Views and advice please....

[icemaiden]

I paid �198.00 18 months ago for a crown on one of my teeth on the NHS. Two weeks ago it became loose and I paid �16.50 to have it recemented.

Came loose again and returned to the dentist last week to be told I need a post in the gum for the crown to hold on to as the tooth underneath is not sufficent. I am going in today to have this done at a cost again of �198.00 and he is going to use the existing crown.

Should I pay �198.00 or do you think I should atleast have a bit of a discount as they are using original crown? The appointment will take half an hour.

Many thanks

[Greedyfly]

surely if it didnt work first time then they should fix it free or at least discounted.

[icemaiden]

They say that NHS crowns are only guarenteed for one year.

[DaisyMae]

I think you are being charged for the new procedure of putting in a post, the original crown would have been charged at the normal rate for that particular procedure. It isn't easy to work out what should or should not be paid for, my dentist always tells me if I can have a repair or replacement free of charge, and it largely depends on the length of time since the treatment. The dentist may well have considered putting a post in initially at a cost of double what you paid, but decided to try and keep the cost to a minimum at that time. Now he seems to have decided that the only way to make sure the tooth remains stable is to put in that post. Dentistry is extremely expensive in this county - I pay �68 each time I go just for inspection, descale and polish.

[icemaiden]

Thanks for your answer Daisymae.

As it was the NHS they have set amounts and the �198.00 is the highest you pay. so if he had done the post originally it would have cost me the same, �198.00.

[DaisyMae]

I see, but if he decided that this was a new procedure wouldn't that mean the full charge again?

I'm afraid I don't have the advantage of an NHS dentist in my area, only private. I would have to traved 35 miles to get into an NHS one and I think a 70 mile round trip is too much at my age.

[icemaiden]

I'm not sure Daisy.

I feel that I have been charged twice for something that should perhaps have been done in the first place. And using the existing crown, surely there will be no charge for making a new one, as I am not needing one.

[misslideaway]

Last year I had to have a tooth filled at my NHS dentist and less than 3 months later had to have the filling replaced- my dentist did not charge me anything- and simply said it was covered as was within 3 months of the initial treatment.

I thought the same logic would apply..

[LoftyLottie]

I have just looked at this (click to open the Poster)

http://www.dh.gov.uk/en/Publicationsandstatist ics/Publications/PublicationsPolicyAndGuidance /DH_083817

It would seem that Miss Slideaway is correct!

[LoftyLottie]

Oh sorry - I have just realised that your initial treatment was 18 months ago. Ignore me!!!

[MrXLA]

Hi icemaiden genuinely sympathise with the fees you have had to (/will have to) pay as part of your NHS dental care.
I have always been apposed to a fee system however it is what it is.
Firstly we should be quite clear what the fee is for, it is a charge subsidy set by the government (by no means the actual cost) for your treatment (although in your individual case it probably more than covers the cost) and is not directly paid to the dentist.
A band 3 charge in this case is for any treatment involving the provision of a lab made dental posthesis in your case a cast post.
- as the initial treatment was greater than 1 year ago your dentist cannot claim a 'free replacement/reapir' without committing fraud.

I accept your argument about whether a post should have been provided in the first place however this is an impossible question to answer.
Presumably the underlying tooth has fractured which may not have been predictable when your original crown was placed. Also placing posts in teeth when there is no absolute need is difficult to justify in my view.

Unfortunately from what you have said I would guess that you are liable for the charge.
Contrast this with someone who requires the same treatment who is charge subsidy exempt and I'll let you work out where some of your fee is going???

[MrXLA]

This charge system is flawed for a number of reasons but not least because:
- typically dental disease and therefore treatment need will always be greater in people from low socioeconomic backgrounds (this is the same for almost any healthcare provision and is not my oppinion it is fact)
- the above group are therefore by inference more likley to fall into the charge exempt group

- this means that there is an unfortunate group of individuals with moderate or low dental needs who have to pay the charge subsidy and who do not have a large amount of disposable income they do however pay NI.
- therefore this group (the 'middle' group) are probably the group worse off with the new system, they work and pay tax but do not earn huge amounts of money but are levied with in my view a large charge for the provision of dental care on top of NI contributions.
- this is so that the government can recover some of the 'cost' of providing dental care

- I appreciate the financial burden the government is faced with and fully understand that dentistry is not lifesaving, however I believe that dentistry (of a high quality nature) should be available free at the point of delivery for everyone or not at all

[MrXLA]

NB - Icemaiden (I might be wrong) however I would question your dentist as to the 'marginal fit' of your old crown once a cast post core has been made.
Since if a new crown was required there would be no additional cost to you.
Depending on why you need the post the old crown may be fine to seat back onto its original preparation margins however it may not.

[MrXLA]

Another 'issue' with the provision of dentistry on any basis is that unlike for instance engineering dentistry is bio-mechanical and therefore an individual's response to even the most basic dental treatment is unique and cannot be reliably predicted.
One thing is 100%certain and that is all dentistry without exception eventually fails, the point at which this happens is the unpredictable element.

[icemaiden]

Wow!

What a fantastic answer MrXLA. Thank you very much. Very detailed and knowledgeable.

Since going to the appointment, I have reconsidered my argument for several reasons.

1. The dentist was incredibly thorough in his work on my tooth and the whole appointment took over an hour. Extremely professional.

2. He has now decided to replace the existing crown as the original one was not a good fit.

3. He has done a fantastic job making a temporary crown, looks just like a new tooth!

4. He was really nice looking and extremely polite.

Okay, number 4 doesn't count.

MrXLA, please don't get me started on people who are entitled to free everything even though they pay nothing towards this country. That would be a very long post indeed.

Thanks again to everyone.