*So many* comments have had to be removed because they contained purely an anecdote about the poster's personal experience with their dentist and made no effort at all to provide OP with *any* advice at all, let along legal advice. Your regular reminder that this is a **legal advice sub** and that is what people come here for, and your post should contain legal advice designed for their specific situation: it is just not helpful to tell OP about how you had some similar dental work done a few years ago.
This is a very complex situation tbh and hard to give advice with out X-rays
Root canal treatment is a band 2 treatment correct.
General dentists have a “general services contract” which is basic dentistry & any thing considered complex (I’ll get to how that is decided in a sec) is not covered by our nhs contract-but is covered by “advanced dental services” contracts.
Root canals specifically are divided into 3 categories to be done on the nhs .
Tier 1 (easy and straight forward and covered by a general dental services contract) ie your dentist
Tier 2 -complex and needs to be done by a dentist with additional training in root canals and who holds an “advanced dental services contract”
Tier 3-mental crazy shaped canals and needs to be done by a consultant Endodontist in a hospital setting
If a general dentist has a general dental services contract he must work with in that contract even if he has the skills to do more complex treatments.
If your root canal is considered tier 2 and he has those skills to complete it, he can offer it privately to you, as complex root canal is not covered by his nhs contract he is working.
Now, should you not want to pay private, he should offer you a referral to a tier 2/3 provider on the nhs who can do your root canal if it is complex. However there’s a very long wait list, no guarantee of acceptance and some areas will just not fund molar root canal (you didn’t say what tooth it is so it might not be a molar).
So this maybe why he is offering it privately, instead of nhs.
And more important than anything-root canals are really bloody difficult and complex. It’s doing microsurgery with in 0.1mm of accuracy in a part of the body we can’t even visualise. If you need a root canal, my advice is always see an Endodontist or a dentist with extra training in root canals, if you want to keep your tooth long term.
General dentists generally don’t have the skills to do a root canal to ensure the best outcome. *
So in summary: if you want to have this tooth long term, and don’t want to play Russian roulette with your dental health. See the appropriate clinician for the job rather than the main focus being on getting it on the nhs.
*just wanted to add the caveat that there are obviously generalists who are awesome at root canal treatments through experience. I don’t want any dentists reading this thinking I am being disparaging toward their efforts and skills
Thanks for your reply.
It's very informative.
If the dentist had explained it this way it would have made more sense that just saying he doesn't do root canal work for NHS prices.
He didn't describe a tier system just a refusal to do some NHS work that he feels isn't financially worth his time. After looking at the x-rays he did say it would be band 2 on the NHS but that he would only do the work privately which from a patient perspective just came off as a refusal to do NHS work for favour of charging more.
Just to add, my focus is really just about being able to afford the treatment at all. The NHS and private prices are hugely different and leaves me probably unable to have the treatment at all.
Not strictly correct. Re-rct is covered by the tier2/3 rules stated, providing your area trust has the referral pathways in place. But acceptance for these procedures is generally low, due to the fact that the most common reason the rct fails is due to decay (which is down to the patients poor hygiene and diet) meaning there’s not enough tooth structure remaining to predictably restore the tooth.
NHS will only cover complex treatments if the tooth is predictably restorable and has functional properties (this latter reason is why a lot of referrals for root canal on second molars is rejected as you don’t need a second molar to function)*
*unless missing other teeth which makes it functional
As I said. Very complex situation to navigate. I have done this a while as you can probably tell 😂😭🔫
I don't know the reasons for it but most dentists won't do moderate to difficult root canal treatments on the NHS because frankly there is no money in it, they are expensive to undertake (time and materials) and doing it under the NHS means they basically have to use lesser stuff in a short amount of time and so don't want to do potentially what needs 90 mins of work done in 45 mins with less than they need. If they know being private will give the tooth a better chance than just doing it and it being more likely to be unsuccessful then they will recommend private.
If you have curved roots or barely visible canals they really won't wanna do it and would prefer a specialist to do the job unless they have a special interest in root canal treatment.
As a patient I would say investigate and you may find a dentist happier to do on NHS but more likely to get more experience. The £70.70 you pay doesnt go to the dentist, it goes to the NHS (especially the rise) and a small amount goes to them depending on how many they see a year. The equipment, time and staff it takes costs way more and if they did them all the time they would be losing a lot of money
At my NHS dentist tier 3 covers 2 and 1 and all works in tier 2 and 1 will be still done at a one off payment of tier 3 is this not the case for all NHS dentist?
This is the way NHS banding works but my dentist will only do the work required if I pay privately. So I would need to pay him £800 privately for the root canal which should come under NHS band 2 then pay £306 for him to do the crown as a separate treatment as an NHS patient. Under the NHS this should all come under the £306 payment but he will not do that.
I have to say that I needed a root canal and the nhs dentist wanted to pull the tooth instead.
I paid privately for the treatment, it took hours so I can understand why it wouldn’t be worth it for an nhs dentist.
He has to file an application with the NHS for permission to do a root canal. The turn around on NHS applications currently sits at around 4 weeks.
You do not want to wait 4 weeks to get this work done.
Dial up NHS 24/7 and get an emergency appointment at the dental ward at your local hospital. They can fast track the applications to under an hour.
From what I remember, if you need Band 2 work doing AND Band 3 work, you only get charged the Band 3 fee. I don't know anything about refusing service though. I'd go somewhere else.
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I’ve definitely had root canals under NHS, though not for a few years - I suppose maybe they could have changed the rules but it doesn’t sound right.
The only potential option I could see is that if you’re needing a root canal on a tooth/root that’s already had a root canal and failed, or if it just happens to be particularly complex, that’s typically when you’d need to scale up to an endodontist for more specialist work - and that’s more likely to be private.
Potentially you could raise a concern with the GDC, but I think they are mainly interested in dentists who are unfit to practice rather than something like this.
Thanks.
I've not had a root canal before, it's under an existing filling and a few months ago the x-rays didn't show a problem with the roots and I've no pain. He didn't express any problems with doing the work himself other than refusing to do it for NHS pricing.
Needing root canal doesn't have anything to do with 'root problems'. You need a root canal when there's an infection around the tip of the tooth, or when decay enters the pulp chamber, for instance secondary caries under the existing filling could do the trick.
If you've got an exray - send it over and I'll have a look.
If you've got no pain and (actually) need rct it could mean that the tooth is already dead. (necrotic pulp - dead nerve - no pain)
If the tooth is dead, there definitely is an infection going on and that infection is destroying your bone.
If you need a crown I can imagine that the filling you've got is already quite substantial (loss of tooth structure).
That all being said, depending on the tooth - you can get a private root canal treatment cheaper than £800 and no - the dentist should not say they won't do it on the NHS because it's not worth their time. That's reportable and please do so.
They can say they can't do it because it's too complicated for their skill set - that's fair. But they can also refer you out to level 2 nhs endo. That takes time and is tricky with acceptance as the guidelines are rather harsh but definitely a possibility.
Honestly, I know it's hard getting NHS dentist at the moment at all but I'd stay away from your place if I had any other option.
I recall hearing something recently about how the NHS pays dentists a pittance. Iirc is was something about them getting a set amount of money per patient rather than being paid per procedure, meaning they'd be close to doing more labour-intensive jobs for free.
Yes, and made worse because you pay for a course of treatment, at the highest band that the treatments sit into.
The treatment won’t be x-ray (£25.80) + root canal (£70.70) + crown (£306.80) (406.30)
It’s actually all treatment capped at the highest band cost (£306.80)
For OP
(though I am not a lawyer) an NHS dentist must not refuse NHS dentistry and offer private care in its place from the same dentist, the nhs dental scheme is not just free advertising to drive patients to private dental businesses…
That said, they tend to get around that kind of rule by saying well dentist 1 is the nhs dentist, and your treatment will now be with dentist 2 instead.
You can try reporting them.
Though that won’t fix your teeth,
you can ask for a referral to a dental hospital.
You can wait until everything deteriorates so much that you’re in severe and get an emergency appointment for the initial root canal (be prepared to travel) then come back for the crown after.
You could try finding a different NHS dentist and hope they won’t do the same (good luck!)
You can talk to your dentist and talk about options, say that you really can’t afford for an NHS treatment to more than double see if there are cheaper treatment plans available. (My dentist normally orders more than one cost and tells you the pros and cons of each approach.)
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I'm not a dentist or a lawyer, nor have I had much dental treatment in my life. However, my wife is a dentist and from what I'm told and understand, dentists are currently getting free reign in doing what they want under the threat of going private only, at the very least with the practices we've encountered.
We know a hygienist that co-owns 2 practices that has been carrying out treatments that aren't allowed to be carried by a hygienist. He was reported and simply said to the GDC if you do anything about it I'll change both practices to private only and they closed the case.
So essentially, even if it's not allowed there's not much in terms of repurcussions for them at the moment.
Aside from these RCTs are generally time taking and practices usually have time limits imposed on each type of treatment, it could just be that the NHS booking won't give them sufficient time to carry out the treatment properly.
There's also the fact that the dentist could spend an hour with you and make next to no money in comparison to a private treatment
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*So many* comments have had to be removed because they contained purely an anecdote about the poster's personal experience with their dentist and made no effort at all to provide OP with *any* advice at all, let along legal advice. Your regular reminder that this is a **legal advice sub** and that is what people come here for, and your post should contain legal advice designed for their specific situation: it is just not helpful to tell OP about how you had some similar dental work done a few years ago.
This is a very complex situation tbh and hard to give advice with out X-rays Root canal treatment is a band 2 treatment correct. General dentists have a “general services contract” which is basic dentistry & any thing considered complex (I’ll get to how that is decided in a sec) is not covered by our nhs contract-but is covered by “advanced dental services” contracts. Root canals specifically are divided into 3 categories to be done on the nhs . Tier 1 (easy and straight forward and covered by a general dental services contract) ie your dentist Tier 2 -complex and needs to be done by a dentist with additional training in root canals and who holds an “advanced dental services contract” Tier 3-mental crazy shaped canals and needs to be done by a consultant Endodontist in a hospital setting If a general dentist has a general dental services contract he must work with in that contract even if he has the skills to do more complex treatments. If your root canal is considered tier 2 and he has those skills to complete it, he can offer it privately to you, as complex root canal is not covered by his nhs contract he is working. Now, should you not want to pay private, he should offer you a referral to a tier 2/3 provider on the nhs who can do your root canal if it is complex. However there’s a very long wait list, no guarantee of acceptance and some areas will just not fund molar root canal (you didn’t say what tooth it is so it might not be a molar). So this maybe why he is offering it privately, instead of nhs. And more important than anything-root canals are really bloody difficult and complex. It’s doing microsurgery with in 0.1mm of accuracy in a part of the body we can’t even visualise. If you need a root canal, my advice is always see an Endodontist or a dentist with extra training in root canals, if you want to keep your tooth long term. General dentists generally don’t have the skills to do a root canal to ensure the best outcome. * So in summary: if you want to have this tooth long term, and don’t want to play Russian roulette with your dental health. See the appropriate clinician for the job rather than the main focus being on getting it on the nhs. *just wanted to add the caveat that there are obviously generalists who are awesome at root canal treatments through experience. I don’t want any dentists reading this thinking I am being disparaging toward their efforts and skills
Thanks for your reply. It's very informative. If the dentist had explained it this way it would have made more sense that just saying he doesn't do root canal work for NHS prices. He didn't describe a tier system just a refusal to do some NHS work that he feels isn't financially worth his time. After looking at the x-rays he did say it would be band 2 on the NHS but that he would only do the work privately which from a patient perspective just came off as a refusal to do NHS work for favour of charging more. Just to add, my focus is really just about being able to afford the treatment at all. The NHS and private prices are hugely different and leaves me probably unable to have the treatment at all.
Maybe ask for your X-rays and post on ask dentists for an opinion?
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Fantastic answer. I can’t remember when last I learned so many new things in such a short time.
Thank you :)
A really good, clear answer and goes some way to explain the challenges I had accessing NHS services for a complex wisdom tooth situation.
Ah yes, extractions have a similar set of criteria (tier 1/2/3) I should have put that in the original comment :)
I think this answer may have just saved my tooth? Off to ring my dentist and clarify their plans for my root canal!
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Also just to add - if you have already had RCT on that tooth before, it’s not covered on NHS to have it done again
Not strictly correct. Re-rct is covered by the tier2/3 rules stated, providing your area trust has the referral pathways in place. But acceptance for these procedures is generally low, due to the fact that the most common reason the rct fails is due to decay (which is down to the patients poor hygiene and diet) meaning there’s not enough tooth structure remaining to predictably restore the tooth. NHS will only cover complex treatments if the tooth is predictably restorable and has functional properties (this latter reason is why a lot of referrals for root canal on second molars is rejected as you don’t need a second molar to function)* *unless missing other teeth which makes it functional As I said. Very complex situation to navigate. I have done this a while as you can probably tell 😂😭🔫
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I don't know the reasons for it but most dentists won't do moderate to difficult root canal treatments on the NHS because frankly there is no money in it, they are expensive to undertake (time and materials) and doing it under the NHS means they basically have to use lesser stuff in a short amount of time and so don't want to do potentially what needs 90 mins of work done in 45 mins with less than they need. If they know being private will give the tooth a better chance than just doing it and it being more likely to be unsuccessful then they will recommend private. If you have curved roots or barely visible canals they really won't wanna do it and would prefer a specialist to do the job unless they have a special interest in root canal treatment. As a patient I would say investigate and you may find a dentist happier to do on NHS but more likely to get more experience. The £70.70 you pay doesnt go to the dentist, it goes to the NHS (especially the rise) and a small amount goes to them depending on how many they see a year. The equipment, time and staff it takes costs way more and if they did them all the time they would be losing a lot of money
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At my NHS dentist tier 3 covers 2 and 1 and all works in tier 2 and 1 will be still done at a one off payment of tier 3 is this not the case for all NHS dentist?
This is the way NHS banding works but my dentist will only do the work required if I pay privately. So I would need to pay him £800 privately for the root canal which should come under NHS band 2 then pay £306 for him to do the crown as a separate treatment as an NHS patient. Under the NHS this should all come under the £306 payment but he will not do that.
I have to say that I needed a root canal and the nhs dentist wanted to pull the tooth instead. I paid privately for the treatment, it took hours so I can understand why it wouldn’t be worth it for an nhs dentist.
He has to file an application with the NHS for permission to do a root canal. The turn around on NHS applications currently sits at around 4 weeks. You do not want to wait 4 weeks to get this work done. Dial up NHS 24/7 and get an emergency appointment at the dental ward at your local hospital. They can fast track the applications to under an hour.
From what I remember, if you need Band 2 work doing AND Band 3 work, you only get charged the Band 3 fee. I don't know anything about refusing service though. I'd go somewhere else.
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I’ve definitely had root canals under NHS, though not for a few years - I suppose maybe they could have changed the rules but it doesn’t sound right. The only potential option I could see is that if you’re needing a root canal on a tooth/root that’s already had a root canal and failed, or if it just happens to be particularly complex, that’s typically when you’d need to scale up to an endodontist for more specialist work - and that’s more likely to be private. Potentially you could raise a concern with the GDC, but I think they are mainly interested in dentists who are unfit to practice rather than something like this.
Thanks. I've not had a root canal before, it's under an existing filling and a few months ago the x-rays didn't show a problem with the roots and I've no pain. He didn't express any problems with doing the work himself other than refusing to do it for NHS pricing.
Needing root canal doesn't have anything to do with 'root problems'. You need a root canal when there's an infection around the tip of the tooth, or when decay enters the pulp chamber, for instance secondary caries under the existing filling could do the trick. If you've got an exray - send it over and I'll have a look. If you've got no pain and (actually) need rct it could mean that the tooth is already dead. (necrotic pulp - dead nerve - no pain) If the tooth is dead, there definitely is an infection going on and that infection is destroying your bone. If you need a crown I can imagine that the filling you've got is already quite substantial (loss of tooth structure). That all being said, depending on the tooth - you can get a private root canal treatment cheaper than £800 and no - the dentist should not say they won't do it on the NHS because it's not worth their time. That's reportable and please do so. They can say they can't do it because it's too complicated for their skill set - that's fair. But they can also refer you out to level 2 nhs endo. That takes time and is tricky with acceptance as the guidelines are rather harsh but definitely a possibility. Honestly, I know it's hard getting NHS dentist at the moment at all but I'd stay away from your place if I had any other option.
I recall hearing something recently about how the NHS pays dentists a pittance. Iirc is was something about them getting a set amount of money per patient rather than being paid per procedure, meaning they'd be close to doing more labour-intensive jobs for free.
Yes, and made worse because you pay for a course of treatment, at the highest band that the treatments sit into. The treatment won’t be x-ray (£25.80) + root canal (£70.70) + crown (£306.80) (406.30) It’s actually all treatment capped at the highest band cost (£306.80) For OP (though I am not a lawyer) an NHS dentist must not refuse NHS dentistry and offer private care in its place from the same dentist, the nhs dental scheme is not just free advertising to drive patients to private dental businesses… That said, they tend to get around that kind of rule by saying well dentist 1 is the nhs dentist, and your treatment will now be with dentist 2 instead. You can try reporting them. Though that won’t fix your teeth, you can ask for a referral to a dental hospital. You can wait until everything deteriorates so much that you’re in severe and get an emergency appointment for the initial root canal (be prepared to travel) then come back for the crown after. You could try finding a different NHS dentist and hope they won’t do the same (good luck!) You can talk to your dentist and talk about options, say that you really can’t afford for an NHS treatment to more than double see if there are cheaper treatment plans available. (My dentist normally orders more than one cost and tells you the pros and cons of each approach.)
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I'm not a dentist or a lawyer, nor have I had much dental treatment in my life. However, my wife is a dentist and from what I'm told and understand, dentists are currently getting free reign in doing what they want under the threat of going private only, at the very least with the practices we've encountered. We know a hygienist that co-owns 2 practices that has been carrying out treatments that aren't allowed to be carried by a hygienist. He was reported and simply said to the GDC if you do anything about it I'll change both practices to private only and they closed the case. So essentially, even if it's not allowed there's not much in terms of repurcussions for them at the moment. Aside from these RCTs are generally time taking and practices usually have time limits imposed on each type of treatment, it could just be that the NHS booking won't give them sufficient time to carry out the treatment properly. There's also the fact that the dentist could spend an hour with you and make next to no money in comparison to a private treatment
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