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Medical Forum / General / Dentistry / April 2007Abscess
I visited my dentist the other day because I have an abscess above a crowned tooth - upper right-hand side,fourth tooth from rear. The abscess isn't giving me enormous trouble at the moment, but obviously I would like it dealt with. My dentist took an X-ray and confirmed that it was an abscess. She then told me that I had two choices - root-canal treatment or extraction, and she recommended extraction. I said that I would think about it for a week or two and get back to her. I suspect that the dentist's recommendation is based on funding, rather that what is the best treatment for me - I am in the UK, and seeking treatment on the NHS. Any comments/advice from anyone here would be very much appreciated. Either find another NHS dentist for a second opinion and possible Root Canal Tx, or unfortunately for you, find a PRIVATE dentist and work out a payment arrangement. BTW, when I was stationed with US Forces Germany in the early eighties, BOAR soldiers and dependents shopped in the US PX. I could always tell they were Brits before they spoke because of the bad condition and repair of their teeth. We see the same shameful situation stateside with Medicaid patients. As I said before, you get what you pay for. Socialism can work, but so far it doesn't seem to in the dental arena. > Either find another NHS dentist for a second opinion and possible Root > Canal Tx, or unfortunately for you, find a PRIVATE dentist and work out [quoted text clipped - 5 lines] > what you pay for. Socialism can work, but so far it doesn't seem to in > the dental arena. Thanks for your reply. Finding another NHS dentist is not that easy here at the moment - because many dentists have stopped carrying out NHS work. What I really wanted to know, though, is whether or not the root-canal is the best option - or extraction? If the state of British teeth is poor (and this is almost always exaggerated by Americans) it is not because of 'socialism' - in fact NHS dental treatment is not free (unless the patient is unemployed), and can be quite expensive these days - it is probably more down to unscrupulous dentists. Often they are greedy and dishonest - many have been prosecuted for carrying out unnecessary treatment and for claiming payment for treatment they haven't actually done (and these must surely be the tip of the iceberg). >> What I really wanted to know, though, is whether or not the root-canal > is the best option - or extraction? Unfortunately, without seeing you and/or a radiograph of the tooth in question, we cannot offer any substantial advice, except if you are unsure about what your dentist has recommended, get a second opinion. John > because many dentists have stopped carrying out NHS work. That should tell you something. > What I really wanted to know, though, is whether or not the root-canal > is the best option - or extraction? *Generally*, a root canal is the treatment of choice. Access can be made through the existing crown and the infection should be gone rather quickly. This works *if* the existing crown fits well and has no recurrent decay. An extraction would be recommended if the crown is not acceptable (and a new one is not likely to improve the situation), or if the tooth is decayed under the crown that would make the entire tooth a poor choice for restoration. No way to say over the net (or across the pond). Best wishes, Steve >> because many dentists have stopped carrying out NHS work. > > That should tell you something. It does, that most dentists are greedy. A year or two back - before we moved to our present area - my wife used an NHS dentist who regularly told her that he didn't understand why many dentists were shunning NHS work. He said the payments were perfectly adequate, and that he could make a very good living by being an exclusively NHS dentist. >> What I really wanted to know, though, is whether or not the root-canal >> is the best option - or extraction? [quoted text clipped - 13 lines] > Best wishes, > Steve Many thanks for that. The crown is sound, and there doesn't appear to be any decay. I think that I will return to my existing dentist and insist on root-canal treatment. > It does, that most dentists are greedy. A year or two back - before we > moved to our present area - my wife used an NHS dentist who regularly > told her that he didn't understand why many dentists were shunning NHS > work. He said the payments were perfectly adequate, and that he could > make a very good living by being an exclusively NHS dentist. I have no direct knowledge of NHS reimbursement. However, here in the US, Medicaid and many HMO/capitation types of insurance pay the dentist 30-60% of average fees. Yes, a dentist can make a good living accepting these rates. BUT, they will not deliver quality dental care for these fees. It cannot be done. My overhead is over 50% of my gross revenue. If I work for those rates, I would break even at best. To make money, I would have to start making a lot of short cuts. Things like reusing disposable items, cutting time for cleaning the operatory rooms, not sterilizing everything in individual bags, sending lab work to the cheapest Asian lab available, running patients through the office like cattle, pulpectomies & Sargenti paste instead of a real root canal, more extractions, alginate impressions and a wax bite for dentures (with no try-in appt.), if amalgam or a stainless steel crown won't fix the problem, the tooth would have to go, having assistants do treatment that is not really legal, speeding up restorative treatment that may leave decay under the new filling, not diagnosing treatment that the insurance won't pay for (regardless of what is best for the patient), and even billing for services that were not done. All of these things happen every day in offices in the US taking this crap for payment. The level of care is significantly reduced because the overhead has to be cut. The only ways to do that are to treat more people faster, and to reduce spending on materials and lab fees. If you are willing to accept this level of care, then have at it. I will not practice dentistry in those conditions. I will not sink to doing bad dentistry and poor treatment just to make money. BTW, I am not a suburban dentist with a $750K home, a lake home, a cabin cruiser, and two Mercedes. Have a good day, Steve >> It does, that most dentists are greedy. A year or two back - before we >> moved to our present area - my wife used an NHS dentist who regularly [quoted text clipped - 40 lines] > Have a good day, > Steve Fair enough - and I do accept your point. Where does all this leave the poor patient though? Fewer and fewer people in the UK - and it's probably the same elsewhere - can afford private dental treatment. Short cut treatment is probably more costly in the long term for the NHS and Medicaid. There simply has to be a better way, otherwise soon only the well off will be able to have good dental health. >Fewer and fewer people in the UK - and it's probably the same >elsewhere - can afford private dental treatment. I think this is largely untrue. Whilst the virtual death of NHS treatment undoubtedly affects low income families (although many never sought regular dental treatment when the NHS system was more ubiquitious), most people could afford dental treatment in UK if they wished. They simply choose to spend their money on other things rather than their teeth. I don't know what the equivalent pound sterling is to USD. A root canal in the US on an incisor or canine varies, but about $600 is the mean. That's a lot more than 43 pounds sterling. Dental Insurance is not medical insurance in the US. They are not funded the same way and there is usually a maximum of $1,000/year. If US should go socialized with the upcoming Democrat, (read Hilary Clinton), President, dental like veterinary will most likely not be included due to the cost. People play the dental benefits game, i.e Root Canal in FY2006 and needed crown in FY2007. Those without coverage either pay out of pocket i.e. either recognize value of dentistry and somehow get the money or are wealthy. Medicaid is free to those who meet certain criteria i.e. need welfare due to joblessness, unemployability, mental retardation,drug abuse, etc. Medicaid pays like NHS. Most dentists either limit their medicaid patient population, do not take medicaid, or donate services to these indigent. Salaries vary from the multi-millionaire entreprenurial dentist/businessman to about $150,000 for the guy on the corner. More than 50% of the population do not get care because of fear or inability to pay out of pocket. Acceptance rates to therapy may also hover around 50% of the 50% who go to the dentist. Free care is offered at the VA system (veterans), but the vets must have a disability and there is a long waiting list. The care is at best limited and the bureaucracy is onerous, usually with the intent to find a reason to deny care(Personal experience). Free, excellent, and accessible dental care is offered to Active Duty military by specialists and generalists who average about $72,000/year give or take a few thousand. The patient in the military system gets the best treatment available. Their specialists are trained at the best dental schools, MCG for perio and UMKC for ortho and pedo to name a few. So US dentists and dentistry are at the top tier, except where the government is involved. Since the government is entrenched in the NHS, sub-standard care seems to be the norm. You also should consider the level of education between the UK and the US. In the UK, a dentist gets a Bachelor's in Dental Surgery, BDS, after a 5 year program, where tuition is affordable. In the US there is a pre-dental 4 year baccalaureate followed by a 4 year Doctor of Dental Surgery or Dental Medicine. Costs for education in the US are astronomical, $40,000 per year being about the norm. Do BDS dentists have the same financial investment? Set-up of most US dental practices is at least in the range of $300K or more. Academic dentists are respected in both systems. I don't think that you can get the same point of view at sci.med.dentistry as most of the contributors are in the US. Maybe you should start a NG that is about dentistry and the NHS/private dentistry in Britain and Ireland, then you would get more answers and information regarding your very important, and troubling, questions. > I don't know what the equivalent pound sterling is to USD. A root canal > in the US on an incisor or canine varies, but about $600 is the mean. [quoted text clipped - 44 lines] > dentistry in Britain and Ireland, then you would get more answers and > information regarding your very important, and troubling, questions. Thank you for an informed and informative reply. I wasn't meaning to get into a political debate when I posted my original question - but it's clear that one or two responders do have their own particular political axe to grind. I know nothing of dentistry in the US, so I can't comment on what happens there - although it seems clear that dental treatment is of a higher standard there than in the UK. A lot of money gets/has got poured into NHS dental treatment over here, and the end result is a nation with - generally speaking - poor teeth and poor dental health. If money goes in one end, and what come out the other is not of a very high standard then surely we have the right to question/criticise the bit in the middle - and from my own experiences alone I can see plenty to criticise. > > I don't know what the equivalent pound sterling is to USD. A root canal > > in the US on an incisor or canine varies, but about $600 is the mean. [quoted text clipped - 60 lines] > > - Show quoted text - I have heard about the NHS system in UK. In many way patient may not get the best treatment. I'm a dentist in Dallas Texas. I always recommend patient to save the tooth with Root canal and a crown. There are consequences when a tooth is pull. Often it can lead to additional tooth lost. The cost of replacing an extracted tooth always is more than saving the tooth. However root canal treatment is never a sure thing.....80% success at best. But if it is my own mouth I will have an root canal before extraction any time. Find someone who is good in root canal is very important..... Best wishes Albert in dallas >However root canal treatment is never a sure >thing.....80% success at best. I think the percentage is considerably higher than that. One of the keys is the final restoration. Without a good coronal seal even the best endo can fail. >But if it is my own mouth I will have >an root canal before extraction any time. Same here. >Find someone who is good in >root canal is very important..... No doubt the skill of the operator, and the anatomy of the canal space are significant factors in sucessful endodontic treatment. If money goes > in one end, and what come out the other is not of a very high standard > then surely we have the right to question/criticise the bit in the > middle - and from my own experiences alone I can see plenty to criticise. Certainly the people delivering the care are not blameless. However, they are being forced to work in a system that has no rewards for exemplary service. The system determines what type of dental care can be delivered while the dentist makes a profit. The dentist adapts the treatment to make money. I wouldn't work for free either. In my mind, the system is at least as much to blame as the dentists. Enough politics for me too. Have a great day, Steve Farmer Giles wrote:...can be quite expensive these days - it is probably more down to unscrupulous dentists. Often they are greedy and dishonest ................................. Farmer Giles, why do you come here seeking free advice from these dentists who try to help people through this site, then start calling them greedy and dishonest. I am not a dentist, but if I were I would leave this group due to the number of people like you who come here for free help, then argue and accuse the profession of being greedy. Go and pay for a second opinion your greedy self. Hummy. > Farmer Giles wrote:...can be quite expensive these days - it is > probably more down to unscrupulous [quoted text clipped - 7 lines] > Go and pay for a second opinion your greedy self. > Hummy. I think that's unfair. I wouldn't criticise anyone here who genuinely wants to help, and there *are* people here who do want to help and I'm very grateful to them for doing so. Most of the dentists who post here practise in the US, and my criticism was about UK dentistry and dentists - and only some of them. Do you think then that there are no dishonest dentists? >Do you think then that there are no dishonest >dentists? Do you think there are no dishonest patients ? >> Do you think then that there are no dishonest >> dentists? > > Do you think there are no dishonest patients ? I'm sure that there are patients who are dishonest, but I can't quite see how they could be, in the literal sense, 'dishonest patients' - unless of course they steal something out of the waiting room! >>> Do you think then that there are no dishonest >>> dentists? [quoted text clipped - 4 lines] >see how they could be, in the literal sense, 'dishonest patients' - >unless of course they steal something out of the waiting room! Never heard of theft of services ? >>>> Do you think then that there are no dishonest >>>> dentists? [quoted text clipped - 5 lines] > > Never heard of theft of services ? Not in a dentistry context I haven't. I'd be happy for you to enlighten me though. > >>>> Do you think then that there are no dishonest > >>>> dentists? [quoted text clipped - 8 lines] > Not in a dentistry context I haven't. I'd be happy for you to enlighten > me though. If you mean what I think you mean Newbie, we simply call them bad debts in the UK. Regards, George >> >>>> Do you think then that there are no dishonest >> >>>> dentists? [quoted text clipped - 14 lines] >Regards, >George In my practice (US) it gets them a trip to the judge. >>>>> Do you think then that there are no dishonest >>>>> dentists? [quoted text clipped - 8 lines] >Not in a dentistry context I haven't. I'd be happy for you to enlighten >me though. Patient walks out the door saying "I'm going to get my checkbook" and doesn't come back, or writes a hot check, or just plain says "I don't have the money" after treatment has been performed. These people get to see the judge. Or there is the ever popular insurance fraud where one impersonates another <only twice in my career> We have taken measures to eliminate these problems. >>>>>> Do you think then that there are no dishonest >>>>>> dentists? [quoted text clipped - 16 lines] > > We have taken measures to eliminate these problems. Ok, I sympathise, but what is your point? There are some dishonest people about - the prisons are full of them you know - but what has that got to do with dishonest dentists? Or do you think that one excuses the other? > >> because many dentists have stopped carrying out NHS work. > [quoted text clipped - 5 lines] > work. He said the payments were perfectly adequate, and that he could > make a very good living by being an exclusively NHS dentist. The NHS pays about as much as a large kebab portion for a filling and less than a playstation game for a root canal. I knew dentists that made a very good living by seeing 5-80 patients a day and treating them like cattle. If that's what your wife's dentist considers perfectly adequate then he's either an idiot or a brainwashed New Labour party member. British teeth are notorious around the developed world and so is the lack of modern cancer drugs and the spreading MRSA/Clostridium Difficile bugs in the hospitals. All the fault of a failing socialist health system remaining firmly stuck back in 1948 and not because of individual doctors/dentists/nurses. Regards, George >>>> because many dentists have stopped carrying out NHS work. >>> That should tell you something. [quoted text clipped - 18 lines] > Regards, > George Stateside, the hospitals are not exactly paradise either. There are a few stars, the rest--fuhgeddaboudit! Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >>>> because many dentists have stopped carrying out NHS work. >>> That should tell you something. [quoted text clipped - 18 lines] > Regards, > George I'd like to know where you get your kebab portions from? And of course things were so wonderful in the early part of the 20th century - before the 'socialist health system'. I accept the system is far from perfect, but there is no doubting that many doctors and dentists are overpaid and inefficient.I don't know what most dentists earn - but I would bet that there are very few poor ones about - and with many a GP on £100k per year largely for dishing out patent nostrums and sick-notes, it's no wonder the system is in trouble. > >>>> because many dentists have stopped carrying out NHS work. > >>> That should tell you something. [quoted text clipped - 27 lines] > year largely for dishing out patent nostrums and sick-notes, it's no > wonder the system is in trouble. Large house special kebab from my local shop (outside London I may add) = £7.50 1-surface filling on the NHS = £7.10 New playstation game = £32-45 Root canal treatment on an incisor/canine on the NHS = circa £31 Prices correct as of March 2006 (before introduction of new contracts) Root canal treatments on the NHS deemed unacceptable = 90% Root canal treatments in Ireland deemed unacceptable = 55% (I wonder why is that... oh, no NHS in Ireland, silly me) Average income of dentists in 2006: £41,000 (National office of statistics) Average income across all jobs in 2006: £28,000 Some other interesting statistics: If you were on a salary of let's say £24,000 (nothing extreme), you would pay £170 per month on National Insurance. With that money you could get private medical insurance from BUPA, unemployment insurance for your mortgage and have spare to put in a pension plan. Instead, you pay all this money and you get... zip, nada (if you're lucky you might get MRSA or your application for a wonder cancer drug politely rejected, unless of course you live in Scotland). The system is broken. Regards, George >>>>>> because many dentists have stopped carrying out NHS work. >>>>> That should tell you something. [quoted text clipped - 28 lines] > add) = £7.50 > 1-surface filling on the NHS = £7.10 £7.10? You can barely get to speak to a dentist for £7.10. My 22-year old student son went to the dentist the other day for a routine examination. In the surgery 8 minutes maximum, a quick look in his mouth - no x-rays or anything - no treatment required - cost, on the NHS, just under £16. That's what he had to pay to the dentist - who would get a further payment from the NHS. £7.10 - you're having a larf. > New playstation game = £32-45 > Root canal treatment on an incisor/canine on the NHS = circa £31 [quoted text clipped - 7 lines] > statistics) > Average income across all jobs in 2006: £28,000 £28,000 average income? You're having another larf. > Some other interesting statistics: > If you were on a salary of let's say £24,000 (nothing extreme), you [quoted text clipped - 6 lines] > > The system is broken. Largely because of greedy and dishonest practitioners like you. You know very well that the above figures are absolute twaddle. BUPA is subsidised by the NHS. Who pays for the training of the doctors/dentists/nurses that BUPA relies on? Not BUPA that's for sure. Unemployment insurance for your mortgage? What about all the other unemployment benefits that the state provides, would your private insurance pay for that? Pension? You obviously missed seeing all those private pension funds going up the duff a while back. The 'system' is first rate, but being destroyed by corrupt practitioners who could teach Arthur Scargill a thing or two about restrictive practices and industrial blackmail, that's for sure. Ok sorry, you are right. I'm a dishonest and greedy practitioner. Go back to reading the Guardian and don't forget to vote for Gordo on the next election. I'm sure he'll sort out all the problems his New Labour pals didn't cause. Oh, and by the way, it's BUPA that's subsidising the NHS. If it wasn't for BUPA and other private insurances, the NHS would have to cater for a lot more patients than it does now, and it's already heavily in debt. The system being "first-rate"? It's actually 18th according to the World Health Organisation, with many European countries well ahead of it. All the data I provided is verified and didn't come out of my mind. Do you have any reliable sources when you say it's all the practitioners' fault? Regards, George > Ok sorry, you are right. I'm a dishonest and greedy practitioner. Go > back to reading the Guardian and don't forget to vote for Gordo on the > next election. I've never voted for New Labour, nor would I - so you're wrong again. I called you dishonest because of the dishonest way that you presented your figures. I'm sure he'll sort out all the problems his New Labour > pals didn't cause. > > Oh, and by the way, it's BUPA that's subsidising the NHS. If it wasn't > for BUPA and other private insurances, the NHS would have to cater for > a lot more patients than it does now, and it's already heavily in > debt. No it isn't - you're confusing the fact that, yes, patients who use BUPA pay twice - but that's not BUPA subsidising the NHS. BUPA doesn't pay the cost of training its staff - that's largely done by the NHS - which therefore subsidises BUPA. > The system being "first-rate"? It's actually 18th according to the > World Health Organisation, with many European countries well ahead of > it. Largely because it's abused and exploited by many of those countries - amongst others. > All the data I provided is verified and didn't come out of my mind. Do > you have any reliable sources when you say it's all the practitioners' > fault? Yes, half a century of experience and observation. >>>> because many dentists have stopped carrying out NHS work. >>> That should tell you something. [quoted text clipped - 10 lines] > perfectly adequate then he's either an idiot or a brainwashed New > Labour party member. Or, of course, he could just be plain old efficient and conscientious! |
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