“I hope that you don’t mind that I have sent you this email, but I really didn’t know who to ask about this, and would really appreciate your advice about something, please. Excuse me that it is a bit long-winded, but I will endeavour to explain my [...]]]> Email received from a concerned dental patient

“I hope that you don’t mind that I have sent you this email, but I really didn’t know who to ask about this, and would really appreciate your advice about something, please. Excuse me that it is a bit long-winded, but I will endeavour to explain my situation.

I am a family carer, and I care for 3 members of my family; for this reason, it is often quite difficult to put myself first, even when it comes to pre-booked appointments. I am an NHS patient and, until recently, I was undergoing treatment between my Dentist and the Hospital, as I am suffering drastic bone loss in my gums, and I am slowly losing my teeth. Unfortunately, due to my role as a carer I have had to cancel dental appointments on a few occasions, as something has happened with one of the people who I care for, where they have been unwell, etc. As I don’t have anyone to turn to for support at these times, I have had no alternative but to put whatever I have to do for myself on hold. As I cannot plan ahead for unforeseeable events like this, on two of the occasions, I have only been able to give them two and a half hours notice of cancellation.

Ultimately, I recently received a letter from my dental practice saying that they were ‘deregistering’ me for missing appointments, to make way for new patients. They argued that they cannot be expected to accept 2 hours notice, as it was not enough time to fit anyone else in the slot. As I already suffer with stress and anxiety, this has only added to my worries. I emailed the Practice Manager, explaining that I am a carer, but they wrote back to me basically saying that they are a ‘busy practice’ and they are not changing their mind.

I feel very strongly that I am being discriminated against because I am doing the job of being a carer, and have to put others before myself. I am at a real loss now as to what to do, because a temporary dental prosthesis has already been made for me, which was supposed to be fitted so that the hospital could see how I tolerate it (I suffer with globus hystericus) so that they could cut back on it’s size. Unfortunately, I now can’t go back to see my own Dentist, so don’t know what to do now!! Therefore, any advice that you could give me as to what, if anything, I can do about this (ie. If I can make a complaint to anyone) would be very much appreciated.

I look forward to hearing from you as soon as possible.

Many thanks”

“A porcelain bridge rooted to my left hand front tooth, that is secured to what I believe to be the eye-tooth has broken away from both anchorage points. Several attempt have been made to correct the decay in the rear tooth, without any repair being effective for anything [...]]]> Email received from a concerned patient

“A porcelain bridge rooted to my left hand front tooth, that is secured to what I believe to be the eye-tooth has broken away from both anchorage points. Several attempt have been made to correct the decay in the rear tooth, without any repair being effective for anything other a relatively short time. I was told a year ago, that should the bridge fail due to the caries it would not be possible to recreate the bridge and due to my overbite I would need to go private should any form of denture be considered. Is there any solution to this situation via NHS Treatment?

If some alternative approach is not feasible and as my teeth are in such a terrible state, (extractions having been carried out since my late teens) it would seem the only viable options is to have total extraction. Can this be conducted on The NHS and dentures be provided?”

Was the treatment NHS dental treatment or was it private dental treatment? The process is different.

NHS Dental Treatment

According to the Department of Health the 2006 dental contract, which has been widely criticised is to be replaced.

A new system will be piloted in the autumn in selected dental practices. The existing 3 bands will be divided up into considerably more (between 5 and 12 bands [...]]]> Review of NHS Dentistry by the Department of Health

According to the Department of Health the 2006 dental contract, which has been widely criticised is to be replaced.

A new system will be piloted in the autumn in selected dental practices. The existing 3 bands will be divided up into considerably more (between 5 and 12 bands – to be decided) so gone will be the old problem of a dentist being paid the same for one filling as for 4 fillings. Much of the dentist’s income will come from the amount of NHS patients on their registers and less will come from the actual work undertaken which will encourage dentists to take on more NHS patients. It is hoped that this will mean that dentists will encourage patients to look after their teeth and adopt good oral health.

Under the new system any poor dental work, such as fillings that fall out, would have to be replaced at the dentists own expense. So it is hoped this will discourage poor work.

Comments such as “rotten mouths”, “fewer dental visits”, and “more extractions” make scary reading.

It seems that NHS dentists in England and Wales are doing [...]]]> Today the Times newspaper gives us a shocking report about the state of patients’ teeth with an article called “The credit crunch has stolen our smiles” link to Times article

Comments such as “rotten mouths”, “fewer dental visits”, and “more extractions” make scary reading.

It seems that NHS dentists in England and Wales are doing less complex treatments, fewer children are seeing a dentist and more people are resorting to DIY surgery by pulling out teeth instead of visiting a dentist. In Scotland where dentists have a different work allocation system the number of complex procedures have actually risen and NHS dentists are “easy to find”.

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.

Band 1 £16.20 – examination, check up, diagnosis of problem, scale and polish, x-rays, advice and discussion regarding further treatment.

Band 2 £44.60 – all treatment in Band 1 plus fillings, root canal treatment, extractions

Band 3 £198 – all treatment [...]]]> If you are lucky enough to be able to get an NHS dentist, there are 3 bands for NHS dental treatment.

Band 1
£16.20 – examination, check up, diagnosis of problem, scale and polish, x-rays, advice and discussion regarding further treatment.

Band 2
£44.60 – all treatment in Band 1 plus fillings, root canal treatment, extractions

Band 3
£198 – all treatment in Bands 1 and 2 plus more complicated procedures such as crowns, bridges and dentures

Check up and filling only?
You will only pay the Band 2 charges. You do not pay both Band 1 and Band 2 charges.

More than one visit to complete the treatment?
You only pay the charge applicable to the Band relevant to your treatment. You do not pay each time you have treatment.

Returning for treatment within 2 months? 
If the treatment is in the same Band (or lower Band) as before you will not be charged. For example if you have already been charged for a filling (Band 2) then need another filling a month later, you will not be charged.

Written treatment plan
If your treatment is in Bands 2 or 3 treatment you should get a treatment plan from your dentist detailing how much your treatment will cost.

Referral to another dentist?
You only pay one fee to the dentist who refers you. You do not pay both dentists unless the 2nd dentist is considered to be offering a specialist service such as sedation, home visit, or orthodontics.

Stitches
There are no extra charges for removing stitches

Writing a Prescription
If you need a prescription there are no extra charges for this

Missed appointment
If you miss an appointment you cannot be charged, however if you continue to miss appointments your dentist might decide not to treat you any more .

Credit cards
A dentist is allowed to charge a handling charge for credit card payments

Cosmetic work
The NHS do not cover work that is considered simply cosmetic such as white fillings for back teeth and whitening.

Urgent Care Charges £16.20
The fee is £16.20 regardless of how many appointments it takes to complete the work. This fee is charged if you are not attending your normal dental clinic or you are not currently having a course of treatment. The fee covers an examination, x-rays, temporary fillings, refixing crowns and bridges, one permanent filling, adjustment of dentures, extraction of no more than 2 teeth, and simple repairs to dentures.