/ 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

Have been with my dentist for 2 yeays (due to moving)which equals 4 checkups. Surprised I wasn’t x-rayed on my first visit and have yet to see any evidence of an x-ray machine at all. Otherwise seems competent.
Hygeneists range from the infantile (use the inter dental brush to push the bacteria out) to the very competent.

X-rays are high energy form of radiation and there is a very small risk of cancer. Improved design of equipment has improved safety but the risk of radiation cannot be eliminated, so it makes sense to restrict their use. It will be up to the judgement of the dentist, who will be aware of current regulations and recommendations. My own experience is that dental x-rays are used much less frequently than in the 70s.

Here is a link to information on the NHS Choices website, which compares the estimated risk of x-rays with natural radiation: http://www.nhs.uk/Conditions/X-ray/Pages/Risks.aspx

The Uk system discriminates especially against the over 50s, as is calling the restorative cosmetic .So if you need sedation because feel pain abnormally acutely you cannot get treatment not only because of cost but because NHS doesn’t allow for risk or chronic conditions relating to a disability as admin directing .
I have not only been passed from pillar to post here in UK, but in Budapest & defrauded in Prague. I had found here in UK neither the hospitals or community have the provision since my cardiac arrest 6 years ago.However all the cardiologists say OK ??!!Yet if it was oxygen getting to main organs there could be a problem . To discuss the medical you need appt after appt often paying for x rays over and over again as Dentists & anaethetists contracted in .
Many from Budapest send others here for first appt . The appt is not with dentist & anaethetist doing it . Not till you sign up do you find they do not want to know and very costly when booked flights & accomodation & mobility assistance.
The regulatory organisations such as Dental Council are incapable of resolving likewise Embassies.
Ihave finally found treatment at a cost here in UK 3 years later . This is with a Dentist who is an anaethetist and Doctor. How many of those are there? He agrees if had had done there may not have returned?
Why then have I contributed when working to NHS to find can’t access help because accountant directed ?
When is the deregulated Government going to get a grip??!! Has someone to die before the system is administered fairly.

Sybilmari says:
21 October 2011

Try to find a Portuguese or Brazilian dentist. These are some of the best in the world. They also have to train as doctors first and then specialise in dentistry. They will be private but mine is the same price as the NHS dentists. He is very caring and good at his work. I have disabilities too and he is always careful to make sure I am comfortable. I have not been able to have anaesthetics until he gave me one without adrenaline – I had no adverse reaction then and didn’t have to suffer the usual pain and after effects! I have had a life time of very bad and mostly unnecessary dentistry which made me ill in the first place and also left me with a misaligned jaw and migraines for 15 years. No UK dentist or doctor (or Eastern European) would take any notice of my pain and discomfort and the metal taste in my mouth (mercury poisoning!). I have had all the metal removed and replaced with ceramic. My mouth is comfortable at last and the metal taste has gone, along with the migraines. I am starting on the road to recovery in spite of the NHS and dentistry, not because of it. Dentistry in UK has a lot to answer for. Have you had your adrenal and thyroid functions tested? You should. Good luck.

semk says:
21 October 2011

I joined an NHS practice with my daughter. We made two visits to an arrogent woman who ignored our concerns, yelled at me when I asked why she left a hole in my daughter’s tooth untreated, maintained there was nothing a 16-year-old could do to help her sensitive teeth and told me she had done all she could for my tooth which was causing pain.

We left and joined a practice up the road. Two weeks later my tooth was repaired and hasn’t given any trouble since,my daughter was given advice about the sensitivity of her teeth and the hole was filled.
Our new dentist is so good, we recommend him to others. I believe I should have made a formal complaint about the first one.

stephen cobbett says:
21 October 2011

having just visited my dentist of 18yrs,he tells me hes going private in jan as he feels with the nhs point systom he has to see to many pations aday he cannt give good enough service,he has to get so many points a year,this is also the trouble with hospitals,it all needs looking in to.

I think the main problem is that unless there are symptoms eg pain, then you have to trust the dentist is correct in their treatment. I am of the generation where school dentists filled as many of children’s teeth as possible, so left with a mouthful of metal the rest of my life. This then needed replacing and then we are on to the next stage of expensive tooth capping.

I tried private dentist, thinking I would get top notch treatment, but felt she was again determined to do as much work as possible. Also, if you go back with discomfort, the latest thing is to threaten you that the only solution is to drill out the nerve – which is again very expensive.

I think they are a pretty barbaric lot really from my experience. I don’t know what the answer is, but I wish someone would sort them out. I have gone back to NHS because at least it costs less.

stephen cobbett says:
21 October 2011

i have just visited my dentist who is going private in jan as he feels with the goverment point systom he can not give a good enoight serves to his patients ihave been with him for 18yrs and have always been happy with him,and i can understand his feelings as he always explains things he is doing.i am one of the lucky ones.

Diana says:
21 October 2011

What I have read on the website so far simply confirms my own findings.

When my previous lovely NHS dentist went private about 10 years ago I thought I was lucky to get in with another one in an NHS practice, but I have now totally lost confidence in him. I’ve realised that the treatment he gave me was only ever when something had gone wrong, like a filling coming out, or a piece breaking off a tooth. I naively assumed my teeth were in good shape as he would always ask me if I had any problems and if I said no, he never found anything !! If I said yes he would look at it and do the necessary, but never spotted a problem before it manifested itself.

If you have a good NHS dentist, hang on to them for dear life. I am now considering going private as it is virtually impossible to get in with another NHS dentist here.

Nadine says:
21 October 2011

My first visit to NHS dentist, I was in the seat for less than 5 minutes. She’d never seen me before and she managed to tell her assistant the state of my teeth at record speed, check my dental health, and give a (super) quick clean… I just could not believe it when she told me I could walk and leave. At that time I was still on maternity benefit (so free consultation) as my child was just born, and I did wonder if the ultra speedy service was related to my status. Considering that child bearing put extra strain on dental health and that she was seeing me for the first time, I was expecting a more careful and lengthy examination… I was absolutely horrified.

After having a very unpleasant experience with a dentist (( when he strapped me down and pulled out 2 back molars as he could not be bothered to fill them ..and didnot want to waste an injection on me )- he was prosecuted eventually not by me but by other brave souls!!!)some years ago i naturally was not very happy to go to another one ..I was encouraged and went with friend..but despite the fact it had been explainrd to them that i had a fear and also suffered from panic attacks etc ..they made no effort to help with this and eventually was told that they would not treat me as i upset the waiting room by crying when i came in

Greg says:
22 October 2011

I have read what you commented and in all honesty have no idea what you are talking about. Are you someone from Eastern Europe coming to the UK for diagnosis? I thought everyone was going the other way, to get better dental treatment.

As for my comments about dental practice in the UK, I would like to say first off that we should be grateful for dental research and science that has helped so many people keep their teeth in good order. I may be a victim of previous years when advice given then means that now I have receding gums not due to gingivitis but over vigorous brushing, following the advice of dentists, now revised over time.

Regarding NHS treatment, I don’t know quite why this is, but for my lifetime I have mostly been unable to get NHS treatment because of my wage bracket, but have only sporadically been able to afford private treatment. I have brushed my teeth with reasonable consistency but now have a series of teeth falling apart and I have no money to get them fixed. Even under the NHS there are more expensive things that you have to pay for substantially, such as crowns and bridges. Where I live the cost to repair my teeth would set me back by at least £5,000. If I didn’t have to pay so much tax I could afford these things, but in my middle income bracket I am neglected and no doubt someone on a lesser income will have support to have such things done because they can’t afford it, while I eat gingerly and choose my food as my teeth gradually fall to bits. So I might have to go to Poland or somewhere to get my teeth fixed, while immigrants to this country get their teeth fixed for nothing.

I have just been to dental practice for a check up and was in there 2 mins and told I was ok then sent to have my teeth cleaned, in the old days the dentist checked and cleaned your teeth all in the one price now you are charged for the check up and then the cleaning as is always the case we are beening ripped off and they just keep putting the prices up, not doing there jobs correctley and over charging what a ripe off. It was like this in the 60-70’s when all they ever did was fill your teeth for the money I know this as all my teeth have fillings and they have aways been cleaned twice a day and I donot have a sweet tooth. I moved to my old dentist in the mid 70’s and the first thing he said to me was “do you want to keep your teeth” and I replayed ” you are not pulling any out” in all the years I went to him I never lost a tooth, however he retired and ADP took them over and within 3 months they had sent me to hospital to have one removed and once out they could not understand why it had not been filled, now they want to remove two more that are not giving me any problums and I have refused to allow this and I still have them however in the check up’s they never look at them its as if they are not in my head but they are still. The service is getting worse and worse and we are paying more and more of course Wales and Scotland get it free now so we in England are the ones being ripped off, what am I paying all my taxs for most likley MP wages or should I say there second homes and the fitting out of them etc etc.

Is this the reason elect the Scots to discriminate here with other agendas. Outrageous . Where is English Government ? What is going on?

Matt says:
23 October 2011

The British are internationally renowned for our bad teeth. So this survey should not be a surprise. I think it’s another scandal that our government allows these so called professionals to rip us off while earning way more than the average no doubt. I have pretty well no trust of dentists. I try to go when I’m on holiday, it’s always better and cheaper.
My most recent British experience was re a wisdom tooth, 3 dentists said I’d have to have it out and/or have root canal work all at ludicrous expense – all were adamant the tooth could not be saved – one of them took about 3 seconds to arrive at that conclusion. Well 3 years later I still have it and I have no trouble with it. I’ve seen dentists in SE Asia, India and South America – they were all better than British. The one’s in India ripped me off re some teeth straightening invisible braces but I couldn’t fault them re replacing my mercury fillings with white ones.
How do we solve the problem – Dentists should be regularly surveyed like Which has done and repeatedly bad ones should be struck off. We should have at least a 95% chance of getting a good service when we visit a dentist otherwise the profession needs reforming.

Neel says:
23 October 2011

Come on Which? do you not have any scrutiny over the quality of your research or are you in the tabloid game of sensational headline grabbing pseudo-research.

“20 visits across England” from a potential sample pool of a few thousand practices is that really good research?

How was your sample chosen… presumably not randomly, seeing that you do not feel the need to mention it.

I, like your experts, am surprised and disappointed with the picture you have reported but I have misgivings about the actual motives of Ms. Pearl your “senior researcher” who seems to be better with sensational headlines then statistics and actual research.

Neel says:
25 October 2011

Hi Joanna,

Thanks for your reply, as you have confirmed it is not possible to properly randomise with such a small sample size and therefore impossible to draw many conclusions from.

I do agree with you worrying questions are raised about the 20 visits you report on but my objection is to the fact that this has been extrapolated to the whole of dentistry in the UK and has been reported as such in the national press.

As a long time Which subscriber I wish you would allocate the proper resources as you do to your car or fridge or kettle reviews because all I see here is an attempt to raise the profile of Which? through a sensationalised headline grabbing “snapshot”. In fact based on your recent similar expose of opticians it almost seems like a word for word “rinse and repeat” tabloid style journalism.

What next Doctors?

Finally what would your highly qualified and independent expert panel charge for what they would consider good or excellent consultation? How does this compare with the fees your researchers were charged for the NHS or private consultations?

Many[ dentists in UK are allowing Receptionists whose language not up to scratch to refer you to hospitals by photocopying admission forms which hospital admin then reject by adhering to corporate remits..Surely its a safety risk & illegal to allow an undirected admin who do not understand the suspect system, to direct your dental health because the dentist has more than one practice.I thought those who were trained in the medical had to follow a medical oath but was told last week optional? Maybe this is where problems lies as I could also find noone regulating fairly .

i’ve used four private dentists over the last ten years, each has criticised the work of the previous dentist and all have been eager to recommend expensive treatment which ‘needed’ to be done, One corrected a cracked filling (which he had done) and charged just under £200 for the privalage even though no injections were required and another quoted a price for a crown only to do additional work without explaining what was happening, work which was to increase the price considerably.
I now only go to a dentist if i have to as i simply think dentists are more interested in their fees than the treatment

Why not do a survey with the over 40’s in London with a mixture of NHS / Private & those from Budapest? . You maybe horrified …/.Although on MA 2003 we learnt surveys out of date research methods as can be made to say what you want & should really only be used with case studies? Your articles may then have more impact.

Tracey says:
28 October 2011

I was with my dentist for 30+ years when he was NHS I was always having fillings then he went private and I had virtually nothing done unless a filling fell out. Fed up of paying £200/yr I moved to an NHS dentist- 1st trip said he was watching 2 teeth as they had decay 2nd trip a filling £116.50(he did ask if I wanted a crown which I’m not sure is a decision I can make). He said alot of my fillings need replacing. Had to go back because the one he filled had toothache – so I saw another dentist who filed it. I returned for a 3rd visit and saw the lady who said I needed 2 fillings (different teeth I may add) £148.00. So all in all more expensive than private. I did ask her why I hadn’t been offered a scale & polish on any of these 3 trips and she said oh most like to pay the hygenist and have 20mins but when you make the appointment for your fillings tell the receptionist and I will allow 5minutes because dentists are busy! The only tooth I have had x-rayed was when I went back with toothache and she just did that one. Needless to say I haven’t been back for last 2 fillings as she said they were non-urgent – 1 she said she would do after I said the tooth was sensitive! Needless to say I’m not sure what my next move will be.

Pat Sawyer says:
28 October 2011

Being a post war baby brought up on sugar as a staple diet, my teeth suffered badly from an early age. Hence my experience of dentists in England is a long and largely unhappy one. As soon as I could, I went private. I have always considered it a better service than NHS but sometimes, I think the difference in quality treatment is marginal. After a particularly aweful experience with a butcher in dentist clothing in Borehamwood, I found my way to a great guy in London who talks to me, shares his thoughts and X rays, gives me options, gives needles that do not hurt and fits caps and partial dentures that actually fit first time. But his fees are high so recently I decided to try my hand at getting some local NHS treatment. I called one surgery and no-one answered, another was very rude and left me hanging on the phone for ages, another was far too busy to even acknowledge that i was standing in the surgery waiting to be acknowledged….and that’s only the receptionists. I did decide to give it a try at the local training college where students are ‘supervised’ by qualified people, It was a total farce. If that is how they are training new recruits, we are in deep trouble. I walked out in the middle of the check up and never went back. ‘Supervision’ was a joke, the young lady who was working with me made some pretty basic mistakes like sticking the needle that they use to test for gingervitis in my gum, leaving it there and walking around to the other side. When she AND the supervisor showed limited ability to take an X Ray, I had had enough and left. I went back to London to the safety of someone in whom I can place confidence. Finances dictate that I do need to find a good local NHS dentist but I am not looking forward to making another attempt at the process.

Dear Which,

Speaking as a Dentist who also teaches Dentistry, there is no big mystery to these findings and the conclusion is very simple.

Quality takes Time in Dentistry !!!

There that’s it, mystery solved. QED.

If you rush people through a system that requires attention to detail, be it Dentists, GPs, Hospital appointments etc, then it is likely something important will get missed or overlooked.

If this is done routinely then important things will get routinely missed.

THE main reason people go Private in Dentistry is to BUY more time – THE main reason most Dentists go Private is to TAKE more time with patients, improving the Quality experience for both.

Of course Time costs money and there are many other pressures to reduce costs, some patients don’t see why THEY should have to pay extra for extra time, but Dentistry is High-Tech attention to detail service which CANNOT be rushed without reducing quality greatly.

IF you are serious about improving quality, then frankly get rid of at least 50% of the growing paperwork targets and introduce a NEW Target of spending more time with each patient – immediately Quality will double across the board.

So just in case I am not being crystal clear, less TIME = less QUALITY for patients and this Which survey, whilst only of 20 Practices, still makes this obvious point, whether the Practice was NHS or Private I would agree with their experts conclusions, 11 minutes makes it almost IMPOSSIBLE to do the job properly, let alone well !

Yours realistically,

Dr. Anthony Kilcoyne
BDS;LDS;MGDSRCS(Eng);M.Med.Sci.(U.Sheff.);FFGDP(UK)
Specialist in Prosthodontics.

Greg says:
7 November 2011

I’m all for paying reasonable additional amounts for quality dental care, but what happens when your dentist starts asking extortionate amounts for treatment? I have no way of affording even going abroad, but exactly why are people of this country going to Poland and elsewhere to have treatment there?

Nick Palmer says:
10 November 2011

Thank you Dr Kilcoyne for an excellent comment.
As a Dentist who has practiced and taught both in the UK and Europe, I could not agree more with your comments.
Dear Mrs Pearl,
What you do not seem to understand is that with the current ridiculous (NHS) UDA (“Nectar Point”) system where the patient is paying £47 for a root canal treatment of a Molar tooth, you can not expect “high quality” Dentistry. Please try to explain this fact to your readers.
The materials that I need to carry out a proper root canal will cost me around £60 – £80 Pounds depending on the brand (Clinical time + fixed costs of running a practice not included)
I would be better off paying the patient £47 asking him / her to find another Dentist to do the root canal treatment. That is why I gave up NHS