So one has to [...]]]> A very interesting article in the Guardian yesterday "British dentistry is in a painful state" written by Patrick Collinson. He details his experiences wading through several dentists in London and Edinburgh in an effort to get an NHS dentist to deal with his painful tooth which needed root canal treatment.

So one has to question – do dental patients get better advice and treatment in Scotland or was it just a coincidence that the Edinburgh dentist gave the reporter the correct advice and was able to immediately sort out some initial treatment for him. I’m inclined to think this was no coincidence. What do you think?

See the article here

Front teeth (incisors and canines) have 1 root and 1 canal. Side teeth (premolars) have 1-2 roots and 1-2 canals. Rear teeth have 3 roots and 3-4 canals (upper molars), or 2 roots and 3-4 canals (lower molars). [...]]]> All teeth have roots, and canals within these roots. Different teeth have a different number of roots and canals.

Front teeth (incisors and canines) have 1 root and 1 canal. Side teeth (premolars) have 1-2 roots and 1-2 canals. Rear teeth have 3 roots and 3-4 canals (upper molars), or 2 roots and 3-4 canals (lower molars). The cost of private root canal work depends on the particular tooth involved and how complicated the work is. If there is infection this must be removed/resolved and then either a filling or a crown must be placed at the end of the treatment.

A tooth has an outer layer of enamel, and pulp, nerves and blood vessels inside the tooth. Sometimes the pulp can become infected because there has been trauma to the tooth or because of decay, fracture or gum disease, and the tooth can die.

The options are to try and save the tooth with root canal treatment or extract the tooth. If the tooth is left untreated, the infection will spread, bone levels around the tooth will begin to lower, and the tooth may fall out. The patient normally has pain and this can become intense.

To save the tooth with root canal treatment the dentist drills into the centre of the tooth, removes the diseased tissue, cleans out the canal and places a root filling (a rubbery material) in the subsequent space to prevent recontamination. The work can be straightforward and routine and take about 1 hour for the dentist to do, or can be very complicated and take significantly longer than this, and can sometimes involve multiple trips to the dentist. Heavy infection will require more time and will not be routine.

When the root canal work has been completed a filling or a crown will be needed to permanently seal the area.

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.

In the UK it seems that [...]]]> The Sunday Express article “Why Labour is at fault for Dental Farce” by Alison Little, discusses the failure of UK NHS dentistry and reports that 40,000 patients a year are now travelling to Hungary for dental treatment they can’t afford at home. Here is the link to this dental article www.express.co.uk/posts/view/75502/Why-Labour-is-at-fault-for-dental-farce

In the UK it seems that more patients are having extractions rather than more complex procedures such as root canal treatment. Why is this? The new dental contract? The new dental contract means that the UDA (unit of dental activity) banding for an extraction is in the same category as root canal treatment. An extraction might take a dentist a few minutes,  root canal treatment might take a few hours. What incentive is there for a dentist to do complicated work if they get paid the same amount for both? And the Government are surprised?

So why should you go to Hungary for dental treatment? You get treatment according to what you need, not in units of UDA.