NHS vs Private Dentistry in Scotland: An Unbiased Review

A comparison and explanation for the differences between NHS and Private dentistry. An analysis of the reason for the higher price point and a side by side review of Private dental treatments and the NHS alternative.

One of the most common questions we get asked is what is the difference between NHS and Private treatment. It’s a tricky question sometimes, and in some cases it is plan and simple. This short article will outline the main differences between NHS and Private and why sometimes patients may not have an option.

OK lets start with simple stuff. Exams, scale and polish, simple x-rays and hygiene advice. From a basic point of view there is no material difference for the majority of practices. The main difference is time. The more time the dentist spends with a patient, the more through they can be.

Imagine painting a room. A Private painter will be given between 3 and 5 times the amount of time to complete. Imagine how the painter with more time can spend on sills and getting into tricky areas and ensuring the quality is high as possible. In some cases a scale and polish may only be used with hand instruments. It has been proven that using an ultrasonic scaler leads to a better clean. The NHS does not restrict dentists to using one type of instruments over another for a simple scale, so many dentists may use different instruments to differentiate the private vs the NHS. All of these treatments above are available both on NHS and private.

Let’s step it up a bit! Fillings, root treatments and extractions. All of these are “in theory” available on the NHS. In theory because in Scotland any filling past behind the front 6 teeth has to be in amalgam (silver) on the NHS. There are a couple of extra rules that makes the slightly more complex, but for the vast majority of people this is the case. White (composite) fillings are allowed in the front of the mouth. The amount paid to dentists is quite modest, so the materials used are of lesser quality than if the filling was private. These materials may discolour sooner of time and the appearance will not be as lovely as “private composites”.

Extractions can be directly related to time and skill. A private practice will offer more time. The issue with not having more time is that if the tooth breaks, an NHS appointment may not allow for a more complex extraction. Also, if the practice mainly deals with NHS there may not be anyone available to do the complex extraction and so the case might be referred to a specialist or the hospital (this leads to waiting lists). The same applies for wisdom teeth (even less dentists go near them).

Root treatments (RCT) have the worst rep in the world of dentistry, it usually isn’t that bad, honestly. We digress. Root treatments on NHS are completely possible. Again, time is a major factor here. RCT can be TOUGH!!! The harder it is, the more time you need. NHS dentists are paid the same if a root treatment take 1 or 5 appointments. The materials, techniques and instruments may also be of a much higher quality. Private RCT treatment may use microscopes that allow the dentist to see to the bottom of the root (smaller than a pinhead). Now it gets complicated. If you have any filling or treatment on a tooth before you have RCT that is private, you are not allowed to have an NHS root treatment for 6 months. HUH?

Yup! If you have a large filling at the back of the mouth and decide to get a lovely white filling, you by law have to have a private root treatment. Many people do not believe dentist when we say this, but that’s what the NHS state. But wait there is more. After you have had a Root Canal Treatment, you will need either a filling or crown. You cannot get a private filling or crown on the NHS if you have had a NHS Root Canal Treatment. Which means you cannot get a white filling after a NHS root treatment, it has to be silver (if at the back of mouth).

Crowns and bridges. Similar to fillings, different rules apply to the front of the mouth and back of the mouth. NHS crowns can be metal and ceramic at the front of the mouth and premolars – front 10 teeth. They have to be fully metal at the back. Remember the rule if you have an NHS RCT you now need a NHS crown -if at that back this is likely to be silver. The crowns at the front have to be metal/ceramic – without doing a course in crowns, it means there is a metal crown (silver) bonded to a ceramic shell (white). Usually there is a collar of metal at the gum level. A bridge is used to replace a single lost tooth. There are a few different types of bridge. The most simple is a resin bonded bridge. This is allowed on the NHS relatively easily. If you are looking to do a more complex bridge – the NHS does allow it sometimes however the entire case (including any other work required) will need to be sent to the local health board to assess the case and give approval – this can be as quick as 2 weeks but usually takes around 1-3 months. Once approval is granted, the NHS will have restrictions as to what materials can be used and may choose to change that plan. Maybe even changing it to denture. These decisions can be argued and appealed -every situation is different. The health board openly invite discussion.

Private Crowns and Bridges can be any material the patient and dentist wish to use. This includes super fancy all white crowns for veneers made for glazed ceramic. Larger bridges can be utilized – however what you are offered will vary widely depending on the skills of the dentist treating.

Veneers. Tricky one. There are some indications to have veneers on the NHS. If veneers or for cosmetic purposes, they are only available privately. When veneers are available on the NHS, the quality is usually of a high standard and modern materials are likely to be used.

Dentures are available on the NHS in plastic and metal. They can be used upper and lower or both. They may replace all missing teeth or just a few. The type of material used on the NHS will be usually pink and made to kind of look like gum. The pink dentures are made of acrylic and NHS dentures are made of a simple acrylic. Private acrylic dentures can be made to look just like real gum and better quality teeth. Despite metal dentures being available on the NHS – the lab costs to make the denture may cost more than the dentist get to make the denture. As such, many dentists will not make them. Ultimately, if they made too many of them the dentist would quickly go out of business (obviously nor likely, but you get the point). In addition to metal denture, private dentures included PEEK dentures. These are the new kids on the block and are super comfortable and help people regain their confidence, especially around eating.

Almost done. Basic x-rays are available on the NHS – anything more complex like a CT scan is only available in hospital (waiting list) or privately. Also, if you are referred for a scan on the NHS, usually this is for NHS treatment only.

Orthodontics (braces and Invisalign). Orthodontics are free for children with significant issues. A referral to an orthodontist is required they develop a treatment plan send it to the heath board and after approval treatment can start. Over the last few years, not all treatment plans are being automatically approved – if it is not, people can pay for NHS braces. For adults, braces and Invisalign are private only.

Cosmetic bonding. In theory this is not available on the NHS, but if someone has a broken front tooth, when it is repaired the process is basically the same. SO, a cheaper option? Sadly, not – the teeth have to be damaged before that claim would be accepted by the NHS. Also, you would need to have a dentist willing to spend the time to do NHS composite bonding. So you may get away with a single tooth, but for the vast majority of time composite bonding is only private.

Implants are available privately only. There are a couple of exceptions to this. If you have lost teeth due to cancer or some medical conditions, you may be entitled to NHS implants. This will almost always be in a hospital. The criteria to qualify is very difficult, so most people will have to get them privately.

Botox? What, really? Yup, Botox is available on the NHS. Once again, not for cosmetic purposes, e.g. wrinkles. Some people suffer significant migraines caused by clenching. If referred to an oral surgeon or oral medical expert, they can refer you for Botox on the NHS. This will be administered to specific muscles. To get this depends on where you live and if the symptoms are deemed suitable. As rare as hens teeth (I know I’m not funny, but the subject is a bit dry, so I’ll try and keep everyone entertained).

We are all done. Not all treatments have been discussed because this document would be 10x as long! These are the main treatments that most people are looking for, and this article provides a basic overview to give all patients more information.

Dr Abraham McCarthy

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