Variations in prescribing patterns between dentists do occur and are quite common. When examining teeth, dentists go through three steps. They consider first ‘is there anything wrong with the tooth?’; if so ‘does it need treatment?’; and finally, if it does, ‘what treatment is necessary?’. They will then discuss the treatment options with the patient.
There is little disagreement among dentists as to whether there is anything wrong with a tooth. Dental decay is a very slowly progressive disease, and therefore the question of whether a problem requires treatment could reasonably be ‘yes’, ‘no’ or ‘not yet’. If a patient is a regular attender and has seen the same dentist within the previous year, it may well be in the patient’s interests to keep a minor problem under observation. On the other hand it might be better for a patient who attends occasionally, or who is attending for the first time, to have all the problems dealt with.
If treatment is needed, there are a wide range of options. The most appropriate treatment is a matter of judgement by the dentist and may depend on the patient’s attention to oral hygiene and the likely cost to the patient. Some dentists adopt a more cautious approach and only recommend a complex treatment if a more simple procedure has failed. In making these decisions, dentists are influenced by the wishes of the patient.
A dentist’s advice about treatment will depend on a number of factors — whether the patient has been seen before, the dentist’s understanding of a particular problem that the patient might have (for example, a cavity which has been present for some time but is not progressing), the patient’s oral hygiene (which might make certain advanced forms of treatment less feasible), the patient’s timescale (a patient might be looking for a major overhaul or for simple maintenance) and so on.
For every dental problem there is a decision to be made about whether to treat or not, and if treatment is decided on, the type of treatment to be given. The decision must always be the patient’s, however. All treatment must have the patient’s informed consent. If you are concerned about a dentist’s treatment proposal, ask questions — ask to be shown the problem in a mirror, or with a diagram.
If you are accepted for treatment by an NHS dentist, the NHS will contribute towards the cost of your treatment. The amount that the NHS contributes towards your treatment is dependent on your individual circumstances.
Please note that NHS fee levels are fixed by the government. The NHS cannot force a dentist to accept you as an NHS patient.
Once you have been accepted as an NHS patient by a dentist, and have registered with that dentist, then you do have an entitlement to NHS treatment, just from that particular dentist. But the entitlement ends if your registration lapses – the process goes back to the beginning and the dentist can decide again whether to re-register you as an NHS patient.
As a registered patient, you may prefer to have some of your treatment privately and some under the NHS. Your dentist will discuss with you the best options for you.
A private dental practice provides dental care largely outside the National Health Service. The contract for providing such care is an entirely private matter between dentist and the patients.
It’s important to remember that oral health is just a part of general health and we cannot call ourselves ‘healthy’ without good oral health as well. The Department of Health in 1994 came up with the following definition of oral health, as ‘a standard of health of the oral and related tissues which enables an individual to eat, speak and socialise without active disease, discomfort or embarrassment and which contributes to a general well-being’.
Many people feel anxious about going to the dentist. They may fear the possibility of pain or feel embarrassed because they have not been to the dentist for a long time. Dentists understand these feelings and are sympathetic to patients who are nervous or who have a phobia. Don’t be worried about telling a dentist that you are nervous or frightened. Try contacting some practices, explain your concerns and ask them what help they provide for nervous patients. It helps if you can identify which things make you nervous and let the practice know before you arrive for your appointment. Make an appointment for a time of day when you will have no other stresses. Do not book it when you know you have to be somewhere else shortly afterwards. Take a friend with you for reassurance. Make sure you understand any treatment you need before you commit yourself. Always ask the dentist to explain it if you are unsure.
Tooth discolouration may be intrinsic – the teeth simply developed with discolouration – or extrinsic – the teeth were stained by coffee or foods, for example. Talk to your dentist if you are worried about the colour of some of your teeth.
If teeth are discoloured, then it may be possible to lighten them by applying tooth whiteners, using a tray which is fitted to the shape of your mouth. The dentist takes an impression of your teeth to make the tray and whitener is then put in the tray beside the teeth which are to be treated. Whiteners normally use hydrogen peroxide (in the form of carbamide peroxide, or urea peroxide).
Superficial staining is generally easier to deal with than intrinsic staining but techniques now in common use in dental practice can help with most forms of tooth discolouration.
Orthodontics is concerned with the management of irregularities of the teeth, jaws and face. The most common orthodontic problems are crowding of teeth, impacted teeth (where a tooth cannot fully erupt because it is partially blocked by another tooth) and protruding (sticking out) teeth. Most orthodontic treatment is carried out in childhood but increasing success is reported with adult treatment.
We welcome self referral. If you would like to make an appointment please contact us.
We accept referral for implant, sedation, oral surgery, advance restoration work and root canal treatment, cosmetic dentistry and facial cosmetics. For further information contact the surgery.
We stock a range of dental products at the surgery for your convenience.
At acorn Dental Surgery we constantly monitor the quality of our service and clinical care through CLINICAL AUDIT which is the cornerstone of clinical governance and total quality management.
Clinical governance has been defined by the National Health Service as ‘a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish’ (NHSE, A First Class Service, 1998). But clinical governance should not be thought of as an exclusively NHS responsibility. All the ideas in this definition could apply in any sector of health care. The definition amounts to a statement that health care should have quality management, just like any other area of work activity.
Clinical (Dental) Audit is the systematic critical analysis of the quality of (dental) care, including:
Audit is often described as a cyclical or sequential activity. The audit sequence is probably more practical and avoids confusion.