Jeremy Laurance: Never mind the rhetoric – how do I find a good dentist?
Tuesday 23 June 2009
I am looking for a dentist – a specialist who can help save what remains of my teeth. And at once it becomes clear how empty is the Government's rhetoric about NHS choice. I have no idea how to set about the task.
Today's review of NHS dentistry does not cover this issue. But it should have done. There must be millions of people in my position – middle-aged patients, raised before the era of fluoride and artificial sweeteners, when dentists drilled and filled every blemish in the enamel in the belief that this was the way to save teeth. The dentists were incentivised by a piece-rate payment system, which encouraged intervention and discouraged conservation – leaving teeth riddled with fillings, crowns and root treatments. The result, in my own case, is a mouth full of enough amalgam to set off a bomb detector.
I looked at the website of the General Dental Council to see if it could help. The GDC holds the register of specialist dentists and, if you have a name, you can look them up. All it will tell you when you do so, however, is what qualifications the dentist holds and what specialties he or she offers – endodontics (root canal treatment) or prosthodontics (crowns, bridges and dentures), for example.
It does not rank them or provide a star rating like those helpful restaurant and cinema reviews. It does not allow them to tell you about their experience or what they have to offer. There are no helpful customer reviews, no equivalent of the hotel website Tripadvisor, where guests warn others about the cockroaches in the bathroom or the harridan behind the reception desk.
So what are my options? I could ask a friend, but what can a friend tell you? How vicious or gentle their dentist is, and what their chair-side manner is like. They cannot tell you how good they are at restoring teeth.
I have stuck with NHS dentists, on principle, with only occasional excursions into the private sector when I was desperate. Now, however, I have reached the point where I no longer believe the NHS offers a standard of care sufficient for my (extensive) needs.
I can't ask my charming NHS dentist for a referral because I am in effect saying I do not believe he's up to the job. It's not like a referral from a GP, where the roles of GP and hospital specialist are clearly distinct. When I ask my dentist for a referral I am taking the drill out of my mouth and the bread out of his.
What is the answer? Today's review of NHS dentistry by the Department of Health recommends a switch from "dental activity to oral health" with the restoration of a registration payment to incentivise long term care. For me, it has come too late. I need highly skilled "dental activity" now. I started with the website of the Eastman Dental Hospital, the UK's leading dental institution. I located its top academics and found some had private practices. I have consulted one and await his report. I hope I am doing the right thing – but one detail I already know: it is going to hit me hard in the pocket.
Is there a better way? There has to be. The GDC says it is looking at the problem. It had better not bury it.
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