Dentist shortage causing misery

[AB Asks]

No one enjoys going to the dentist but it must be done. As many as one in six people cannot access an NHS dentist and so haven't gone to see one in years. People on low incomes have been hit the worst by the NHS contract that was brought in in 2006. Private treatment is just not affordable on any level for a lot of people. What are you experiences of private or NHS dentists? Is the current system working or do we need radical change?

[chazza]

I'm the same, I hadn't been with the dentist for a while and when i phoned one to join, the first one I phoned took me on and gave me an appointment within 7 days

[Booldawg]

I've heard horror stories of NHS dentists with fairly shoddy dentistry skills. Whenever a patient attempts to sue they simply flee the country, as they are associates of the surgery then the surgery itself neithers cares or is culpable for the actions of the dentists. Not one of the dentists at the practise I go to are British and seem to change around with alarming regularity.

[alijangra]

Even as a student I was on a dental plan which is very affordable. It's all about priorities. �10 per month (�2.50 per week) can easily be found by cutting back on other things.

[alijangra]

For example, my sister who smokes 20 cigarettes per day claims she cannot afford a dentist. Yeah right.

[tiggerblue10]

My former dentist went private so I contacted the NHS and the sent me a list of all NHS dentists in my area. I am now registered with one and it costs me �15.50 every check-up months as opposed to �15 each month.

Luckily I don't mind going to the dentist. I know a few people who have never ever been!

[toby99]

I am NHS and have no problem either - They insist I am seen every six months even though I never need anything doing - if they extended this to annual they could see twice the amount of patients who only require check ups though

[MrXLA]

Booldawg your comments are insulting and clearly not based on fact (only your own limited experience).
'An NHS dentist' (and such a thing doesn't really exist but I'll not bore you with details) has to do a VT (vocational training year) in practice after the 5 year undergraduate degree if they wish to practice in the NHS.
Whereas most do a VT year if a dentist decides not to they can practice independently the day they graduate (subject to registration with the GDC).
Of course many private dentists have done additional post graduate qualifications (so too have many NHS dentists)
Each dentist is liable for there own actions and in the NHS so too is the principal.

[MrXLA]

The new NHS contract is a disgrace it does not benefit dentists and certainly does not benefit patients.
However it annoys me when (misinformed) people point the finger at private dentists for the lack of NHS dentists accusing them of being greedy.
- A few points to consider:
- Many NHS dentists earn as much as or in some cases significantly more than their purely private counterparts (of course there are a large number that earn alot less)
- Most dentists set up privately to avoid the ridiculous treadmill imposed by the NHS contract or simply because they have a 'special interest' or specialty not funded/available on the NHS
- PCTs receive a dental budget each year and dentists essentially bid/apply for these contracts (since 2006).
- A dentist wishing to work in the NHS and/or set up practice (and there are a large number!) cannot do so without a contract
- More so if an existing dentist 'goes private' the PCT is able to re-allocate 'give the contract to someone else' so a dentist going private has no effect on the local provision of NHS dental care

[MrXLA]

-The FACT is there are more than enough dentists willing to work in the NHS, they simply cannot get contracts (it simply makes better headlines to say 'X number of patients cannot get NHS dentists' than 'X number of dentists cannot get NHS contracts'
- The government isn't interested in quality of care they simply want 'access' figures and making each dentist see a ludicrously unsafe amount of patients a day to achieve this is unethical and dangerous

[MrXLA]

- People often complain about the expense of dentistry, but imagine if you had to pay a private medical bill to be collected by emergency ambulance taken to A&E, assessed by an A&E doctor admitted to a surgical ward and operated on by a consultant general surgeon after which you spend say 3-4 days on the ward
- Your private dental bill would be peanuts in comparison
- The FACT is health care of any kind costs alot of money and the government can't pay for it all.
- Id personally rather pay for my dentistry and have access to acute medical care when I really need it

[MrXLA]

- Another very important point to note (that seems to be lost in all the newspaper hype) is this:
- More than 90% of dental disease (often leading to pain) is entirely preventable
- Avoid smoking, cut down on the sugar, and use a fluoride toothpaste twice a day for 2 minutes and MOST of us would never develop dental disease
- Of course the following are important:
- Oral cancer screening
- Congenital/developmental abnormalities
- Trauma leading to fracture of teeth etc...
there are a couple of other examples, however sadly dentists spend more than 90% of their time treating conditions that can be prevented by people themselves.

- It is true that there is a problem with 'dental access' however if you speak to people involved in this area what actually emerges is:
- patients can't walk in off the street when in acute dental pain, dental practices simply aren't set up in this way and perhaps provisions need to be made to have more 'walk in/access centres'

[MrXLA]

12 miles! So What!!!! I know of dentists and doctors who drive more than 50miles! to work!!!!

[MrXLA]

I think what everyone needs to realise is that there is a finite amount of funding available for NHS care on the whole and a never ending demand.
That situation CANNOT continue indefinitely, therefore cuts have to be made and dentistry is not life saving.

If people expect to have a access to an NHS dentist on their doorstep with the ability to see them at 5 minutes notice and provide high quality oral health care then they are deluded, the population is too big and the available funding too small. The government needs to be honest about this.

[Ice.Maiden]

Local anaesthetics don't work on me, so I had to find a dentist who offered intravenous sedation (which I have to pay for privately). There must be other people in this situation, but if you can't afford to pay - you don't get it. However, I understand that if a NHS dentist refers you for hospital treatment, then a low wage earner or those on benefits can get the work done for nothing. Whatever, I think it's disgusting that all basic treatment isn't offered to those who need it. Poor oral hygeine can cause other complaints - which in turn cost more money.

[MrXLA]

Hi ICE MAIDEN perhaps you should clarify because local anaesthetic works on everyone (in high enough quantities) unless you are allergic to a component of it (true allergy to dental LA is very rare). Sedation is used as an anxiolytic to make dental treatment (which lets face it can be unpleasant) more acceptable to especially anxious patients. However sedative agents don't provide analgesia so you'd be in a pickle if the LA didn't work on you. That said there are many people who genuinely cannot have dental treatment while totally aware (you are probably one of them).
Many dentists used to provide sedation on the NHS and some still do, however many PCTs don't believe commissioning this service is of value its up to you the patients to tell them otherwise

[Ice.Maiden]

Thanks, that was interesting, MrLXA. I have intravenous sedation because prior to this treatment, 5 shots of anaesthetic had no effect on me whatsoever, so the IS was suggested. I asked my dentist if he provided this service, and he said no, so I had to scout around for a practice that did. Four years ago, whilst on holiday, I required some emergency treatment, and had the usual injections. Again, the treatment was too painful for the dentist to be able to work on me, so the jon was aborted and I had to wait until I got home before seeing my regular dentist again. For the record - when I had my first child, I opted for an epidural - which didn't work either! An hour after the birth, a very small area became numb. Had it worked at all, I doubt I'd have felt a thing.

[MrXLA]

Sedation (at least if your speaking of IV sedation used in dentistry) does NOT provide pupal anesthesia. If a dentist attempted to to work on you with ONLY IV sedation you would be in agony. The analgesia/pain relief/'numbness' still comes from the conventional dental anaesthetic.
Occasionally if the LA is not placed correctly it is ineffective, however if sufficient volume (safe doses) is administered in the correct anatomical location (in the absence of infection) pulpal anesthesia will occur.
However dental LA does not remove proprioception (feeling) you are always aware of vibration, pressure, movement a large number of people are unable to tolerate this but that does not mean the LA does not work in them (it still blocks the sodium channels).
Incidentally the same applies with an epidural and you were probably very unlucky (sometimes even consultants have to site epidurals more than once)
Then again perhaps your neural tissue is of a unique composition.

[MrXLA]

Have you had any special tests done?