A UDA depends on the type of work undertaken. A dentist is contracted by his PCT (Primary Care Trust) to do a set number of UDAs and dentists have to be within 4% of their targets. If dentists don’t achieve their contracted number [...]]]> A UDA is a “Unit of Dental Activity” undertaken by an NHS dentist.

A UDA depends on the type of work undertaken. A dentist is contracted by his PCT (Primary Care Trust) to do a set number of UDAs and dentists have to be within 4% of their targets. If dentists don’t achieve their contracted number of UDAs they are financially penalised by their PCT. If dentists do more than their contracted number of UDAs they don’t get paid any more.

The 3 Band System

This determines what patients pay and the amount of UDAs a dentist gets.

• Band 1 excluding urgent treatment – 1 UDA
• Band 1 urgent treatment only – 1.2 UDAs
• Band 2 – 3 UDAs
• Band 3 – 12 UDAs
• Issue of prescription – 0.75 UDA
• Repair of dental appliance (denture) – 1 UDA
• Repair of dental appliance (bridge) – 1.2 UDAs
• Removal of stitches – 1 UDA
• Stopping bleeding – 1.2 UDAs

Band 1
Diagnosis, treatment planning and maintenance
Examination, x-rays, scale and polish, preventative work, for example an assessment of a patient’s oral health, minor changes to dentures.

Band 2
Treatment
Simple treatment, for example fillings (including root canal treatment), extractions and periodontal (gum) treatment.

Band 3
Complex treatment that includes a lab element, for example bridges, crowns and dentures (excludes mouth guards).

Urgent treatment
Examination, x-rays, dressings. Re-cementing crowns which have become loose, up to two extractions and one filling.

A UDA is variable, one UDA might be worth anywhere between £15 and £25, but can be more than this or less. The actual UDA varies according to where in the country a dentist is located (although it might vary street to street) and the amount of work previously carried out by the dentist before the new contract. It is thought that the more desperate a PCT is for NHS dentists, the more a UDA might be worth.

What does this mean for the dentist?

Example – One Crown
A dentist is allocated 12 UDAs for doing a crown. So if the UDA is valued at £25 it means a dentist is paid £300 for doing one crown (£25 x 12 UDAs). If a dentist does 2 or 3, or more crowns he still only gets paid £300 even though he has a lot more lab work to pay for.

Example – Several fillings, x-rays, scale and polish
A dentist is allocated 3 UDAs for doing the above work, so a dentist is paid £75 (£25 x 3 UDAs).

Example – One filling
A dentist is allocated 3 UDAs for one filling, so a dentist is paid £75 (£25 x 3 UDAs)

Example – One extraction
A dentist is allocated 3 UDAs for one extraction, so a dentist is paid £75 (£25 x 3 UDAs)

Example – Root filling (a complex and time consuming process to do properly)
A root filling might take 1-2 hours or more. A dentist is allocated 3 UDAs for a root filling so a dentist is paid £75 (£25 x 3 UDAs)

So as you can see from the above there is a problem. There is no incentive to do a root filling when a dentist gets paid the same for an extraction.

There is just no incentive for NHS dentists to do complex and time consuming work such as root fillings. In fact doing root canal work can actually penalise an NHS dentist. A NHS [...]]]> There are lots of stories in the press this week reporting that tooth extractions have soared by 30% in four years. What a surprise!

There is just no incentive for NHS dentists to do complex and time consuming work such as root fillings. In fact doing root canal work can actually penalise an NHS dentist. A NHS dentist has to achieve his UDA target (he is contracted by his Primary Care Trust to do a set number of UDAs, units of dental activity) and because he is allocated the same UDA for doing an extraction (which might take a few minutes) or root canal work (which might take 1-2 hours) the NHS dentist is of course going to suggest an extraction to the patient.

So what is happening? Patients are having their teeth removed unnecessarily when more complex treatment could have saved the teeth. What a scandal.

The amalgam (metal) fillings might have been in place for many years and some might be very large. The amalgam might be holding the structure of the tooth together and removing the amalgam might destabilise the tooth, so great care is needed when considering what to put in place of the amalgam.  It [...]]]> When replacing amalgam fillings with white fillings what might you have to consider?

The amalgam (metal) fillings might have been in place for many years and some might be very large. The amalgam might be holding the structure of the tooth together and removing the amalgam might destabilise the tooth, so great care is needed when considering what to put in place of the amalgam.  It might not be as simple as just replacing the amalgam with a white filling. Sometimes an inlay or onlay is needed, sometimes a crown. It depends on the patient and the particular tooth.

To protect the patient during amalgam removal it is important to minimise the mercury vapour a patient is exposed to. During the preparation of the tooth an exhaust system should be used and the suction should be increased to minimise vapour uptake.  To prevent damage to the tooth lots of water should be in the immediate area to keep the tooth cool. A drill causes heat and it is important to keep the tooth as cool as possible to avoid damaging the internal structure of the tooth.