You and your dentist

8/14/2019 You and your dentist

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You and

your dentist

a guide for

patients


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Introduction 1

Frequently asked questions 2

Glossary 11

Useful addresses 14

Contents

This booklet is supported by an educational grant from


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Introduction

Going to the dentist is not like going to the doctor. Most people only

go to the doctor when they are unwell, whilst most people who visittheir dentist are well and have no symptoms. This can mean that a

visit to the dentist is low on some peoples list of priorities. Anxiety

and fear about going to the dentist can also put people off making

the appointment. Some people do not know how to find a dentist,

whether to be treated on the NHS or privately, what kind of service

to expect from the dentist, what treatments are available, and what

to do if something goes wrong.

The Patients Association believes in patient choice but you can only

decide what is right for you and your family by having access to

accurate and independent information. This booklet aims to answer

the most common questions about dentistry and to help you to

make informed choices about your dental care.

Over the past 30 years, dental health has improved considerably.

In 1968 about 20% of adults had no natural teeth left. By 1998, this

figure had dropped to only 8%. More comfortable treatment,

fluorides in water and toothpaste, and a greater awareness of the

benefits of healthy teeth have all contributed to this change for thebetter. Nevertheless, there remains room for improvement.

According to government figures, only about 50% of us visit a

dentist regularly. Thirty per cent go irregularly or only when in pain

and 20% do not visit a dentist at all.

With regular visits to the dentist, a healthy diet and good self care,

most dental disease is preventable. Maintaining the best dental

health for life is the objective of modern dentistry. We hope that this

booklet helps you and your dentist to achieve this goal.

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Frequently asked questions

How many dentists are there in the UK?There are about 30,000 dentists registered with the General

Dental Council in the UK. Of these, about 18,000 work in

general practice and about 4,000 work in hospitals,

community clinics, educational establishments and

such like.

Why is dentistry not free at the point of delivery?When the NHS was set up in 1948, there was a nine month

period when dentistry was genuinely free. However, the

government at the time had grossly underestimated the

number of people who would seek dental treatment andso began to charge patients a flat rate of 1.00 for all regular

dental treatment. Since then, dentistry has always

maintained a fee structure.

How do I find a dentist?Most people find dentists by asking family, friends,

neighbours or colleagues for a recommendation.

Alternatively, you can look in the Yellow Pages where

dentists practising in your area will be listed, or you can

contact NHS Direct (see Useful addresses) or your local

Health Board in Scotland which will have a list of NHS

dentists in your area. Lists of both NHS and private dentists

are available from public libraries. If you have special needs

(for instance if you are very frightened of seeing a dentist

or if you need a particular specialty) you can call the British

Dental Association or the British Dental Health Foundation

or visit their websites. Both these sites have a search

facility to enable you to find a dentist in your area (see

Useful addresses).

What should I look for in a dental practice?It is a good idea to visit the dental practice you are

interested in before you register. A good practice should be

clean and tidy and the staff courteous and welcoming. Ask

whether NHS and/private patients are accepted and what

treatments are available. A good dentist will ensure that

regular check-up or treatment appointments are available

within a reasonable time and that emergencies are normally

available within 24 hours. Out of hours emergency covershould be available. Opening times should be broadly

convenient for patients.

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The dentist should be friendly and communicative. He or she

should put you at your ease, listen to your concerns and discuss

any questions you may have. Treatment options should be outlined

and the risks involved explained. Cost implications should be

addressed openly.

Examinations should be thorough and should include your teeth,

the condition of your gums and examination of the mouth lining.

Any previous medical or dental conditions or problems should be

taken into consideration.

Plans for future treatment should be written down for you in certain

circumstances or on request.

The roles of other staff in the practice, such as dental hygienists

or health educators and their part in your treatment, should

be explained.

Good dental treatment should be unhurried, caring and as gentle

as possible. There should be committed attention to pain control

during and after treatment.

How do I find an NHS dentist?

NHS Direct (see Useful addresses) or your local health board inScotland will have a list of all the NHS dentists practising in

your area. They should be able to provide you with a list of

names of addresses but they will not be able to make any

recommendations. You can also look in Yellow Pages where

some NHS dentists advertise.

Do I have a right to NHS treatment?There is no obligation for dentists to offer you NHS services even

though they are included in a health authoritys dental list. Dentists

are independent practitioners who are free to choose whether they

accept NHS patients, private patients or both. Once you have found

an NHS dentist who will accept you as an NHS patient, then the

NHS will contribute to the cost of treatment you receive. Once you

have been accepted and have registered with your dentist, you are

entitled to receive NHS treatment from the dentist you registered

with for the registration period of 15 months. If your registration

lapses (usually due to non-attendance) then the dentist can decide

whether to accept you for NHS treatment again.

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Is it difficult to find an NHS dentist?Over the past few years in many areas of the country, some

dentists have reduced their NHS commitment. However,

more than half of the family dentists in the UK are still

seeing three quarters of their patients under the NHSso NHS dental treatment is being provided. If you have

difficulty finding an NHS dentist, ask NHS Direct or your

health board for help.

What if I cant find an NHS dentistand need treatment urgently?

NHS Dental Access Centres have been established in many

areas. These offer NHS treatment and their priority is the

treatment of emergencies and seeing those patients whoare unable to access NHS care elsewhere. You can find

your nearest Dental Access Centre by calling NHS Direct

(see Useful addresses). NHS Dental Access Centres only

provide emergency treatment during normal working hours.

Out of hours this is provided by the Emergency Dental

Service. Contact NHS Direct for further information.

How do I find a private dentist?Unlike NHS dentists, private dentists are not listed with

NHS Direct. Personal recommendation is usually the bestway to find a private dentist or you can look in Yellow Pages

where private dentists will often advertise. Some companies

offering dental plans keep listings of dentists who are

registered them. You can also look at the websites of

the British Dental Association, the British Dental Health

Foundation or Denplan (see Useful addresses).

How do I find a specialist?If you have special needs, your own dentist should be able

to refer you to a specialist if he or she does not offer these

services themselves. Alternatively, you can contact the

British Dental Assocation who will be able to help you

(see Useful addresses).

Can I go to any dentist?Yes you can. Dentists, unlike doctors, do not have a

catchment area. If you are registered with a particular

dentist and move out of the area, you do not need to change

your dentist if you do not want to. It may be moreconvenient to register at a dentist near your work.


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Can I mix private and NHS treatment?Yes you can. All dentists in general practice are free to provide

treatment to patients either on the NHS or privately. This does

not apply to dentists employed by health authorities in Dental

Access Centres or clinics. Discuss the options with your dentistbefore you embark on treatment and obtain a written statement

outlining which treatment is provided under each system and

the associated cost.

Can I have any sort of treatment on the NHS?No. There are some treatments, particularly some cosmetic

treatments, that are not available on the NHS. You are entitled to be

offered the treatment necessary to secure and maintain your dental

health as an NHS patient. This does not necessarily encompassany kind of treatment. The individual dentist will advise you on

what treatment is available on the NHS to ensure your dental

fitness. They may also suggest alternative treatment under

a private arrangement.

How much does NHS treatment cost?The following figures are meant as a guide. They are correct until

31st March 2002. The actual amount may vary according to the type

and amount of treatment provided.

Check-up 5.12 Check-up and 2 small X-rays 8.64 Check-up, scale and polish 13.20 Check-up, 2 X-rays and a scale and polish 16.72 Filling (silver in back tooth - large) 14.08 Filling (white in front tooth) 10.28

Extraction 9.16 Crown (precious metal) 70.72 Dentures (full set upper and lower) 111.16 Maximum NHS charge 360.00

Who has to pay for treatment?Everyone has to pay unless they are entitled to free treatment.

People exempt from paying NHS dental charges include:

Children under 18 years of age; Young people under 19 in full-time education; Women who are pregnant or who have a child under 12 months;

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Anyone receiving Income Support or Job SeekersAllowance. Some people receiving Working Families Tax

Credit or Disabled Persons Tax Credit may be also be

entitled to free treatment;

Families with a certificate for full help with the cost ofNHS services.

Pensioners, the unemployed or students are not

automatically entitled to free treatment unless they come

under one of the above categories or if they can claim for

help with charges because of low income. You should ask

your dentist or the receptionist for an HC1 form or pick up

an HC11 form entitled Are You Entitled to Help with HealthCosts?These are available from post offices.

Who sets charges for NHS dental treatment?The Government sets NHS dental charges. Patients who

are not entitled to free treatment from the NHS have to pay

80% of the cost of treatment up to a maximum of 360.00

(up to 31st March 2002 - this figure is reviewed on an

annual basis).

How much does private treatment cost?Private fees are set by each individual dentist. There are no

national guidelines to regulate the cost of private dental

treatment. Private fees are a contractual matter and must be

agreed between the dentist and the patient. Your dentist will

explain to you before treatment starts what the fees are and

how they are calculated.

Why are there variations in the price

from one practice to another?Private charges will relate to the overheads of the dentistand to the variety of treatments available. Costs may vary

across the country and may reflect the differences in

expenses from one area to another.

What can I expect to get for the extra moneyI am paying to my private dentist?

If you choose private treatment your dentist may be able to

offer you a wider range of treatments than can be obtained

with NHS services. This is particularly true of cosmetictreatments such as white fillings or porcelain crowns on

back teeth that are not available on the NHS.

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Private care should also mean that your dentist has more time

to spend with you and can therefore provide you with a more

personal service.

How can I tell that private dental treatmentsoffered to me are what I really need?

Everyone has individual needs and a good dentist should give you a

full explanation of what has been found when your mouth is

examined. A discussion should then take place between you and

your dentist looking at the treatment options and costs. You can

then agree a treatment plan with your dentist proceeding only once

you completely understand, and are happy with, what is proposed.

It is a useful practice to ask for a written treatment plan so that

you have a record of what has been agreed and how the treatment

will proceed.

Are there any controls on dentists?All dentists, both NHS and private, are regulated by the General

Dental Council (GDC). They must abide by the GDCs guidance on

professional and personal conduct, Maintaining Standards.

In recent years the NHS has introduced Clinical Governance which

requires all dentists to consistently review the quality of their work.

They do this through regular updating at courses, through peerreview where they compare their results with other local dentists,

and by clinical audit where they measure the quality of the results

they obtain in their practice. This currently only applies to

NHS dentists.

Some private schemes and the British Dental Association now also

provide accreditation for dentists. In general, accreditation means

that the dentist has undertaken to meet certain professional

standards and, in some cases, has agreed to be regularly inspected.

Denplans Excel accreditation scheme operates throughout the UK

and accredited dentists must agree to thorough annual inspection of

their practice to standards approved by the Patients Association.

Patient records are also reviewed for good treatment and patients

are given an Oral Health Score which measures the continuing

health of their mouth and ensures thorough examinations. Patients

are also regularly consulted for their views about the services

provided by the accredited dentist.


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What does the dentist expect from me?You should try not be late for your appointment and, if you

are unable to keep an appointment, give the dentist good

notice. Dentists often have to work to tight time schedules

and if you are late, or miss an appointment, this will almostcertainly inconvenience other patients and result in a direct

loss of income to the practice and its staff. Dentists may

charge for appointments missed without good notice.

This applies to NHS and private practices.

Do explain your dental problems to your dentist as clearly

as you can. This helps your dentist to make the correct

diagnosis. It may help to write this down in advance.

If you are taking medicines or having other treatment, let the

dentist know and take along any medicines of which you are

unsure of the name or purpose to show your dentist.

If you are very nervous, let the practice know in advance.

They will be sympathetic and will have the opportunity to

allow extra time for you.

Dentists often operate out of hours schemes which they may

organise themselves or there may be a local rota or oneoperated by the NHS. Only contact the dentist out of hours if

there is a genuine dental emergency and bear in mind that

certain treatments can only be carried out during normal

hours when support staff are available.

How do I complain if I am dissatisfied with the treatmentI have received from my NHS dentist?

If you have a complaint about the treatment you have

received from an NHS dentist, discuss this first with the

dentist who may be able to resolve the issue. The services

of a Dental Reference Officer may be used. A Dental

Reference Officer is an official dentist who can examine

patients and assess the quality of completed work. Your

NHS dentist can arrange this examination.

If you are not satisfied with the result you can ask the health

authority for an independent review.

In serious cases a Complaints Panel may be convened tohear the complaint formally and, ultimately, the Health

Ombudsman may hear appeals against a decision of the

Panel. These bodies may order a refund of NHS fees paid


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and must publish their findings, in confidence, to you and

your dentist.

In particularly serious cases, a complaint may be brought to the

General Dental Council. If the Councils conduct committee findsa dentist guilty of a serious professional misconduct, the dentists

professional registration may be suspended or erased. The Council

cannot, however, order compensation or repayment of fees.

Do ensure that you make your complaint in writing and that you

keep notes of face-to-face discussions and telephone conversations.

You may wish to have somebody with you when you make your

complaint to help you make notes. Remain calm and polite but do

be firm and persistent.

For further information ask for the Patients Associations booklet

Making a Complaint.

How do I complain if I am dissatisfied with the treatmentI have received from my private dentist?

In private practice, complaints should firstly be brought to the

attention of the dental practice concerned. Some dental plans,

such as Denplan, may help to look into complaints if they are not

resolved at practice level but they do not have powers to compeldentists to provide solutions to issues. Such plans can, however,

exclude offending dentists from their accreditation schemes.

Otherwise, private patients will need to take their case to law. In the

first instance you should seek advice from a Citizens Advice Bureau

or consult a solicitor. Bear in mind that legal actions may be

expensive to bring and can take considerable time to conclude.

For further information ask for the Patients Associations booklet

Making a Complaint.

Can I get a second opinion?Sometimes you may want to obtain a second opinion about your

condition or the treatment recommended by your dentist. You may

wish to arrange to see a dentist who specialises in the particular

problem, either working in a specialist practice or in hospital.

See How do I find a specialist, page 4.

How are private dentists fees structured?Private fees should always be explained in advance of commencing

any work. Many practices have a list of typical private fees. Private

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fees may be charged for in three ways:

Fee per item: each type of treatment or care has itsown price;

Fee for time: charges are related to the time taken forthe treatment: some materials costs may be charged

in addition;

Capitation: most dental plans, such as Denplan, charge afixed monthly fee which varies according to the amount

of work expected to be needed by a particular patient.

The monthly cost is predictable and covers most routine

work (usually not cosmetic work or implants).

In most cases, prescriptions and laboratory fees (for crowns,bridges or dentures, for example) are charged for separately.

What methods are available to me to payfor private dental treatment?

You can pay directly to the practice for each course of

treament. Most practices will ask you to settle your bill as

each stage of treatment is carried out.

Another option is to take out dental insurance. A regularpremium is paid, usually monthly or yearly, and when

treatment is needed a claim form must be obtained, filled in

and returned to the insurers with the dentists bill. It is

usually necessary to pay the dentist yourself and then claim

back the cost.

Make sure that you read the terms and conditions of the

insurance in advance before completing your application

and check with your dentist how much of his or her fees

would be covered by the insurance. Check your policy forany exclusions such as problems evident at the time of

taking out the insurance.

Another option is dental loans - some practices can offer

special loan arrangements run by financial organisations

tailored to cover the costs of dental treatment.

Can I gain access to my dental records?You have a legal right of access to your dental records,

subject to certain rules. The dentist must give access within

40 days of a request for access from the patient. Patients are

also entitled to copies of records, again subject to certain

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rules. Dentists may charge a reasonable administration fee for

copying records.

Can I take my records from my old dentist to my new one?

No. Original dental records are normally kept by the dentist whocarried out your treatment. It is a legal requirement for the dentist to

keep your records for a certain period of time.

A new dentist will make new records for you relevant to his or her

diagnosis and appropriate to the treatment undertaken.

Can my dentist give me a general anaesthetic?Only doctors who are specialist anaesthetists can give dental

anaesthesia.

Where can I get a general anaesthetic for my dental treatment?You may be given a general anaesthetic in hospital

or at a specialist clinic.

Glossary

AbscessAn abscess is an infection located at the root of a tooth. Abscesses

are very painful and, if not treated with antibiotics, draining or

apicectomy, can lead to the loss of the tooth.

ApicectomyAn apicectomy is the process by which the dentist cleans out an

abscess at the root of a tooth. This is normally carried out on a

tooth that has already been root-filled.

Bleaching teethThe colour of teeth can be lightened with hydrogen peroxide

(bleach). Tooth bleaching is completely safe as long as yourdentists instructions are followed.

BridgesA bridge replaces a missing tooth (or teeth) by fixing the

replacement to the natural teeth at each side of the gap. Bridges

are made of metal and porcelain or sometimes just porcelain.

Chronic peridontitisThis is next stage on from gingivitis (see entry). Some of the

bone that supports the teeth is lost due to gum disease whichmay cause the teeth to have to be taken out. This condition may

be avoided or treated by good oral hygiene and root planing

(see entry).


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CrownsA crown completely covers a weak tooth above the gum

line. Crowns are made of metal or porcelain, or porcelain

with metal inside for strength.

EndodonticsEndodontists specialise in root filling teeth. Teeth which are

seriously damaged or where the tooth nerve has died or

has become infected (abscessed) may need root filling

to survive. This treatment has become increasingly complex

and demanding and whilst general dental practitioners may

be able to carry out routine endodontics, more complex

cases may need referral to a specialist.

ExtractionThis means taken out. Teeth are generally only taken out if

they are very decayed or damaged or sometimes for

orthodontic reasons to create more space in an otherwise

crowded mouth (see also Peridontology).

GingivitisThis is inflammation, redness and swelling of the gums. It is

caused by plaque and tartar deposits and can be treated bythorough brushing at home and professional cleaning.

HalitosisHalitosis is bad breath often caused by oral bacteria. Good

oral hygiene and attention to diet can help, and your dentist

can advise.

ImplantologyMissing teeth can now be replaced by titanium or porcelain

fittings screwed or fitted into the jaw. The result is oftenindistinguishable from a natural tooth. The alternatives,

dentures and bridges, can thus be avoided.

Oral surgeryOral surgery involves the jaws or face, the removal of

wisdom teeth, cysts, buried tooth roots and other problems.

Surgical dentists are specialists who have completed

additional training usually in practice. Oral surgeons are

usually hospital consultants who are trained both in

medicine and dentistry.

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OrthodonticsOrthodontists specialise in straightening or correcting the growth

of teeth. Although in the past this service was only usually

available to children, today it is not uncommon for adults of any

age to benefit from modern orthodontic treatment. Treatment may

involve wearing removable or fixed appliances (braces) which

gently reposition teeth over a period of months. Treatment may be

quite lengthy and involves good oral hygiene and co-operation by

the patient.

PeridontologyPeridontology concerns itself with the treatment of gum diseases

and disorders. Whilst mild gum problems may be treated in

general practice, more complex cases are dealt with byperidontologists.

Root planing and curettageRoot planing and curettage is used to scale parts of the teeth

below the gum line that cannot be reached with a toothbrush. It is

used to treat pockets of infection and peridontal gum disease.

Wisdom teethWisdom teeth are the last teeth to appear at the back of the mouth

from late teens onwards. A common problem is lack of space.

VeneersA veneer is a thin layer of tooth-coloured material that is put onto

the front of the tooth to make it look better, either to correct the

shape or colour of the tooth.


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Useful addresses

British Dental Association

64 Wimpole StreetLondon

W1G 8YS

Phone 020 7935 0875

Fax 020 7487 5232

Email [email protected]

www.bda-dentistry.org.uk

Word of Mouth Helpline 0870 333 1188

British Dental Health Foundation

Eastlands Court

St Peters Road

Rugby

Warwickshire

CV21 3QP

Phone 01788 546365

Fax 01788 541982


www.dentalhealth.org.uk

General Dental Council

37 Wimpole Street

London

W1G 8DQ

Phone 020 7887 3800

Fax 020 7224 3294


www.gdc-uk.org

Dental Practice Board for England and Wales

Compton Place Road

Eastbourne

East Sussex

BN20 8AD

Phone 01323 433550

Fax 01323 433517


www.dpb.nhs.uk

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NHS Direct

Phone 0845 46 47www.nhsdirect.nhs.uk

Patients Association

PO Box 935

Harrow

Middlesex HA1 3YJ

Helpline 0845 608 4455

Fax 020 8423 9119


Denplan Ltd

Denplan Court

Victoria Road

Winchester

SO23 7RG

Phone 01962 828000

Fax 01962 84084


Date of publication: October 2001

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Notes


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Patients Association

PO Box 935 Harrow Middlesex HA1 3YJ

Tel: 020 8423 9111

Fax: 020 8423 9119

Helpline: 0845 608 4455

Email: [email protected]

www.patients-association.com

Registered charity no. 1006733

Written by Mary Hicks

You and your dentist

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