Dental Advice

[dave87]

The metal joints problems in the UK is just one case.

As you say, one case. One case doesn't equal a trend, which is what I was describing.

[petercook7]

As you say, one case. One case doesn't equal a trend, which is what I was describing.

is just one case of many.

[dave87]

is just one case of many.

......


Care to expand?

I'm not sure the fact that there is more than one case disproves a general trend that though there are inevitably such cases in the UK, there appear to be more of them in the US.

[Macman]

Thanks for the info guys..!

[Saracen]

There is never going to be an absolutely perfect process for approval for use in the NHS. If you take every reasonable care, you end up with things taking a long time and, yes, sometimes people suffer and maybe die, in the meantime. And if you rush and don't take every reasonable care, you end up with Thalidomide.

Also, you have to be careful what is meant by "approval". Products that are CE-marked are generally approved for sale, across the EU and therefore in the UK, with a few exceptions in the medical field where relevant regs don't apply, such as those controlled by regs monitoring active implants and some in-vitro products.

But .... approved for sale and approved for fully-funded NHS use are different, with the latter being determined by NICE, not a CE mark. The CE mark is about product safety and compliance with regs, but the NICE approval is about value for money versus clinical effectiveness, especially in the context of other possible treatments.

The logic is simple - money in the NHS is not unlimited. If two treatments that are clinically identical are available, and one is ten time4s the price of the other, why should the NHS pay for the latter? But what about one that is marginally more effective but a LOT more expensive? That's a trickier case. And underlying it is that a given pound can only be spent once, and as funds are limited and the budget has to stretch, funding product A for patient 1 may mean no funding for product B for patient 2.

But a lack of NICE approval does not mean the product, even a medical product, cannot be used in the UK. It merely means that it won't be NHS-funded, or at least, not fully NHS funded. If the patient wants to pay (i.e. go private) or sometimes even stump up a "co-pay", that is, pay the difference between what it costs and the NICE-approved alternative, then it can be used.

My dentist is very, very good. He's also private. So, he uses what he wants (within the bounds of product safety regs) and that I'm prepared to pay for. But he's also a private business, and was, when he was an NHS dentist, until a few years ago. He has to run his business in a way that's profitable, or he doesn't eat. He pays for his own premises, has to pay staff wages, invest in equipment and pay for materials used, lab bills, and so on.

Even in his NHS days, he regularly used to tell me what treatments were available on the NHS, and what weren't, and what products he could use (like particular polishing pastes) on the NHS and what he couldn't. Eventually, he left the NHS entirely and went completely private, much against his wishes I might add, because NHS funding criteria and procedures were getting to the point that he felt he couldn't justify not doing the treatments he knew were better for the patient, but couldn't get NHS funding approval for.

And the guy is a close, personal friend, as well. So yeah, I trust him, and I believe him, both on what treatment is and isn't necessary, and on costings.

There are some very good dentists, both in the NHS and private, and there are some bad ones. There are those that keep up with their training, and invest in the latest technology, and those that don't. My dentist friend, for instance, was among the first in the UK to bring in digital xray equipment into the UK .... and to pay for it.

The trick with dentists, and especially NHS ones, is to find the good ones, not the ones resting on their laurels, or just out for the quick profit. Like every else, they're human, and that means a mix of superb, good, okay, mediocre and downright lousy.