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.