You And Your Dentist

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You and your dentist a guide for patients

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Contents

Introduction

1

Frequently asked questions

2

Glossary

11

Useful addresses

14

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 visit their dentist are well and have no symptoms. This can mean that a visit to the dentist is low on some people’s 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 the better. 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 and so 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 cover should 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 in Scotland 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 authority’s 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 NHS so 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 can’t find an NHS dentist and 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 who are 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 best way 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 more convenient 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 dentist before 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 encompass any 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 Crown (precious metal)

£ 9.16 £ 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 Seekers Allowance. 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 of NHS 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 Health Costs? 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 dentist and 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 money I 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 cosmetic treatments 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 treatments offered 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 GDC’s 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 ‘peer review’ 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. Denplan’s 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 almost certainly 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 one operated 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 treatment I 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 to hear 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 Council’s conduct committee finds a dentist guilty of a serious professional misconduct, the dentist’s 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 Association’s booklet Making a Complaint.

How do I complain if I am dissatisfied with the treatment I 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 compel dentists 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 Association’s 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 dentist’s 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 its own price;

•

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

•

Capitation: most dental plans, such as Denplan, charge a fixed 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 pay for 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 regular premium 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 dentist’s 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 for any 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 who carried 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 Abscess An 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.

Apicectomy An 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 teeth The colour of teeth can be lightened with hydrogen peroxide (bleach). Tooth bleaching is completely safe as long as your dentist’s instructions are followed.

Bridges A 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 peridontitis This is next stage on from gingivitis (see entry). Some of the bone that supports the teeth is lost due to gum disease which may 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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Crowns A crown completely covers a weak tooth above the gum line. Crowns are made of metal or porcelain, or porcelain with metal inside for strength.

Endodontics Endodontists 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.

Extraction This 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).

Gingivitis This is inflammation, redness and swelling of the gums. It is caused by plaque and tartar deposits and can be treated by thorough brushing at home and professional cleaning.

Halitosis Halitosis is bad breath often caused by oral bacteria. Good oral hygiene and attention to diet can help, and your dentist can advise.

Implantology Missing teeth can now be replaced by titanium or porcelain fittings screwed or fitted into the jaw. The result is often indistinguishable from a natural tooth. The alternatives, dentures and bridges, can thus be avoided.

Oral surgery Oral 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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Orthodontics Orthodontists 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.

Peridontology Peridontology 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 by peridontologists.

Root planing and curettage Root 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 teeth Wisdom teeth are the last teeth to appear at the back of the mouth from late teens onwards. A common problem is lack of space.

Veneers A 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 Street London 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 Peter’s Road Rugby Warwickshire CV21 3QP Phone 01788 546365 Fax 01788 541982 Email [email protected] www.dentalhealth.org.uk General Dental Council 37 Wimpole Street London W1G 8DQ Phone 020 7887 3800 Fax 020 7224 3294 Email [email protected] 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 Email [email protected] www.dpb.nhs.uk

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NHS Direct Phone 0845 46 47 www.nhsdirect.nhs.uk Patients Association PO Box 935 Harrow Middlesex HA1 3YJ Helpline 0845 608 4455 Fax 020 8423 9119 Email [email protected] www.patients-association.com Denplan Ltd Denplan Court Victoria Road Winchester SO23 7RG Phone 01962 828000 Fax 01962 84084 Email [email protected] www.denplan.co.uk

Date of publication: October 2001

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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 Designed and printed by Direct Design