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Nation of people with beautiful accents and dreadful teeth

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are - www.rxroots.com
From: "Jeremy Rourke"
To: "ROOTS"
Sent: Friday, January 15, 2010 2:54 AM
Subject: [roots] The whole sorry process repeats itself - Dental Health Care Reform

I have worked in the United Kingdom in the General Dental Service (NHS) 
dental system I went there in 1991 to give my family a better life

Six weeks after I arrived the health minister in the government of 
Prime Minister, John Major, announced a 13.8 percent cut in dentists fees.

Socialised dentistry in Britain had almost completely destroyed the ability 
of the dental profession and individual dentists to deliver even basic, 
honorable, professional and ethical dentistry.

One commentator on Britain stated they were a Nation of people with 
beautiful accents and dreadful teeth.

I remember a British Dental Journal study that showed 96 percent of root 
canal fillings were short of the apex to the extent that they would be 
considered a failure in University undergraduate clinics

The Chairman of the UK Dental Laboratories Association wrote an open 
letter (study) to the profession stating that crown preparation impressions 
and models were of such poor quality to make it almost impossible for dental 
laboratories to make a crown that fitted

The authorities in Eastbourne that ran the NHS dental service have 
consistently changed the standards they use to assess dental care to cover 
these issues

An open crown margin is NOT considered a failure if it is less than ONE 
millimeter

A root filling is considered a failure if there is an unfilled canal or the
filled canals are filled LESS than 50 percent of their length

I was shocked to learn that the average replacement time of small amalgams 
was 8 years and large amalgams 5 years.

The most obvious failure of NHS dentistry was that the average age of total 
tooth loss was REDUCED by 5 years and women who visit the dentist more often 
that men lost all their teeth at an earlier age than the men

In Scandinavian socialized dentistry this is worse with 5 years for an 
occlusal composite and three years for large composites.

In Australia I had a job at the Sydney Town Hall clinic of a private health 
Fund - The Government Employees Health Fund

The clinic had been open for just on one year a few weeks after I started 
work there on a piece meal (sweat shop) fee for service basis.

Dentists were paid for the work they did
low production = low income
high production = high income

With a family to support I worked as hard as I could without descending to 
the standards of care found in the UK

The accountants went over the financials of the dental clinic and found it 
was running at a loss
The equipment was under a lease contract, monthly repayments were fixed
The premises were rented and the rent was fixed
The supplies had to be bought at market rates
And the staff had to be paid the legal award rate

But the dentists were paid an agreed rate and there was no signed contract 
and the fund accountant set the fee for service rate

At the end of my third week there it was "explained" to me that the dentists 
fees would be reduced by 33 percent to sdave the financial viability of the 
clinic, if it closed it would be an embarrassment to the Fund Directors.

The Fund had a budget and it had to be balanced - none of the clinic expenses
could be shaved except the dentist payments

I resigned.

This tale of woe is what ALWAYS happens with socialised dentistry and medicine

For the accountants at the clinic in this story transpose the National 
Department of Health and Treasury

The only thing they can cut back on when the dentists work too fast and hard is 
the fee for service. In the UK there have been a number of Parliamentary enquiries 
into the NHS dental service.

No one quote from any of these is of more value to read than this one;

The reference is paragraph 2.14 of the Tattersall Report of 1964 and it was 
consider so pivotal to an explanation of the problems in Dentistry that Sir Kenneth
Bloomfiled decided to reprint it in the Bloomfiled REPORT to Parliament in 1992.

"The scale of fees as at present used is little more than a device to ensure that 
the individual dentist cannot earn at the approved rate unless he completes a certain 
quota of work, that quota being determined by the speed at which "average" dentist works. 
The speed at which the average dentist is working, or the quota of work necessary to 
achieve the standard rate per hour, can only be ascertained in retrospect over a period. 
No individual dentist at any given time can know how fast the profession as a whole is 
working; what he can know is that the faster he personally works the greater will be his 
pay cheque next month. He also know that he on his own can have very little influence the 
factors which affect the scale of fees. If one man in ten thousand decides to work more 
slowly the practical effect on the average will be nil, but the effect on his own finances 
may be serious. Therefore he works as fast as he can, and so do his ten thousand colleagues. 
When the > reckoning comes we find that the rate per hour of the average practitioner  
has exceeded prescribed. Therefore it is necessary to devalue the scale of fees and,
conversely, to set a new higher quota which the dentist must meet in order to maintain 
his rate of earnings and to keep pace with his financial commitments. He has no way of 
ascertaining at which precise rate he must now work in order to maintain the previous 
balance, even assuming that his colleagues do likewise. All he knows is that he must work 
harder than before. He does so, and so do his colleagues, and the whole sorry process 
repeats itself.''

And so this whole sorry process is about to repeat itself in the USA with the Obama 
health reforms and in Australia with the Rudd Government inspired National Health and 
Hospital Reform Commission proposal of a Universal Denticare system.

http://nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/188-interim

Dr Jeremy Rourke

This is the result of a culture that thinks access is more important than quality. Exceptionalism and Excellence takes a back seat to just "getting it done". The AAE's focus on access as a theme is politically correct ------- that demeans the entire purpose of elevated specialty level care. These cowardly submissions to mediocrity make me vomit. Socialized medicine is not medicine it is a dismissal of human empathy and consideration, an abortion of the very essence of care-giving - Terry I remember a British Dental Journal study that showed 96 percent of root canal fillings were short of the apex to the extent that they would be considered a failure in University undergraduate clinics The Chairman of the UK Dental Laboratories Association wrote an open letter (study) to the profession stating that crown preparation impressions and models were of such poor quality to make it almost impossible for dental laboratories to make a crown that fitted Personally, I don't like the UK system, but the above statements has more to do with the dentist, rather than whether its socialized or not. Many of you will say that socialized dentistry causes this, but that's BS. Bad or uncaring dentists cause this. If the endo is 5 mm short of the apex, then its the dentist's fault and no one else's. Low fees would have nothing to do with getting the proper length. If the impression is so poor that the lab can't make a proper crown, then its, wholly, the dentist's fault. You can't blame bad work (not cheaper materials) on whether is socialized or not. Even using generic brand materials, a conscientious dentist can do quality work - Jack Thatís where you are wrong =- absolutely wrong The choice is to go bankrupt financially or go bankrupt morally there is no other choice The TANI and TAGI figures for NHS payments indicated that an average dentist working at average speed had a total of 14 minutes and 40 seconds to start and complete a single root canal debridement and obturation My boss asked me to do his RCTs and I stated I was losing money doing mine properly and couldn'ít afford to lose income doing his as well Unless you have worked in the UK NHS system you canít possibly know how appalling it is - Jeremy Rourke

Protaper flaring

6 yr old Empress

Cvek pulpotomy

Middle mesial

Endo misdiagnosis

MTA retrofill

Resin core

BW importance

Bicuspid tooth

Necrotic #8 treatment

Finding MB2 / MB3

Deep in a canal

Broken file retrieval

Molar cases

Pushed over apex

MB2 and palatal canal

Long lower third

Veneer cases

CT Implant surgury

Weird Anatomy

Apical trifurcation

Canal and Ultrasonics

Cotton stuffed chamber

Pulp floor sandblasting

Silver point removal

Difficult acute curve

Marked swelling

5 canaled premolar

Sealer overextension

Complex anatomy

Secondary caries

Zygomatic arch

Confluent mesials

LL 1st molar (#19)

Shaping vs Cleaning

First bicuspid

In Vivo mesial view

Inaccesible canals

Premolar 45

Ortho and implant

Radioluscency

Lateral incisor

Obturation

Churning irrigant

Cold lateral

Tipped to lingual

Acute pulpitis images

Middle distal canal

Silver point

Crown preparation

Epiphany healing

Weird anatomy

Dual Xenon

Looking for MB2

Upper molar resorption

Acute apical abcess

Finding MB2

Gingival inflammation

Irreversible pulpitis

AG BU ortho band

TF Files

using TF files

Broken bur

Warm technique

Restorative prognosis

Tooth # 20 and #30

Apical third

3 canal premolar

Severe curvature

Interesting anatomy

Chamber floor

Zirconia crown

Dycal matrix

Cracked tooth

Tooth structure loss

Multiplanar curves