray. You might have warned us that this video is not for the squeamish.

Ray I watched the video and although you may be taking the mickey I had great respect for the Indian dentist and think he is doing a great job. Maybe there is an opportunity over here for “onshore” pavement dentists who can do tooth extractions and replacements and an affordable cost, and I would use them if I couldn’t afford better. After all, what use is all the better technology if no one can afford it in their moment of need?

A worker, thanks for your analogy. But actually, me and most people I know can’t afford to go away even for one night for £40, so what are you talking about?

Greg

I put the link to the video to indicate what really low cost dentistry means and how it is being achieved, i.e. by total lack of regulation.

I wonder how many others in the population would be prepared to accept that level of treatment? I suppose a lot, if the country goes totally to pot.

The existing level of regulation forces prices up (as well as overall standards). In a totally unregulated market, some of us would compete with the street dentists by offering much higher quality for those who wanted it and could afford it. The market would take over, and basic treatment would be available to all at affordable costs.

NHS dentistry is supposed to do the same, without resorting to street dentists, and maintaining reasonable standards, but people still consider it expensive. As a dentist, knowing how much the service costs, I think people need a reality check. Unlike the street dentists, it is free for those who are exempt from charges, i.e tax payers are funding all their treatment, rather than subsidising part. All NHS treatment is subsidised out of taxes. As it turns out, the system is set up so that those who neglect their mouths most and require most treatment are subsidised by the dentist treating them. Unsurprisingly the system doesn’t work as set up, because it was forced onto dentists without agreement. They were given the option of signing or closing their practices.

Have you checked whether you qualify for free or reduced contribution? If you don’t , should we feel sorry for your plight? Have you made spending decisions which have affected your ability to get care for your mouth?

Ray,

Interesting question:

Have you made spending decisions which have affected your ability to get care for your mouth?

Are you suggesting that all my financial decisions should be pivotal around how I care for my teeth and pay dentists?

I’m sure you are not, but your question indicates how disproportionate the expectation is in terms of spending for dentistry against other financial demands on our lives. In practice other demands are more imperative, for example in my life funding my daughters in their sixth form schooling, so what I might have spent on a tooth goes on a digital SLR camera for my daughter for her course (£250 second hand), or to pay for fines they have incurred through dodging train fares (£150 last month). Think on.

Thanks, your explanation helps me understand a lot more. Time for a considered survey by Which, I think?

Greg

What kind of survey can uncover the complexities? Surveys can only look at minute areas, usually selected for an anticipated result, and based on some prejudice. Perhaps a full analysis and inquiry is required. Even this is likely to have terms of reference set, and if set up by HMG the parameters will exclude government action, I suspect. Can Which? afford to carry out such a thorough and unbiased investigation?

Ray, to your comment “what kind of survey can uncover the complexities”. You are right, a proper review is different from a survey, by definition the former being deeper, more probing and conclusive hopefully than the latter, which can be done just for buzz and to sell itself. A review also investigates with the expectation of some action being taken, even if the reviewers may have no power to take that action.

I suppose, having read the recent superficial indictment of poor dental practice by Which recently, I was frustrated because I just saw rag mag material, that didn’t tell the whole story and so irritated me. I was pleased to find the forum here and having shouted my biases and listened to the views of dentists better informed than me, it has helped me start to get a better view of how things really are.

Regarding whether Which could take on such a challenge as this, that is another matter. This is a completely different realm to scoring consumer products. But it would be great if they could, as this could be a step change in their maturity as not just a consumer watchdog but also a (hopefully) balanced and independant judge of other services that take into account more complicated issues such as history, past and current legislation, mistakes made, challenges for the service provider (as in this case dentists), current state of affairs and what could be done about these.

I gather from what you are saying that you don’t feeled adequate care is given for by your dentist because your dentist is lacking in funds. But then you say he/she could make up for it by a smile, and maybe a seminar to explain their problems? I would suggest that you are too polite and a national enquiry is needed. Or perhaps Which could lead the way on this survey…?

Sorry if I appear unsympathetic, but my dentist told me the only treatment he could offer me for a cracked tooth was extraction and replacement with an implant at a cost of 3,000 British pounds. All this with a big grin on his face and a large picture of his very luxurious yacht moored in Salcombe harbour behind him on the wall. Salcombe is about as posh as it gets, he went on to talk about his very expensive house, car and the boat – just tactless. He is extremely wealthy and most of us could not afford to spend all that money on the grossly overpriced treatment he offered to keep him living in the lap of luxury. Perhaps the dentists who are milking the system would feel less suicidal if they offered value for money and didn’t foster resentment from poor saps like us who line their pockets. I am sure not all are the same and I have met some that are honest and caring, but lets just say you never meet a poor one do you.

Dear Jools – you make some interesting points not least your last one which is it is up to Dentists to kick up a fuss! When we do, we are quickly put down with accusations of being Greedy or Selfish or Resistant to change etc – the systems we have now in England were imposed DESPITE warnings from the Dental Profession this would be bad for patients and we were given the ultimatum of Like it or Lump it, we can always ‘import’ Dentists from other ‘poorer’ countries to replace you if you don’t tow the line whatever the consequences for patients and if more of you go Private to spend more time on average, we will damn you for that too

UDA capped-funding dentistry in England and Wales has been a disaster for patients and the public in terms of dental health, more extractions and less advanced options being offered to save teeth on a National scale, which is what the English DH designed it to do by mainly/only providing ‘simpler’ courses of treatment. Thus IF a Dentist spends more time and more care with each individual patient, they face fines and clawbacks from the WHOLE practice as punishment, for not meeting ‘volume’ targets to rush through people to meet centralised targets of Access so the Politicians can say dental access has been improved, but what they don’t say is at what price – that price is less time per patient and thus less ‘care’ and treatment options than used to be offered on the NHS before this was imposed in 2006.

Coming full circle to this story from WHICH, saying how examinations didn’t tick all the quality checks that ideally should be done – this is quite clearly DIRECTLY related to the time spent with the patient and at the risk of repeating myself and stating the very obvious point that Less Time = Less Quality overall for something as intracate and detailed as a dental examination and treatment planning for the short, medium and longer term too.

If WHICH is willing or unable to make this point publically, that government targets are too biased towards rushing higher volumes of people through a clinic as a measure of quality ‘performance’, rather than the time spent with each individual as a better qualitative measure, then nothing will change frankly and we will head straight into another Mid-Staffordshire disaster where an EXTRA 400-1200 people died in Hospital because Medical Staff were forced to chase Paperwork/Volume Management targets and inevitably spend less time with the patient – this mentality is spreading to the Private sector too as it becomes dangerously ‘normalised’ by the Department of Health for England and Political rules that regulate Professionals.

Yes Time = money too, but who thinks rushing people through a healthcare system (Dentistry or Hospitals) and putting paperwork before direct care is a good idea or value for money overall?

The answer is not you or I, but the Politicans and their Civil Servants at the Department of Health and their Agents do, they think it’s clever saving money using cheaper Breast Implants to save the NHS money too and worst of all, the Private sector start getting told if it’s good enough for the NHS then their managers say let’s copy this ‘established’ World-Class system, so everything gets ‘dumbed-down’ over time in the name of ‘Quality’, when it’s really Quantity measures which MUST impact upon quality negatively at some point.

I agree the Profession AND the public together, including bodies that claim to Champion the public interest like WHICH, need the Courage to say actually, this Emperor is Naked, time with patients is THE most important Qualitative target and if you compromise this you compromise everything else !

It really is as simple as that, but of course it isn’t simple, it requires a cultural change and pressure to be put upon Politicians and the DH to act, not just spout out the usual sound-bites but continue with the same failed approaches to dumbing-down care by relabelling quantity as quality just to look good on paper

I’m not sure I would recommend anyone to have a career in Medicine or Dentistry in England under the current DH regieme now, where their Professionalism is so restricted or even penalised for spending extra time to care for patients individually – how sad is it that I and many others who actually like our Profession and helping patients, are made to feel like this?

Yours genuinely concerned,

Anthony Kilcoyne.

Agreed. It would be great if WHICH, as an apparent Ombudsman of public interests, could take up this challenge rather than leave it in their chat area. I don’t think that everything has been said though, all of this needs go through a proper evaluation and I suspect WHICH is not competent enough for this challenge, as I have said before in this forum, and as is corroborated by their silence.

I appreciate that introductory articles on Which? Conversation are provocative to stimulate discussion, but apart from your personal experience this is rather negative and tarnishes the reputation of those dentists who are doing their best.

If an organisation published a brief report that was highly critical of consumers’ organisations, I am sure that Which? would be rather annoyed.

What we need is more constructive criticism and less journalism.

Well said wavechange, my point entirely.

Joanna I thought the whole ethos of Which was to campaign on matters of interest to the consumer, and not to engage itself in tittle-tattle journalism that does not give a fair representation but sells your magazine. I am suspicious of the real value of Which as a result, unless there is a follow up, if you really want to get into this territory.

I think we will soon be seeing “onshore” street dentists (or at least the equivalent behind closed doors) in the near future, imported from India because less and less people can afford the dentists here. Mark my words. Even the cheaper solution, to go for a trip to Hungary or wherever, is beyond the reach of most people of a certain age.

Meantime some people I know with teeth problems are finding their own solution. I am one of them

I think part of the problem is the difference between NHS dentistry and general medical care. Visiting a GP or hospital costs nothing and many people get free prescriptions. Those that pay for prescriptions can purchase a pre-payment certificate that will cover any number of items for £104 per year. It is not so long since I spent around £500 pounds on a single tooth, which eventually had to be removed. I am glad that I have always been able to afford dental care and feel sorry for those who are faced with large bills.

a.paris

If you put up a contact email address, or if Which are prepared to forward your email address, I’ll contact you. I don’t want to put mine on the list with the possibility of being bombarded.

Ray Steggles

a.paris

Just to let you know that I’ve received no response, so far.

Ray Steggles

I assume that the main purpose of dental mouthwash is to mask unpleasant tastes. Most chemicals that are harmful to bacteria are not that good for humans. I believe my dentist has stopped using mouthwash, though I have not had any major work done recently.

It’s an interesting question, so let’s wait to see what the current recommendation is.

Plain water for rinses is usually the best – it’s simply to help remove fine debris and remoisten the whole mouth and lips etc.
There will have been antiseptics used inside the infected root canals though as they were cleaned out, then sealed shut.
Any doubts, ask your Dentist to help prevent/reduce any misunderstandings, because even though very busy, they’d appreciate the opportunity to explain.
Dentistry is a very complex process done in a small area on a living, swallowing, moving, feeling human being – that’s what makes it challenging and unique, of course.

No just different ways of paying – prevention and regular visits is best though, the trouble is the NHS system has ‘quotas’ to send people away for 2 years (so someone can take their slot) to artificially bump-up Access figures, when in reality YOU then miss out on your Annual Oral Cancer check = recommended to spot Oral Cancer (it’s on the increase!) early.

It’s prevention in the widest sense and all these things take time and good staff and facilities and keeping up to date, has high overhead costs.

But again, the most economic and healthy option, is prevention first!