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orthodontics
12 Answers
Good morning ABers.
My 15 year old granddaughter Charlotte went to see the orthodontist yesterday and was told that she needs braces on both top and bottom teeth. Her wisdom teeth, on x-ray are actually growing sideways and are already pushing her other teeth out of alignment. However, because in an ordinary photo her teeth don't look to distorted, my daughter will have to pay for the treatment (�3,000) as it will be classed as cosmetic dentistry. In the years to come, there will be pain because of the teeth being crowded out by the growing wisdom teeth
I feel that this costing decision is grossly unfair and what I am wondering is if there's any sort of route through which we can appeal for either some sort of financial help or to try and get the orthodontist to re-classify Charlotte's case so that it's not seen as cosmetic work. Surely the fact that she will be in pain at some point in the future should make this a necesary treatment and perhaps it should be available under the NHS. �3,000 seems a huge amount to have to pay but my daughter is going to scrape around to find the money but if she can get at least some of the cost back it would help.
Sorry this is a long question but we really don't know where to begin!
Many thanks, Maz.
My 15 year old granddaughter Charlotte went to see the orthodontist yesterday and was told that she needs braces on both top and bottom teeth. Her wisdom teeth, on x-ray are actually growing sideways and are already pushing her other teeth out of alignment. However, because in an ordinary photo her teeth don't look to distorted, my daughter will have to pay for the treatment (�3,000) as it will be classed as cosmetic dentistry. In the years to come, there will be pain because of the teeth being crowded out by the growing wisdom teeth
I feel that this costing decision is grossly unfair and what I am wondering is if there's any sort of route through which we can appeal for either some sort of financial help or to try and get the orthodontist to re-classify Charlotte's case so that it's not seen as cosmetic work. Surely the fact that she will be in pain at some point in the future should make this a necesary treatment and perhaps it should be available under the NHS. �3,000 seems a huge amount to have to pay but my daughter is going to scrape around to find the money but if she can get at least some of the cost back it would help.
Sorry this is a long question but we really don't know where to begin!
Many thanks, Maz.
Answers
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each pct (primary care trust) will have its own procedure for appealing and the orthodontist will know about it. in ours, for example you write a letter to the priorities committe as does the dentist. at a neighbouring trust you just write to an adujicator. Alternatively you could ring your pct's Patient advice and liaison service (PALS) who will guide you through the process.
If the work needs clinically to be done then the orthodonist would have given her a score between 1-5
1 and 2 dont qualify for nhs treatment 4 and 5 automatically qualify. If she sores a 3 then it is boderline and the dentist will show pictures and ask the child how they feel about their teeth, or which pictures they think look like their own teeth. This is to assess the psychological impact of having wonky teeth on the child. If this score is above 6 then it can be done on the nhs
so in summary if a child has a score of 3.6 or above they will get the treatment free, if it below 3.6 they will have to pay
It would be helpful if yu could ask her dentist what her "EOTN" score is. if the first number is 1 or 2 you have no chance with an appeal. If it is three you may have a chance.
The system is there to ensure that children who need the work for a clinical reason rather than a cosmetic one get priority
If the work needs clinically to be done then the orthodonist would have given her a score between 1-5
1 and 2 dont qualify for nhs treatment 4 and 5 automatically qualify. If she sores a 3 then it is boderline and the dentist will show pictures and ask the child how they feel about their teeth, or which pictures they think look like their own teeth. This is to assess the psychological impact of having wonky teeth on the child. If this score is above 6 then it can be done on the nhs
so in summary if a child has a score of 3.6 or above they will get the treatment free, if it below 3.6 they will have to pay
It would be helpful if yu could ask her dentist what her "EOTN" score is. if the first number is 1 or 2 you have no chance with an appeal. If it is three you may have a chance.
The system is there to ensure that children who need the work for a clinical reason rather than a cosmetic one get priority
A very comprehensive answer and quite correct. Find out the IOTN (Index of Orthodontic Treatment Need).
Unfortunately if it's low (and it sounds like it is) then you can appeal (and create several busy people unecessary headache) but unless the aesthetic component is high you have no chance, and to be honset quite rightly so.
Orthodontics is extremely expensive to provide and is not a life saving speciality (not usually anyway).
It's quite likely that due to lack of resources in the NHS that the minimum IOTN will be raised, something I support.
Afterall where would you like the money spent, cardiac care, cancer treatment....or teeth. For me its a no brainer, I don't know about you.
With regards to the wisdom teeth, there is no conclusive evidence that unfavourable position or impaction contribute to displacement of teeth.
Oro-facial development is extremely complex if it wasn't it wouldn't take 5-6 years to train as a dentist and at least an additional 5 to train as an orthodontist.
Orthodontic treatment does not necessarily prevent pain from impacted wisdom teeth (and not everyone develops symptoms), there are far too many factors to consider.
Your daughter may for example be unfortunate enough (as many young people are) to develop multiple epsiodes of pericornitis and require removal of her wisdom teeth. But orthodontics won't necessarily prevent this.
My advice would be get the IOTN if its high enough appeal, if not and your daughter really wants the treatment then accept that its cosmetic and pay for it.
Unfortunately if it's low (and it sounds like it is) then you can appeal (and create several busy people unecessary headache) but unless the aesthetic component is high you have no chance, and to be honset quite rightly so.
Orthodontics is extremely expensive to provide and is not a life saving speciality (not usually anyway).
It's quite likely that due to lack of resources in the NHS that the minimum IOTN will be raised, something I support.
Afterall where would you like the money spent, cardiac care, cancer treatment....or teeth. For me its a no brainer, I don't know about you.
With regards to the wisdom teeth, there is no conclusive evidence that unfavourable position or impaction contribute to displacement of teeth.
Oro-facial development is extremely complex if it wasn't it wouldn't take 5-6 years to train as a dentist and at least an additional 5 to train as an orthodontist.
Orthodontic treatment does not necessarily prevent pain from impacted wisdom teeth (and not everyone develops symptoms), there are far too many factors to consider.
Your daughter may for example be unfortunate enough (as many young people are) to develop multiple epsiodes of pericornitis and require removal of her wisdom teeth. But orthodontics won't necessarily prevent this.
My advice would be get the IOTN if its high enough appeal, if not and your daughter really wants the treatment then accept that its cosmetic and pay for it.
Thank you for your reply Mr XLA. My daughter is going to speak to Charlotte's orthodontist to see what her score is.
Whilst I wholeheartedly agree with you regarding funding of cardiac,oncology and many other life-saving treatments, I have to say that to an extent, people's views on NHS spending is somewhat subjective. For instance, if someone is suffering a certain illness, then they would wish for more funds to be directed into research and treatment for their condition.
Surely the word NEED comes into the equation-if the orthodontist says that a child needs braces on her top and bottom teeth then is that different to merely having the treatment for cosmetic reasons?
I do realise that orthodontists and dentists are highly trained professionals and that their decisions as to who gets treatment on the NHS are based on perhaps many years experience and that unfortunately, not every patient can recieve free care.
Of course, a 'sliding scale' fee system, whilst being a fair way to allocate funds, would be both expensive and difficult to implement and there has to be a cut off point for free treatment. As I said in my original query, my daughter is prepared to pay for Charlotte's orthodontic treatment but we did need to be aware of the facts and now, we can proceed to find out from her practitioner whether she falls into the borderline category before needlessly launching into an appeal that would fail anyway.
Thanks again for your reply.
Whilst I wholeheartedly agree with you regarding funding of cardiac,oncology and many other life-saving treatments, I have to say that to an extent, people's views on NHS spending is somewhat subjective. For instance, if someone is suffering a certain illness, then they would wish for more funds to be directed into research and treatment for their condition.
Surely the word NEED comes into the equation-if the orthodontist says that a child needs braces on her top and bottom teeth then is that different to merely having the treatment for cosmetic reasons?
I do realise that orthodontists and dentists are highly trained professionals and that their decisions as to who gets treatment on the NHS are based on perhaps many years experience and that unfortunately, not every patient can recieve free care.
Of course, a 'sliding scale' fee system, whilst being a fair way to allocate funds, would be both expensive and difficult to implement and there has to be a cut off point for free treatment. As I said in my original query, my daughter is prepared to pay for Charlotte's orthodontic treatment but we did need to be aware of the facts and now, we can proceed to find out from her practitioner whether she falls into the borderline category before needlessly launching into an appeal that would fail anyway.
Thanks again for your reply.
Morning Mazzywoo!
Sorry to hear of your predicamant. It will be no consolation to say that many parents are now in a similar position where orthodontics is not offered under the NHS. You can thank Tony Blair for that one, when NHS dentistry was reformed in 2006.
To answer your question try this link to the British Orthodontic Society, which explains how children are assessed for NHS treatment and explains the current situation on provision.
http://www.bos.org.uk/orthodonticsandyou/ortho donticsandthenhs/thenhsandorthodontics.htm
Hope this helps explain the situation, even if it does not alter it.
Best wishes
J9PUR
Sorry to hear of your predicamant. It will be no consolation to say that many parents are now in a similar position where orthodontics is not offered under the NHS. You can thank Tony Blair for that one, when NHS dentistry was reformed in 2006.
To answer your question try this link to the British Orthodontic Society, which explains how children are assessed for NHS treatment and explains the current situation on provision.
http://www.bos.org.uk/orthodonticsandyou/ortho donticsandthenhs/thenhsandorthodontics.htm
Hope this helps explain the situation, even if it does not alter it.
Best wishes
J9PUR
'NEED' Thats the whole crux with orthodontics and why its becoming (and as I've stated rightly so!) more difficult to justify on the NHS.
The benefit to the patient is usually cosmetic (NOT oral health related).
The justification for providing treatment is based on detriment to dental/oral health if the treatment is not carried out.
However rarely does lack of orthodontic treatment lead to any significant dental/oral health problems.
People have begun to realise this.
The benefit to the patient is usually cosmetic (NOT oral health related).
The justification for providing treatment is based on detriment to dental/oral health if the treatment is not carried out.
However rarely does lack of orthodontic treatment lead to any significant dental/oral health problems.
People have begun to realise this.
I don't wish to rant about the NHS (it is essentially a separate issue).
However many people speak of what they 'want', the 'way' in which they would 'like' the service provided.
Many people cite the high tax rate, sorry but you are not paying for you own treatment (and in alot of cases take out of the system alot more than they paid in).
People DIE everyday (and some of them really shouldn't) in the UK due to LACK of STAFF, EQUIPMENT etc..
Its because there is not enough money to run it in the manner to which we have become accustomed.
The population is simply too big and the demand too high.
The government has yet to admit this because they are too frightened to do so (but remember this when in twenty years the NHS is all but gone).
So to be honest in a system in which people die needlesly, where do you thing orthodontics should rank?
However many people speak of what they 'want', the 'way' in which they would 'like' the service provided.
Many people cite the high tax rate, sorry but you are not paying for you own treatment (and in alot of cases take out of the system alot more than they paid in).
People DIE everyday (and some of them really shouldn't) in the UK due to LACK of STAFF, EQUIPMENT etc..
Its because there is not enough money to run it in the manner to which we have become accustomed.
The population is simply too big and the demand too high.
The government has yet to admit this because they are too frightened to do so (but remember this when in twenty years the NHS is all but gone).
So to be honest in a system in which people die needlesly, where do you thing orthodontics should rank?
Also anyone wishing to use the tax argument, consider this:
If the government was to give you back the component of your taxation that went into the NHS.
Do you think you could afford to pay the cost (in a non profit organisation) so just the actual cost, of all the aspects of your healtchcare (or anything provided at no additional cost to you via the NHS) throughout life and not have to subsidise it with additional payments?
The answer in most cases would be probably not.
This for me rings big alarm bells, because what it means is that the figures simply don't add up and therefore the system is not sustainable.
If the government was to give you back the component of your taxation that went into the NHS.
Do you think you could afford to pay the cost (in a non profit organisation) so just the actual cost, of all the aspects of your healtchcare (or anything provided at no additional cost to you via the NHS) throughout life and not have to subsidise it with additional payments?
The answer in most cases would be probably not.
This for me rings big alarm bells, because what it means is that the figures simply don't add up and therefore the system is not sustainable.
Mr XLA-I entirely agree with you that the NHS as it stands is unsustainable and yes, people do die because of the shortfall in funding, staff shortages and vital equipment not being available. As you say, it is a huge dilemma and there are definitely no easy solutions.
However I am going to stick my neck out here re distribution of funds. I am obviously not as knowlegable as yourself about how decisions are made within the NHS as to which specialities are allocated which budgets but as I see it, there are glaring inequalities. Take geriatrics and psychiatry. Whilst these two examples are not 'sexy' and heroic branches of medicine, huge sections of the population are affected by the diseases and problems associated with old age and with mental health issues of varying severity (increasingly so).
Also, do you not think that the public are more impressed by advances in say, cardiac treatments where results are sometimes rapid and dramatic rather than in chronic conditions where the progression of the treatment is often slower and the prognoses poor in many cases?
Sorry, I have wandered off the original point here! Of course, in the massive system that is the NHS, orthodontics come way down the list. I could go on and on and the ethical dilemmas are many and varied. I am really not well enough informed to argue in depth on this subject but it is one that I think about a lot. Having had experience of managing and coping with elderly parents one of whom suffered dementia, and personal experience of psychiatric in-patient care whilst having several depressive episodes, I can safely say that underfunding exists in these areas. This proves my earlier point that people are subjective in their reckoning about how the NHS should allocate their funds. Thanks for an interesting debate and your views!!
However I am going to stick my neck out here re distribution of funds. I am obviously not as knowlegable as yourself about how decisions are made within the NHS as to which specialities are allocated which budgets but as I see it, there are glaring inequalities. Take geriatrics and psychiatry. Whilst these two examples are not 'sexy' and heroic branches of medicine, huge sections of the population are affected by the diseases and problems associated with old age and with mental health issues of varying severity (increasingly so).
Also, do you not think that the public are more impressed by advances in say, cardiac treatments where results are sometimes rapid and dramatic rather than in chronic conditions where the progression of the treatment is often slower and the prognoses poor in many cases?
Sorry, I have wandered off the original point here! Of course, in the massive system that is the NHS, orthodontics come way down the list. I could go on and on and the ethical dilemmas are many and varied. I am really not well enough informed to argue in depth on this subject but it is one that I think about a lot. Having had experience of managing and coping with elderly parents one of whom suffered dementia, and personal experience of psychiatric in-patient care whilst having several depressive episodes, I can safely say that underfunding exists in these areas. This proves my earlier point that people are subjective in their reckoning about how the NHS should allocate their funds. Thanks for an interesting debate and your views!!
Hey bednobs-We haven't got the number as yet BUT the good news is that Charlotte is getting a second opinion next week, with an orthodontist who apparently does more NHS work. So, it's fingers crossed. I guess that Charlotte's notes will be available to the other practitioner and the number from the original assessment will be in there. I'll keep you posted and thanks for your replies Maz x
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