Better living through dentistry

[j4]

I'm registered with the only dentist within about 25 miles who claimed to take new NHS patients.

They did a checkup and an xray, and a few days after the xray they phoned to tell me that I needed a filling. (Bummer, thought I, I nearly made it to 30 without needing any fillings.)

So I went in for the filling, and when I was on the chair with my mouth propped open they asked if I wanted the NHS filling (mercury filling, lots of drilling under anaesthetic, painful, unsightly grey lump in the tooth, cost = £45) or the private filling (non-mercury, very little drilling, painless, invisible, cost = £70). I opted for the invisible/painless option, which took about 5 seconds of drilling and 2 seconds of holding some kind of instrument against my tooth (I'd been told to close my eyes so I have no idea what).

After that was done, the dentist showed me the xray and said that there was another 'shadow' visible on the xray and I might need another filling. "It's only a very slight shadow, you probably won't even be able to see it," they told me, pointing at a completely blank bit of xray. They were right. They took another xray from a different angle and said they'd phone me back if anything showed up.

Surprise surprise, they reckon I need to pay them another £70. This feels like a phenomenal ripoff; for all I know, they are inventing these 'fillings' out of thin air. They can't provide any evidence except a blank space on an xray where they claim to be able to see something. Now obviously being able to spot things that mere mortals wouldn't spot on a postage-stamp-sized xray is the sort of thing that one might get from 7+ years of training to be a dentist. But they're certainly not inspiring me with confidence.

The 'drilling' is apparently only a tiny bit (no pun intended) on the surface of the tooth, so the 'filling' must only be the merest cat's whisker of the dental equivalent of polyfilla. I've always taken the view that teeth are worth protecting; but, if I was being completely cynical, I would point out that it is hardly rocket science to work out that people of my age a) were probably brought up to take this view of toothcare, b) probably feel slightly guilty about not brushing seven times a day and not using all the available tooth-cleaning technology, so can probably be persuaded that the fault is theirs, and c) have a reasonable amount of disposable cash.

I don't think there's any way I can get a second opinion without paying outrageous amounts of cash to some other private dentist; there simply are no NHS dentists in the area (and of course you still have to pay for checkups even on the NHS). Of course, they know that, too.

But if I just told them I didn't want to have it done, then a) they'd kick me off their books (they'll only take NHS patients in the first place if their teeth are okay) and b) I'd feel as though my teeth were a ticking time bomb in my mouth. Maybe £140 isn't too much to pay for peace of mind. But it still leaves me feeling as though my mouth is full of snake-oil.

Comments

[rgl.livejournal.com]

I could be wrong, but I don't think that going to see a dentist privately - as opposed to being an NHS patient - is actually that much more expensive, which might give you a wider choice of dentists. As you've already noticed, many of the things you actually have done during an appointment cost money anyway, so I'm really not sure what the difference is. I'm registered with a dentist privately (because I wanted to go to a dentist near my work rather than near my house), and they seemed to charge me a mixture of NHS and private rates at my only appointment with them to date.

[nja.livejournal.com]

I think I pay £30 for an amalgam filling at my private dentist. I would prefer to be with an NHS dentist if all other things were equal, but I have an even greater preference for having a dentist who I trust (to be competent and conservative about treatment), so I picked this one on the recommendation of a friend.

[(Anonymous)]

If you made it to 30 without fillings then it is likely that the areas you have had filled are "arrested" tooth decay where tooth decay has started, not developed and just remains as a liitle weakness in enamel. If this is the case then most dentists would put a "watch" on the tooth, perhaps record an image and check it out in 6 months. 6 months on if it is getting bigger then intervention is required, if not then it is not.

You didn't have a written and signed estimate provided before treatment.

You were misled reagrding what the NHS solution and the private solution actually are.

The treatment was explained to you incorrectly

If they asked you to close your eyes then you were likely not properly kitted out with suitable eye protection - a breach of H&S.

To suddenly "find" another cavity, AFTER you had chosen the private option, when on initial radiograph assessment they had only seen one, means they had not examined the radiographs correctly.

No doubt you were given the legally required FP17DC form clearly outlining what treatment is NHS and which is private and giving you all your rights etc.

No doubt you were informed that both fillings on the NHS would be covered by the NHS quoted fee whereas privately you have to pay for each item.

The concept of "taking you off their books" implied "registration". This concept has now gone for ever. If you ring them up next week they are not obliged to see you at all if they are "at capacity" unless it involves a situation regarding a duty of care ie it related to something they have done previously. The new procedure is you ring the PCT and they allocate you to a dentist who has available slots. If none of them have then you go on a waiting list.

My advice, abandon the NHS find a reasonably priced private dentist. Expect to pay about 30.00 for a check up, 30.00 for scale and polish and 30.00 - 45.00 for normal fillings and more for white fillings. If you have a very healthy mouth - which it sounds like you do, it will likely be cheaper in the long (and probably short) run.

All the above IMHO and based on your post being true.

cheers
J

[katstevens.livejournal.com]

Does the tooth actually hurt? If not then I'd tell them to bvgger off and put the £70 towards a Bupa plan or something similar.

Saying that I'm lucky in that I have a wonderful sensible dentist who has been dealing with my teeth since I was five, and even when they got bashed in (I swam into a wall) he said "oh, they're not going to fall out or anything, as long as you don't mind if they're a bit wonky". But he does tell me when something *does* need doing, such as "your wisdom teeth are growing sideways, that's why they hurt, let's take them out." He moved his practice to Hounslow when I was about 13, and on my first visit to the new dentist I was told I needed four teeth out & braces & whatnot, all costing £££. My mum and I told the new dude where he could shove his braces and have been going all the way to Hounslow for check-ups ever since. I don't know what I'm going to do when he retires. :(

[j4.livejournal.com]

Nah, it doesn't hurt at all, I don't even know which tooth it is!

I have never had a sensible dentist. :( I had one who insisted on taking all my milk teeth out to make room for the other teeth (okay slight exaggeration but I have had TWELVE AND A HALF TEETH OUT in my life) and have had several who've been, y'know, meh. Okay but nothing great.

If I had a sensible dentist I would move in with them, I think.

[hatmandu.livejournal.com]

A couple of years ago (well, er, three now) we went to a dentist in Oxford accepting NHS patients - in St John Street, northern end on the right. A year ago we signed up at the massive tooth farm of a place in Kidlington (er, sorry, no name, but it's next to the post office at the northern end of Oxford Road, on the right) which claims to do only NHS stuff - though have never heard from them and I'm not brave enough to go there yet (though lurking twinges make it inevitable...).

I've long been convinced that dentists often stir (or make) up more trouble than good, though.

[rysmiel.livejournal.com]

That is a remarkably cool userpic.

[hatmandu.livejournal.com]

Oh, er, thanks! Like an old sock, I'd almost forgotten I was wearing it...

[j4.livejournal.com]

in St John Street, northern end on the right

Yep, that's the ones I'm with. :-/

[brightybot.livejournal.com]

I have to say I was not at all impressed with them when I went there. The woman claimed that if my wisdom teeth needed taking out, I'd have to go to hospital. Apparently she simply did not remove wisdom teeth, which given I'd had that done with the upper ones by a dentist in Headington a few years before, seemed rather dubious. I never did have the lower ones out in the end. I was also put off by the cramped and untidy surgery which didn't really inspire me with confidence.

As A said, we signed up with the one in Kidlington, but I've never been, due to procrastination. Must sort that out soon. Will let you know if they're good, although obviously a long schlepp for you.

[lnr]

Could you ask your practice to take another look in 6 or 12 months time? My dentist has a couple of teeth he's "keeping an eye on" that have a small amount of decay but not enough to warrant a filling.

And though they're private he's not charged that much for either of the two fillings I just had, and they're bigger than yours.

(Mind you check-up, x-ray, temp filling, 2 real fillings, and some serious scaling under anaesthetic, over 5 sessions in total has come to 210 quid - but then I hadn't been in 5 years! The emergency appointment when I had a sudden excruciating pain after the second filling was free, though it mostly went away on its own and he just applied some fluoride goo which apparently makes teeth less sensitive.)

I suddenly wonder if you can get macro lenses for x-ray machines so they can make the picture bigger, but I suspect it doesn't work like that.

[bellinghman.livejournal.com]

Macro lenses for X-rays would be quite an advance, indeed. I don't think there's anything that actually deflects X-rays, only stuff that blocks them. So X-ray machines use a point source, like a back-to-front pinhole camera.

Straight line optics. You've got to love it.

[fivemack.livejournal.com]

You _can_ reflect X-rays; I was at ESRF yesterday and saw the microfocus beam-line. The X-ray mirror has to be six metres back from the target, is a box two metres long and 50cm square at the ends, has to be kept in an air-conditioned perspex box because it goes out of focus if the temperature changes by one degree, has to be bolted to granite blocks set in the floor, and goes out of focus for fifteen minutes from the vibration from slamming the door to the experiment hutch.

Smaller pixels on the X-ray detector would be a better approach to magnification, but then you'd need a brighter X-ray source, and a longer exposure, and more risk of bad health effects from X-ray exposure.

If only flesh were more transparent, or teeth more reliably opaque.

[rgl.livejournal.com]

And, importantly, for a fixed pixel size on the X-ray detector, magnifying the resulting image will potentially make the job of picking out abnormalities harder rather than easier, due to the increased blockiness (cf the "Lincoln illusion", though at the moment I can't find an online reference to that which isn't slightly misleading).

[bellinghman.livejournal.com]

Aha, interesting. I'm obviously out of date scientifically, even though definitely not practical for dental surgeries!

[hairyears.livejournal.com]

You can refract X-Rays. Or rather, appear to: one of those odd bits of economically-useless research that shouldn't be funded turned up a very peculiar type of lens in horseshoe crabs' eyes. It's an array of tubes - much like fibre-optic cables - acting as beam guides by total internal reflection off their inner surfaces.

The central guide is straight, and they become increasingly curved towards the edge of the 'lens' (picture a longitudinal slice through an onion, or take a column of parallel straws and press it down, so that the outermost straws bow outwards in a barrel shape). The geometry for off-axis incident rays at is quite complex but it can indeed focus an image from a narrow cone of vision.

If this structure can be reproduced at nanometre scales (say, in a distorted crystal) there's a way of focusing X-Rays for high-definition lithography, a topic of interest to Intel and AMD. I know of no attempts to put this discovery to work in medical imaging.

[sparrowsion]

One of the reasons some people are getting excited about metamaterials is that you can make X-ray Fresnel lenses from them. That would take all the fun out of crystallography.

As far as dentistry goes, a short while back my dentist (although not his practice) stopped doing NHS treatment. Rather than switch to one of his junior colleagues, I went private. It's costing me £40 (IIRC) for an annual check-up rather than £15 for an NHS 6-monthly one. If your teeth are in good health, and you're not in an exempt category, I really don't see the advantages to NHS dentistry.

[bellinghman.livejournal.com]

I hadn't considered the possibility of Fresnel lensing - I'd got hung up on traditional lens lenses (i.e. those lenses named because they're shaped like lentils.)

And mirrors. Hmm.

Metamaterials are seriously weird, I'll grant you that.

[j4.livejournal.com]

Could you ask your practice to take another look in 6 or 12 months time? My dentist has a couple of teeth he's "keeping an eye on" that have a small amount of decay but not enough to warrant a filling.

That's a good plan & I might try it -- thanks!

[simont]

Off-topic for this post: your choice of icon reminds me that I just finally got round to putting up a web page about the various silly polyhedral models of things I've created, with downloadable nets and things. I didn't have my own instance of your badger, and couldn't quite be bothered to either make another one or ask you for a photo, so I ended up doing a CGI rendering of each of the models instead of using pictures of the real ones :-)

[oldbloke.livejournal.com]

I'll bookmark that, I lurve polyhedra

[atreic.livejournal.com]

Yay!

[vinaigrettegirl.livejournal.com]

How do you know they'd kick you off their books? Did they say so? if they did then (a) that sounds like blackmail to me and (b) i think you could get a second opinion - Westfield over in Temple Cowley are the folks I go to - and the most they would charge you would be 15 quid.

I would also think about calling up the NHS and ask their advice - I expect there is someone you *can* call to ask this sort of thing - and tell them that you feel you're being had, and what about it, then?

caveat: i grew up with exclusively private dentistry so I'm conditioned to expect high charges, and the best advice i ever heard about finding a good dentist was "ask the rabbit who HE goes to"... that said, I like my dentist and do trust him. Dr. Jensen.

[j4.livejournal.com]

How do you know they'd kick you off their books? Did they say so?

Nah but since they're only in it to make money I suspect they'd have no truck with people who won't do what they say (ie pay money). Maybe I am maligning them. They don't give any kind of indication of it being a choice, though.

I will see if anybody will give me a second opinion. Temple Cowley is a bit of a bugger to get to from Botley (which is a shame because personal recommendations are a Good Thing) but I will see if anybody recommends anybody nearer home/work.

I don't object to high charges per se, in principle -- I mean, they're doing a skilled job, using expensive materials -- but if I'm going to shell out 70 quid for something I can't see/feel, then I want quite a lot more confidence that I'm not just buying skyhooks!

[gerald_duck]

If they did a "filling" in ten seconds flat, it sounds as though it wasn't a real filling, rather a fissure seal. That's a kind of preventative pre-filling: they just drill away a tiny quantity of decay, splat some stuff on, fix it with UV light (which will be the bit they wanted your eyes closed for).

My mother seems to have a fetish for dental work: they're always extracting this, crowning that, filling the other. When I was seventeen I went to her dentist and he said I needed four fillings. The first filling gave me toothache for nine months when I'd previously never had any, so I skipped the other three fillings.

Seven years later I summoned up the courage to see a dentist of my own choosing and find out what the damage was: he gave me a quick scrape and polish and said everything was OK! Things continued OK for another five years until finally my dentist suggested fissure seals and I accepted. That was several years ago.

The moral of the story is that dentists can be wrong, or at the very least wildly overzealous. In my case I've now gone nineteen years without those allegedly-essential fillings. I still have only one filling, and it was almost certainly counterproductive.

Incidentally, I had the fissure seals on the NHS.

It might be worth seeking a second opinion, or even just asking your current dentist what will happen if you leave the tooth for the time being. Once you're on their books, I'm not sure they can delete you at whim: if they're going to try deleting you for rejecting necessary treatment they'd better be very sure the NHS would agree on behalf of the taxpayer that it was necessary.

[1ngi.livejournal.com]

Westfield Dentists in Temple Cowley were still taking in NHS patients in June 2006. I had a lovely dentist there. Really missing them now.

[j4.livejournal.com]

Is that the same people vinaigrettegirl is recommending? Unfortunately Temple Cowley is really about as far as you can get from Botley while still being (nearly) in Oxford.... :-/

[1ngi.livejournal.com]

[scrolls back] Yes, looks like it.

I used to live in Eynsham. Seems like bloody long way for a dentist but I have real white coat syndrome and the dentist at this lot was the first one who was gentle, kind, would talk me though everything she was going to do. So for me it was worth the hassle of the journey. Can see why it wouldn't suit others though.

They are in theTemple Cowley shopping centre which is on the two of the bus routes you can pick up from Carfax - 7 and 10 I *think*.

[redbird]

If you have to pay private prices anyway, it's certainly worth getting a second opinion and/or going elsewhere. And, as others said, check with the NHS about whether this dentist is playing by the rules.

[juggzy.livejournal.com]

It must be a day for dentists - I've just had to visit one,too.