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amused

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  1. Even if it was I wouldnt look on that suspiciously. But as I said, I know dentists at my place that were seeing new patients in the weeks leading up to a departure. They were often building a "list" for the next dentist to take over. That said there is no registration anyway so you are only "registered" for the duration of your course of treatment. If that course only lasted for 3 fillings then thats all the time she had a responsibility to you legally speaking. Labours new contract shifted all patients over to the responsibility of PCTs and LHBs in wales so you are only "registered" with them anyway. On the subject of sudden moves I have known dentists start working in a practice then 2 weeks later leave as a better offer came along. Like i say, regardless of your experience dont read too much in to that. For a more accurate opinion check out the disciplinary hearings at the GDC. They have the information as public access on their website
  2. Its quite common for a dentist to move practices. They will also continue to see patients up until they leave. They would normally try and avoid taking on patients that need a lot of work though as they would be unable to complete it. They may not have had a new dentist arranged to take over hence you seeing her. People leave for a variety of reasons. They are still human after all I know people that have left one place to go part time somewhere else. Take a hospital job, dislike the principal. A higher UDA value on offer in another practice. Lots of reasons. But as I say, you would still be likely to be booked in with them even if they are planning to leave. Often, dentists may not plan to leave but something just pops up that was appealing. If their principal is happy they can leave early. My principal for example has made it clear that if we need to move on he wont hold us down. Just complete the courses of treatment we have open and they we can leave.
  3. Hi Cells. without seeing the tooth it is difficult to say for sure if its cracked tooth. I find a good test is to bite on a cotton wool roll hard. Release. If you have pain on release it is often cracked tooth. I would be careful in saying its due to the filling though. I had a patient in today that has never had a filling in this tooth and it literally split down the middle. Cracked teeth are not just ones in filled teeth. Fillings do weaken the tooth and amalgam fillings will make a tooth more prone simply because it is a space occupier not a binding material. Teeth can take a little while to settle after fillings but 5 - 6 months does seem a long time. So too does immediate pain that lingers. My feeling is you may ave a couple of things going on. Possible a cracked tooth in one and irreversible pulpitis due to pulp irritation that does not abate. The one that is just sensitive to cold I would worry less about. That is likely to see reparative dentine forming and walling the nerve away from the cold stimulus. Its common for this in deep fillings because the buffer between the nerve and the outside world is less. also the amalgam is metal and so conducts thermal stimulation easily. As I say though, it is difficult to diagnose properly without seeing the teeth and doing the various tests we have available
  4. I simply can not agree with you on the idea that if it doesnt hurt its fine. It isnt like that. I know people that have died of cancer which initially didnt hurt them but would one say there was nothing wrong? You may scoff at that but it IS like that more often than you will care to admit. That isnt to say I do not agree with you that there ARE problems. I see work I think is woeful quite often and its left to me to put it right which is a lot more stressful than one would usually care to admit. I think there are a combination of factors not just the system being bad or the dentist being bad. Each individual case of what some may consider as bad dentistry would need to be considered. It may be, as is often stated ... a shoddy system that perversely penalises dentists for doing quality or advanced work. It may be a lazy dentist that simply cant be bothered. It may be a tired one on patient number 45 of the day missing something. I can not give sweeping generalisations nor would I like to give specific reasons. All I can do as an individual is try my best to practice dentistry that is evidence based, I am competent at undertaking and stay up to date with modern techniques and materials. re Poland... there are excellent dentists there just like there are rubbish ones. Same as here. I have seen a few eye opening/watering cases from there that would not have been my chosen treatments shall we say.
  5. Cells cracked teeth are a nightmare to manage. It all depends on where the tooth is cracked and how deeply it runs. Even then they are often impossible to see. I have a microscope so it makes the job a little easier but even then, seeing it doesnt mean it is fixable. Its generally a wear and tear problem due to the teeth flexing in function. White fillings can help but thats not to say they WILL. What wlll NOT help is amalgam ones due to the reason you have alluded to elsewhere ... they do not stick to the tooth. Can I just say how impressed I am that you were not impressed at the antibiotics. In a case such as yours the symptoms would have pointed me towards an inflammation rather than infection. As such they would have been useless. Quite the opposite in fact in todays world of resistance. I had a lad in once, 17. One small filling in his Upper left first molar tooth. It has been there a few years and he started to get some symptoms. X Rays showed no decay so I offered to remove the filling and see what was going on under the filling. When the filling was taken away literally half the tooth fell off. I think a little dose of saliva surface tension and some blind optimism was keeping the fragments there. We placed a white filling with a view to review for a crown in the future but he has been fine ever since and wants to leave it. It started with pretty much an intact tooth though and due to normal function it developed a crack all along the outside wall.
  6. Dave what exactly was pretentious about the post? From what I could see it was just a post pointing out some facts. Not praying on anything. Would you prefer us as dentists to NOT tell you that there are other problems despite everything LOOKING ok? That would IMO be rather unprofessional. If you decide not to act on advice thats fine but your hostility is not very helpful when someone is simply trying to explain the view from the other side of the bridge. I appreciate you may have had some bad experiences but I would hope that you could at least not tar everyone of us with the same brush. Some of us actually care and want to provide a high quality service. You may find the financial aspect very distasteful ... but everyone has to earn a living. Its not like we are pimping out prostitutes! In an ideal world everything would be free and no one would have and tooth problems. We do not live in an ideal world sadly.
  7. SOrry I have been away for the weekend. Why do you view the treatment as unnecessary out of interest? You do know you would be saving the dentist a packet by only having one done dont you? They would bite your hand off for that approach. We are paid per course of treatment. That means that when you come to see us for an examination that opens a course of treatment. We have to offer to provide what is needed to stabilise your condition. That is not the same as the previous contract. That may mean dressing all dental decay with a good temporary filling while we improve oral hygiene as one course then another to place final fillings for example. Now the thing is, we get credited one set amount of activity points depending on the band of treatment irrespective of how many items of treatment is carried out. That is why so few dentists are keen to take on new patients. Just because the payment stays the same doesnt mean costs do. If one person needs 10 fillings and one needs 1 ... they both "earn" 3 UDAs but the patient needing 10 fillings costs the dentist more in materials and clinical time therefore staff pay, bills etc. Now if you insist on having one done when potentially many more are needed then I doubt the dentist will force you to have more done as they wont be paid extra for doing the extra if that makes sense? Now it is hard for me to advise you what to do one way or another as I have not seen your mouth. I would expect the dentist to tell you what they see as being needed and how they can fix the problems. It is up to you to accept treatment or decline. BUT ... do not base .... and this applies to everyone DO NOT BASE DENTAL NEED ON PAIN OR LACK OF IT! I have lost track of the number of people that fail to come back to see me for treatment because "it wasnt hurting" and then come back to see me for a far more invasive/uncomfortable procedure that would have been avoided had they come to see me at the time when I diagnosed the problem. By the time teeth start to hurt its often too late for simple things. Toothache in laymans terms is often that which keeps you up at night. That is only dealt with in 1 of 2 ways. Extraction or, if the tooth is suitable for restoration after ... root canal treatment. for a tooth to get to this stage normally would have taken months/years of ever advancing decay .... which VERY often does not cause ANY symptoms. You MAY get the odd sensitive feeling but very often you do not. With the case of broken teeth. The dentine of a tooth is composed of thousands of tightly packed tubes called tubules. Once the enamel cap is removed bacteria can have straightline access to the nerve and kill it off over time. Bacteria can and will invade it. This leaves you with the options of extraction or root canal treatment. IF these conditions were identified and managed earlier then you could more than likely avoid these problems. Thats not a guarantee. A few people have commented on here that they actually get pain after fillings. Well yes thats quite possible. When bacteria invade a tooth via decay they get close to the nerve. The nerve does its best to avoid the bacteria getting at it but it can only do so much. If the action is taken to remove the decay then this can cause what was a symptomless inflammation to become symptomatic. Its not the filling, it was the decay in the first place that just happened to be a quiet destruction. It got too close to the nerve and it flared up ... as a very annoying coincidence. Sometimes you can predict it sometimes you cant. At no point do you deliberately plan for it! Moving on to the subject of root canal therapy. Some on here have suggested that dentists only do them for money. Highly unlikely in my opinion. If the dentist is NHS in wales or england ... not a hope in hell was it done for money. More likely it was AVOIDED for money. The reason I say this is because dentists are not paid to do them full stop. A root filled tooth can not be left open. All the root filling does is obturate the canal space so to seal this off you need either a filliing or a crown on top of the tooth. Therefore It is either a band 2 or a band 3 course of treatment. SO I hope you can follow this ... if fillings and root fillings are both band 2 ... and you only claim 1 band regardless of the number of items ... you get 3 UDAs for a filling and you get 3 UDAs for a root fillings and a filling. Likewise you get 12 UDAs for a crown and you get 12 for root filling and crown. Equally you get 3 UDAs for taking the tooth out. SO As it SHOULD take a minimum of an hour to do a root filling ... and thats going quickly ... and it should take about 10 minutes for the extraction .... logically the dentist is not offering the root filling for the cash incentive! Equally A pack of files to shape the tooth inside costs around £30 for a cheap system, the hand piece to use them in costs around £1500, Rubber dam kits cost a couple of hundred with it all in ... root fillings are NOT the money earner you may think they are. They actually make a loss. Privately where the costs can be absorbed they are still not big earners. Not as much as other treatment items can be. Also I know very few dentists that actually like doing root fillings. The treament is fiddly, time intensive, fraught with a tooth anatomy that is often impossible to see without highly expensive magnification systems ... and its not a guaranteed success. Personally I love doing them, I see them as a rewarding challenge personally to take a person from pain, to no pain then to having a functional tooth again. Few have the same approach. But believe me ... They are not done to earn a few easy notes! Quickly I would like to touch on x rays. Cells doubts that we can see caries/decay on a 2 D image. Well sometimes we cant. But often we can. It shows up as a dark area within a tooth http://vanumu.com/wp-content/uploads/2009/03/image47.png In this X ray you can see the solid nature of healthy teeth i.e. how they SHOULD look http://www.physicsconsultantsinc.com/images/teeth.jpg These 2 images are known as bitewings. On the left it is fine but in the right image you can see on the bottom right tooth ... decay http://www.cdhb.govt.nz/dentalcare/images/decay.jpg THis image shows a dark shadow at the end of a tooth that has a dead nerve and requires root canal treatment http://www.toothiq.com/dental-images/dental-x-ray-tooth-abscess-infection-numbness-swelling.jpg Cells, you are very up to speed on your comments about white fillings. The one thing I must take issue with is they are not suitable for all cavities. They are not as strong as we would like and as such, cast or lab made solutions such as inlays, onlays and crowns would be better in large situations involving a loss of cusps of the teeth. Also where isolation is difficult i,e, keeping the field dry in a patient that finds the available options too much for them to manage; white fillings should be avoided as they require a dry clean field. In patients that experience high levels of decay then composite white fillings are not suitable. Amalgam actually helps prevent decay as the silver inhibits some bacteria. Its all viewed on a case by case approach though. I am deliberately NOT commenting on safety. I dont want to go on all night about it LOL, Just as a final observation ... NHS and NI ... I know everyone thinks that by paying NI they should get free dentistry. Well, the people to talk to are probably dead now. NHS dentistry was only free for I believe 2 years ish. Shortly after the introduction of the NHS, HMG introduced patient charges in dentistry. I can not really speak of the new contract as its a mess ... but prior to this all the NI contributions gave was a 20% contribution to a set price. Dont blame me I am merely pointing that out
  8. With your first paragraph you show me exactly what a good diet can do ... and I am hoping exposure to fluoride ... although I am guessing possibly not? We know that frequency and amount of sugar directly affect the amount of decay so decrease it and you remove the food that the bacteria use to decay teeth, thus no decay. I do not for one second buy that sites idea that bacteria is not responsible for dental caries. If it wasnt then why would substrate removal stop decay? I do not have the benefit of seeing your mouth or indeed your mouth at 15 so I can not comment on your individual case. I can however comment on the approach I take. If it is small and only in enamel then I would give diet advice and apply fluoride topically. This is shown to strengthen and facilitate remineralisation of enamel. If it is in to dentine then usually it has gone a bit too far. The bugs can then crack on with their illegal raves out of sight and progress a carious lesion happily with shelter and a steady stream of substrate. There are apparently some studies showing treatment with ozone is leading to remineralisation of even these ... following initial removal of completely destroyed dentine. However not many dental practices have access to these machines which cost tens of thousands of pounds. Following this cautious approach I would normally review the patient in 3 months and assess any changes. The work showing completely sealed decay arresting is all well and good but I would need to be positive that the bonded sealant restoration I placed over the top is perfect. Usually I can not be that positive because we are talking a gap of microns in size being the difference as far as bacteria is concerned. The problem I and many dentists face is patient compliance. A carious lesion should in theory progress quite slowly. However I have many patients that develop new ones on a weekly basis it would seem! No amount of brushing advice and diet advice will do much good if they dont listen or actually do it. That said, you are quite right about fillings and crowns can potentially kill the nerve off in teeth. I completely agree that being able to avoid treatment is better but when it is indicated it needs to be done and done well. Its all about balance. That brings me on to root canal treatment. If done properly then they DO work. Sure not so as every single tubule is accessed and cleaned. Thats an impossibility at the stage of development we are at. Thats not to say we can not clean them at all. Ultrasonic activation of sodium hypochlorite can in fact cause some penetration of these tubules. My bone of contention with endodontics is precisely related to the comments you have made. The process, once all the anatomy is discovered is simple. Isolate the tooth and leave it soaking with bleach which not only breaks down the organic tissue from the pulp but also kills the bacteria. BUT from my experience as an anally retentive wannabe endodontist is that they are NOT being done properly. Be it due to incompetence, lazyness or whatever else. At the higher echelons there is much questioning over semantics, but what they are all agreed on is that the tooth needs to be isolated properly with rubber dam. Firstly what you are trying to do is kill the bugs off. Well how can you do that if you keep reinfecting it with saliva which is teeming with bacteria? You cant. Secondly instead of using hypochlorite which is the universally advise medicament they may use saline, water, local anaesthetic or any other such thing. None of which combine removal of dead tissue and killing of bugs. The body does not have a chance if these are not done ... and if these steps are not taken I can quite understand why people have experienced problems. BUT when carried out PROPERLY ... they can and do work. I have a success rate of approximately 95%. As I have said before they are not 100%. Only extraction will give you this. But I have seen large areas of bony destruction from an infected tooth literally vanish in 3 months after years of problems prior- these are also symptom free. Tenderness gone on tapping, no spontaneous pain .. unlike before I base my assesment of success on those factors not just the x ray image. You arent looking for bacteria on the x rays by the way you are looking for signs of bony healing... but yes they are rather crude methods. BUT the body CAN deal with certain levels of bacteria. It does it everywhere. On the mouth, on the skin, in the gut, genitalia, everywhere. Regards the tublues again .... yes hard to seal ... but many of these are occluded by bone and ideally those above bone would be sealed by either enamel or a crown. Its all about tipping the balance in the bodies favour. Re the expense ... depends how you look at it. The files alone cost around £30. Thats discounting the equipment to use them .... around 2 grand. Microscope which ideally would be used ... around 10 grand upwards, the actual sealers and fillers for the canals are not cheap. Depends on the system you use. There is also a very time and labour intensive implication. Ideally the shortest time for treatment of these teeth would be 1 hour to do correctly IMO. Therefore you need to pay staff for that time, pay bills etc. The cost soon adds up to provide it. That said, the nhs charge in england is £42 and in wales £39. If you pay more it is to have the crown on top of it which is part of the process to seal it especially back teeth. 198 and 177 ... not bad for root filling and crown provision especially when compared to the private costs. re amalgam. Well I have no real alternatives working within the NHS framework. The government are happy with it and have been unable to find problems with it as a dental material. It last longer than direct white fillings and is easier to handle. I wouldnt have one done but thats because I am fussy about aesthetics. There is a misreporting that the states have banned it ... thats not correct. It is still used regularly out there. Also I believe one of the scandinavian countries banned it then reinstated it. As for my level of depression ... I love the work. I hate working within the health service. I get a great deal of satisfaction helping my patients and managing them to the best of my ability and providing treatment that I would be happy to receive. I find the health service over bearing, meddlesome and highly frustrating. the system treats front line clinical staff dreadfully and people that have no idea about the job are in positions of power to dictate to those that DO know how it works. That applies accross the board, medicine, dentistry, nursing, physio, OT. Morale is beyond rock bottom. On the whole though I am happy in life. I drive a nice economical car, I have a lovely girlfriend and I have nice holidays. I am waiting for that mercury to kick in though!
  9. p.s. that site is rather .... interesting ..... I wouldnt put too much faith in it though. An infection in a tooth can NOT be cured. I have seen plenty to know that. You can develop a sinus causing the pus to drain out via it and relieve the pressure. But thats not sorting the problem. The treatments are extraction ... or ... and you wont like this ... root canal treatment/endodontics. The endo isnt ideal as yes ... spaces of tissue within the tooth are left. its impossible to fully clean it inside. Its no miracle cure. BUT elimination of the bulk of the dead tissue and bugs allows the body to cope with whats left and we can show definite signs of the body healing once the tooth is cleaned and sealed off from bacterial substrate. As I say, no miracle cure and for some ... namely yourself its not a suitable alternative due to your personal beliefs. Thats fine. ... but just be careful what you take from that site as you dont want to end up with a life threatening dentoalveolar infection on the basis you believe dentists are scum and teeth heal themselves. also there is no removal of the hard tissue from the tooth after formation other than on the surface which is cause by acid demineralisation. Teeth do not soften with age. They in fact go the other way and deposit more dentine inside away from what you can see. After teeth are fulle erupted and completely formed, it IS your diet that causes decay but only because of amount and frequency of refined carbohydrate intake.
  10. Not that you are interested but we can not re grow enamel or dentine. BUT ... in the right conditions ... it can re mineralise. Thats not the same thing though. We can cause caries (not cavitation) to firm back up but that involves complete cooperation from the patient and removal of all substrate. Often it also involves removal of some of the hopeless tissue before being able to do this anyway. Working as I do on a day to day basis, there are very few in my area that I would happily risk this with. Most, even with the best of intentions could not manage it. I also doubt the materials at my disposal in all cases to adequately seal the caries and bacteria from substrate to allow the bugs to die off. That said ... what you are alluding to is possible.. but you are a little incorrect with terminology and interpretation. But of course we are all scum so there we are
  11. tajak1000 very well summed up. Unfortunately there are clearly still many that are closed to the realities. None so blind as those who will not see eh?
  12. and interestingly , yet glossed over .... most of the cases up before the GDC are from OS dentists
  13. You are completely incorrect on this one. Student numbers are controlled centrally by the government and standards required are set out by the general dental council via a document entitled the first five years. The BDA has nothing at all to do with it .... or in fact anything. They are a representative organisation of which not all dentists are members. I dont know their figures off hand but I know most dentists I know are not members. Entry requirements for the course is set by the individual university. The reason the entry grades are so high is because they have in the region of 80 applicants per place available. Moving along to your other point i.e. prices high ... well NHS dentists ... and I am assuming you mean NHS ... have no control over the fees charged. They are set nationally by the DOH or WAG in wales. dentist payments are based on locally set contract valuations by PCTs and LHBs. About 5 years ago or so when the government decided to change the contracts they set a reference period. Whatever work the PRACTICE ... not the individual dentist carried out in that period was converted in to the new units of dental activity. These units equated to a set of units for a grossed cash amount. This gave you contract value and activity. The DOH guaranteed this money for 3 years ASSUMING ... all the targets were met. Money was paid to the PRACTICE/provider monthly as 12 divided amounts. At the end of a financial year any outstanding UDAs are clawed back. That is to say if you fail to meet your target the PCT/LHB claw back money from you. A 5% over performance is carried over to the next year, beyond that the dentist has worked for free. How the individual practice performs that contract is up to them. Many principal dentist will appoint a dentist as an associate and say the UDA value is £X and I have Y UDAs available. Go and do as many as you can. Others say you have X UDAs allocated to you and I will pay you £Y for doing them all. Now the problem many of you seem to have on this site is mixing up payments with a salary. There are NO NHS general practice dentists on a salary. Certainly none in traditional general practice. The only salaried dentists work in community services and in the hospital service. They are a small percentage. By that token then you should also be able to see there are no general practice dentists EMPLOYED by the NHS. Dentists by and large are self employed independent practitioners carrying out work that the NHS agrees to compensate for. They are all in effect ... private. Tey just agree to work according to a system set out by HMG. Therefore due to there being no salary the dentist will only be paid for work they complete and in effect patients they see. SO if they DO earn £300K they have cared for £300k worth of patients. Had they only earned £30K they would have only cared for the equivalent of £30K worth of patients. A good analogy is to say if you are a self employed car tyre changer and you change 1 tyre ... you are paid a fee for 1 tyre. If you change 4 ... you are paid for 4. Now you also need to consider that the dentist/practice is not compensated for material costs, staffing costs, lab bills for the dentures and crowns that they get made for them to fit on the patient. All those costs MUST come out of the gross fee earned ... be it £30K or £300K. As an average most principal (owner) dentists run at an average of costs being around 60% of the gross fee earned. An associate dentist will agree to give 40 - 60% of their gross to the principal in exchange for them providing them with a surgery, equipment and staff. As a result the dentist takes home about 40% of the gross fee after expenses are deducted and then they are taxed. SO that £300K immediately gets significantly smaller. I do however reject the idea that all dentists are on at least 100K and some earn 300K. Personally ... if you hadnt guessed I am an NHS practicing dentist ... I earn a great deal less than even the quoted average amounts. The only person I know that earns close to that works 6 days a week - that means a lot of dentistry is done by them to a lot of people. re Private earnings. you need to distinguish between private earnings and private patients. An NHS dentist may well make a lot of money from private earnings but that does not mean they are prioratising private patients. An NHS patient may come in and need some crowns and some fillings on back teeth but they do not want gold and amalgam (NHS) they may want white. That is going to be provided to them privately but they are still NHS patients. you are just treating them with materials outside the heath service. Its up to you to decide if the cost is value for money. If you live in an affluent area then people may well WANT the non NHS options. you would be unethically working in denying them these options. I noticed it commented that a few posters find it unlikely that people would not wish to have a private option unless forced in to it. I have to take a strong disagreement with that. Maybe YOU would not want it but YOU are not everyone. Just as some people here like marmite and others do not. We all have differing views, opinions and tastes. I know a lot of people that would actively avoid NHS services and are perfectly happy seeing practitioners privately. I myself have health insurance and would have no qualms taking out dental cover if I felt it was needed - currently it is not as I have no dental issues and do not expect any. If I did develop them I would happily pay the appropriate cost for what I felt was value for money to the practitioners I rated the best for me. re cars ... The choice of car a person makes is irrelevant and smacks of jealousy to me. My cousin is a teacher and drives an Audi TT. I am a dentist and I drive a car tax exempt fiesta. I could afford more but I am happy with my car. To pass judgement on someone driving a ferrari is misguided. For all you know they may have come in to a large inheritance to be able to pay a big deposit on one and then arrange a favourable PCP arrangement at the dealership. Most cars are affordable now on finance plans. The issue to bear in mind is do you WANT to afford it? Cars are cash absorbing monsters but that doesnt mean only high earners can afford them. I could buy an audi on the same money I once paid for a corsa. I wouldnt have owned it at the end of the finance deal but that woulnt stop people saying I was driving an audi. Hence cars being driven is an irrelevance. There is a great deal of misinformation on this board ... and a hell of a lot of hostility. Dentists train for a minimum of 5 years as undergrads and thats not counting the post grad hoops they need to jump through. Some doctors only train for 3 or 4 years at uni. you can not shorten dentistry like you can medicine. They have to pay fees just like all the other students do. They emerge with more debt due to the extra training. I think some really need to take a step back and view the situation with dentistry through less tinted specs. When in uni the provide free dentistry to hundreds of people, saving the NHS thousands. Trainee doctors do not do this. Dental students, under supervision assume the role of a qualified dentist. If they were not there, those patienst would need to be accomodated elsewhere. They pay fees for the privilege of this training, Look in to it all folks. Some of you may be surprised what you find out
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