NHS Dentistry – the beginning of the end?

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Do the British hate the Dental profession?

Is the almost universal demonising and negativity to dentists expressed in the UK press a reflection of our nation’s attitudes to those professionals whose careers are dedicated to dental health and care?

Has anyone ever read anything positive in the press about Dentistry?

One thing is ‘for sure’ …  all that intensely negative press breeds mistrust and a lack of confidence in the profession as a whole. Is that really ‘in the public interest’?

The Great Dental Rip-Off

A few weeks ago the ‘esteemed’ Times had a headline on the front page: ’The great dental rip off’. This maintained that ‘thousands of teeth were being needlessly extracted by NHS dentists.  These teeth could have been saved with root canal treatment but apparently dentists are extracting them because they are greedy, unprincipled and only interested in ‘maximising their profits’.

There are over 25,000 NHS registered dentists in the UK and The Times quotes ten dentists earning about £450,000 pa. They failed to mention whether these were gross or net earnings as the expenses of running a dental practice can take 50% of any ‘gross figure’.

Anyway the point isn’t whether a few practitioners are earning too much unethically; and indeed there may be some ‘rogues’ among them. The main issue is that the Government system does encourage dentists to see as many patients as possible and work to ‘targets’. It is stated that the 30 patients a day should be considered the upper limit for NHS dentists. That equates to about 12 minutes a patient if one allows three minutes between patients to clean and tidy up, and perhaps for the dentist to ‘greet’ the patient .

NHS Dentistry: Time for Change

NHS Dentistry: Time for Change

Time for dental appointments

Unlike GPs who usually sit behind a desk and will write a prescription or referral letter, dentists have to ‘do’ something. How much can be done in 12 minutes? A visual check up and perhaps a couple of x-rays is ‘doable’ and even that leaves almost no time to explain or discuss anything with the patient. What dental procedure can be done in 12 minutes? Talking about quality and standards of clinical care would perhaps be somewhat irrelevant under such circumstances.

A good private practitioner would see about 5-12 patients a day. He or she would spend generally ½ to ¾ hour over doing a filling, up to two hours to complete a molar root canal treatment (a complex procedure), and irrespective of whether it is the dentist or a hygienist … at least ½ hour to complete a scaling, cleaning and oral hygiene monitoring/instruction. To a good clinical standard. So what can an NHS dentist do? So for an NHS dentist to see and treat 30 patients in a day … some will take, say ½ hour …. Leaving others to have … what, a 5 minute appointment?

Private v NHS dentistry treatment options

Take the example of this issue of removing vs. saving teeth (with root canal treatment).

Once decay has spread into the nerve of the tooth (with or without concurrent pain), there are only two choices: extraction or root canal treatment (unless the decay has gone too deep into the roots). The pain has to be alleviated. A competent NHS dentist should be able to remove that tooth in ten minutes. A root canal treatment cannot be done in that time; not even in three times as long. The fee the dentist is paid under the current system mitigates against being able to do a root canal treatment half way decently. So if the dentist cannot afford the time to carry out a root canal treatment and certainly not for the ludicrous fee paid by the NHS what is he or she to do? The choices are: offer an extraction, refer to a dental hospital (with its amazingly long waiting lists) or refer to one of 200 odd root canal specialists, the vast majority of whom are in private practice, the fees for which would be unacceptable to the vast majority of NHS patients.

The facts are:

  • Dental disease (decay and gum disease) is preventable over a life time. It just needs education.
  • NHS dentists are put in an untenable position. It is simply not possible to do good dentistry under the time and financial constraints required to practice NHS dentistry.
  • You will be hard put to find an NHS dentist working in practice!
  • It suits the Government and the press to always blame the practitioners and not ‘the system’. The system needs radical change, not just being ‘tweaked’ … it does not work.
  • The government really cannot afford to pay for NHS dentistry given the demands on the NHS as a whole and funding more critical aspects of Medicine.


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