Wednesday, November 6, 2013
Dentistry in the US vs UK
While I don't think this is really generally the case, it's true that Brits don't place as much emphasis on orthodontics and dental hygiene as Americans typically do - it seems to me that the attitude is more of a "repair when needed" basis rather than "obsessive check-ups and braces for everyone when you reach 14" (not to mention, the floss is TERRIBLE here. I stock up on Johnson & Johnson's Mint Waxed every time I'm back in the States). We were first introduced to oral hygiene in elementary school (aside from whatever was taught at home and at the dentist's office), when a dentist would come in to our 1st grade classroom and hand out toothbrushes and travel-sized toothpaste while using illustrations to explain the differences between tartar, plaque, cavities, and educate us on keeping our teeth healthy.
Private dental care in the UK is outrageously expensive though - probably just about as much as it costs in the US without dental insurance. Recently, an American posted in the American Expats In London group on Facebook (I like to sit back and observe rather than join in - it's fascinating) about looking for a dentist and immediately, a flurry of recommendations poured in: all private doctors' offices (with one on Harley Street, the group of private doctors catering to celebrities and the affluent). A root canal could set you back £800-900 (I know, because I researched this for my own root canal last year) and just an initial consultation could cost an eye-watering £160 (I know, because I thought about switching to private dental care recently).
In contrast, NHS check-ups currently cost £18 per visit and my root canal last year (despite having to return several times) cost a total of £45. So it's considerably more affordable.
But sitting in the dentist's chair this morning, I just had to laugh: a US dentist's visit is SO different to a UK NHS dentist's visit. I remember being completely shocked and taken aback during my first visit, before I adjusted and accepted that that was just the way it was, and if I wanted more, then I could always shell out a couple hundred pounds and get the full "US experience".
In the States, I'm greeted by a dental hygienist (the dentist doesn't even make an appearance at this point in the appointment) who sits me down, makes small talk, and assesses my teeth and gums in silence before finally tutting, "How often do you floss? How often do you brush? I'm seeing a looooooottt of plaque back here. What mouthwash do you use? This is looking reeeealllly bad." Then she'll proceed to vigorously poke and prod at my gumline with a pointy metal tool until it bleeds and triumphantly announce, "See, you're not taking care of your gums or your teeth. You have signs of gingivitis." I want to say, no, my gums are bleeding BECAUSE YOU ARE VIOLENTLY POKING AT THEM WITH A POINTY METAL TOOL. I want her to trade places with me so that I can have a go at poking at her gums with a pointy metal tool.
Anyway, after that, she'll polish each tooth with the same rigorous energy as she devoted to poking, often drawing blood, and tutting along the way, while another hygienist enters the room to do the suction. Meanwhile, the guilt and shame rising up inside me for not having taken better care of my teeth makes me want to bury myself in the chair and never emerge. I FEEL LIKE A BAD PERSON. Then I'm given some pink fluoride in a plastic cup and commanded to swish for 2 minutes (a timer is put on for this exercise, and when it beeps, I stand over the sink and spew as hard as I can because the stuff is gross and stings like hell). "Don't rinse, DON'T RINSE," she barks.
When she's all finished with her various forms of torture, then the dentist announces her arrival, cheerfully snapping on some latex gloves and saying something like, "So! I heard you're not doing very well with the brushing! Let's take a look!" After a lot of murmuring and consultation of the x-rays, she'll turn and say, with quite a bit of affected grimness, "Looks like ya have a couple cavities kiddo" (they all call me kiddo - even when I was in college, they called me kiddo). "We're gonna have to take care of that today." So I'm given novocaine injections, drilled into, filled up, and sent home with a pamphlet about gingivitis.
"We'll bill you, sweetie," the receptionist says as I pass her desk on my way out. The invoice arrives one week later to the tune of $250 something.
Meanwhile, in London ...
I arrive to my NHS dental surgery (which is also affiliated with a prestigious London university) and am called to the dentist's chair by a young (most-likely a dentistry student) dental assistant/hygienist. She points me to the chair, where I am immediately greeted by my dentist, who is reading my case history. "Any problems since your last visit?" she asks brightly before beginning to examine my teeth. "Nope," I say, and settle back in the chair. The only similarity between US and UK dentist's offices is that they always give you those hilariously large safety glasses to shield your face from the spray of water (or possibly worse) when they clean your teeth.
She examines my teeth one-by-one, dictating notes on each tooth (as they do in the US) to the hygienist. Now, the hygienist doesn't really do any cleaning - at any stage. I guess she's more of an assistant than a hygienist. She only holds the suction and hands tools over to the dentist that the dentist requires (this is usually wrong, and then the dentist has to calmly explain why it is wrong and where to find the right one).
Then the cleaning commences - or what is known as the "scale and polish". She cleans any tartar or plaque off by ultrasonic cleaning and then "polishes" the teeth afterward, which basically involves scrubbing some gritty paste over all my teeth and then asking me to sit up, rinse with the plastic cup of pink liquid on the side and to spit in the little sink attached to the chair. Interesting. It's the shortest version of "cleaning" I've ever received at the dentist's.
She then has a look at my x-rays and checks for any cavities or changes that require repair. Amalgam fillings (silver-colored) are covered by the NHS, but composite (tooth-colored) cost extra. Depending on her schedule, she can complete a filling in the same appointment, but I often have to reschedule for this.
If it's only a check-up that day, I sign an NHS form and hand over my debit card to the receptionist, who charges me £18 and tells me to take care.
No guilt here, but I guess the only worry I have is whether she's been thorough enough, which is why I considered switching to private dental care. I often wonder, are my teeth really okay? Or is there another root canal waiting to happen? My root canal last year was a nightmare, and nearly every appointment ended in tears - either because I had an infection which needed to be treated by antibiotics and the rest of the procedure couldn't be continued or because it just never seemed to be resolved until my fifth (!!!) and final visit. I would have seen an endodontist at that point, but the thought of paying £800 (plus another £160 for the initial consultation) hurt more than my tooth. Today, that troublesome tooth doesn't bother me any more and I continue to go to my 6-monthly check-ups with my NHS dentist.
So, yeah. That's how the two experiences compare for me. One thing's for sure: teeth are expensive and a headache to deal with. Literally.