Dentist shortage causing misery

[AB Asks]

No one enjoys going to the dentist but it must be done. As many as one in six people cannot access an NHS dentist and so haven't gone to see one in years. People on low incomes have been hit the worst by the NHS contract that was brought in in 2006. Private treatment is just not affordable on any level for a lot of people. What are you experiences of private or NHS dentists? Is the current system working or do we need radical change?

[Ice.Maiden]

Are you a dentist MrXLA, because your knowledge of the subject is admirable! However, no one's ever found the reason for me still being able to feel everything unless I have sedation first - followed, I assume, by the very injections which don't work on their own. I've had x-rays done, & have no gum disease or immediate problems with my teeth. Injections never failed to numb the area until it just happened one day, and I have always visited a dentist for regular check ups, so had no reason to fear going. Now though, that's a different matter, because although the sedation puts me to sleep completely, I worry that I might wake up during treatmentI

[Whoever]

I had an NHS dentist near my place of work as I couldn't find one close to home. Now I no longer work there I have a 20 mile journey but have to keep going there. I think there is something radically wrong with the NHS dental system and until we have more trained dentists and a system which rewards dentists adequately for doing NHS work, the situation sadly will only get worse with a rising population.

[MrXLA]

Anyway...Yeah there needs to be radical change

[MrXLA]

Hi ICEMAIDEN I draw both medical and dental information from more than one source.
I think regardless of the problems you have with anaesthetic agents you highlight very well one of the many problems that exists in NHS dentistry.
You are not alone in requiring sedation to carry out dental procedures. It would be prudent for PCTs in general (and some already do) to acknowledge this and commission this service, however it is not cheap and they are stretched with their budgets

[MrXLA]

Oh and with regards to waking up while sedated I wouldn't worry too much, in the UK its referred to as consciouses sedation, simply because you are awake for the procedure. However the drug has amnesic properties and as such you don't remember. Its fairly likely that if you have in the past been subject to amnesic effects such that you remember nothing that you would continue to do so.

The are several complex reasons why a person may not be treated while awake under dental LA and the most important thing to note is the mis-use of the wording Local Anaesthetic in fact its a 'Local Analgesic' and thats where the problem is for most people

[MrXLA]

An analgesic provides pain relief/prevention, however not necessarily in everyone to imperceptible levels (for almost all of the population it does). Higher doses usually remedy this problem (or supplemental techniques) however on rare occasions this may require the administration of a very dangerous volume.
The other factors that complicate matters are that pain perception is entirely subjective, can be influenced by anxiety levels and expectation and therefore can vary greatly.
Some people perceive proprioception (movement/pressure) as pain, in those cases the LA DOES do its job, but it wont allow those people to be treated while fully conscious.
If someone believes or expects to be in pain and they also believe that the agent used will not work and they are anxious then feeling, pressure (or other unusual/unfamiliar sensations) will be recognised and EXPERIENCED as pain and the pain is REAL.
It also possible with the above scenario that a given tooth will give no response to vitality tests i.e is objectively 'numb' but NOT subjectively.

[MrXLA]

There are enough dentists to provide NHS dental care, there are simply not enough contracts.
However the above statement only hold true if dentistry is practiced in the insane manner that it currently is in the NHS.
If you speak to NHS dentists most are very happy with the pay they receive, its usually very good.
Most don't have an issue with pay, thats not the problem, the truth is NHS dentists see far too many patients.
Their fully private counterparts (some earn alot less than NHS dentists) are happier not because of pay but because they get to take their time with patients properly assess them and are able to provide high quality treatment (which all dentists are trained to do).
Thats why private dentistry is better and unfortunately more expensive if you see only a quarter of the patients then thats why its four times the price.