Wednesday, November 6, 2013

Dentistry in the US vs UK

So, I went for my regular check-up at my NHS dentist this morning and thought about a question I get a lot when I'm back home in the US. And it's pretty downright rude: "Why do the British have such awful teeth?"

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.


  1. Oh Jaime, this is one of those things that I am also weirded out by in the UK. I'm used to it now and I know things are okay, but it is so so so different. I had a clean and quick check up last week. Their suction tool wasn't working. At all. It was so degrading, but the hygienist was so nice and kept apologizing for how medieval it all was. And it was really, really messy. But I dealt with it and it wasn't such a huge deal. That would just never ever happen at the dentist back in the US. I can't bear to tell my Aunt who is a hygienist...I don't think she'd even be able to comprehend it.

    1. Abby, I definitely left my appointment yesterday with a wet neck and hair. Our dentists in the US would be HORRIFIED!

  2. Hi Jaime, gosh I want to know where this amazing NHS dentist is! Things are a little bit different once you get outside of London and into some really rural areas like the southwest where I'm living. I have met MANY people who have never been to a dentist in their entire life as, 'It's too expensive on the NHS'. Meanwhile their teeth have turned into brown pegs due to acid erosion and poor hygiene (I cringe every time I see their teeth). When my partner came back with me to the US, he thought he'd get his teeth checked out as his NHS dentist had been telling him that his cavity wasn't that big a deal, and wait a year and come back then. In the US, they found 16 cavities and two root canals that needed doing. My NHS dentist refuses to scale and polish my teeth as 'they don't need them'. Believe me, I still take advantage of my old dentist in the US every time I go back!

    Seriously though, where is your dentist? So interested in switching when I move back to London!

    1. Hey Ashleigh, I wouldn't classify my dentist as "amazing", but I've heard that it's one of the better NHS dental practices in London! I go to The Imperial College Dental Surgery in South Kensington. I think they're accepting new patients - just call them up.

  3. Superub, have noted it down for when I return from the southwest! x

  4. After two years in Northern England I've avoided the local dentist for myself (making dental appointments on my visits home). That said, I've taken my son for some minor check-ups and I was a bit stunned at a few differences beyond what you've observed. 1) My dentist in the states converted to all digital x-rays about 5 years ago. The dentists I spoke to here can't even accept them. 2) Children cannot get into private dentists (at least not up here) unless their parent's also become patients at that practice and start paying annual fees (somewhat analogous to dental insurance). That shocked me. Fortunately NHS dentist was willing to accept us as long as we paid non-NHS rates. 3) Back home whenever I'd moved I'd simply asked friends and neighbors who their dentist was and whether they'd recommend them. That had served me well through a half-dozen moves in the USA. I probably asked 20 people directly as well as posting to a school group of 50 parents. I got 1 person to actually recommend their dentist (who's private practice ultimately refused to see my son because I wasn't a patient). Others either flat out refused to recommend their dentist or remained silent. That seemed pretty telling to me about the degree of satisfaction English people have with their dental care (perhaps compounded by their difficulty with complaining).

    1. Hi Phil, it's so interesting to hear about your experiences! Thank you for sharing. I definitely used to "save" up my dental appointments until I went back to the US. But now that I've found a somewhat competent NHS dentist (by recommendation), I'm happy to continue seeing her (I'm also just too lazy to make appointments in advance of my US trip, ha!). The NHS dental practice I currently go to uses digital x-rays but I'm sure every practice is different.

      Interestingly enough, on a different matter, I've also heard a lot of people here in the UK tend to go abroad for root canals and other dental procedures e.g. in Poland or Hungary because it's cheaper but just as professionally done as in a British private practice. I would be hesitant to do this if only because any complications meant you'd have to travel abroad again to fix!

    2. I have been a registered dental hyg in NYC for 15 years. living in London and now working in London ( as a practice manager in a Harley street practice) I am sickened by the care in this country. It is so far behind and there is very little cross contamination control. in other words its dirty as all. in the usa we are use to preventative medicine. this country fixes and patches when it does go wrong. its disgusting

  5. I am British and now live in the USA. US dentists appear better in some ways but I always feel they are more concerned about profit than actual patient healthcare. There is no scientific evidence for amalgam fillings to be worse than composite, yet nost us dentist refuse to do amalgam - why? Because they can make more money. There is no other reason. Ask them if you dont believe me. Insurance comes out of your pay and then you still have a lot to pay with co-pays, deductible, 80% coverage etc.
    Yes they are more pro-active but what is the actual scientific evidence? US dental system suffers from cost-plus inflation and quite frankly I don't trust any of them. The amount of money I pay each uear with insurance and out of poclet is disgusting.

  6. Interesting view, some quite harsh critisism from fellow commenters.

    I am a UK based dentist, who has experienced dental practices in the US. Yes, there is a significant difference in how dentistry is carried out, but I think you'll find that it's actually the Americans who adopt the 'drill and fill' treatment approach, mostly for cosmetic reasons. While British teeth are regarded as 'awful' because they're not straight or white, however healthy they may be. Metanalysis after metanalysis has shown that Americans, on average, have less teeth in adulthood that us Brits. How so? Crown and bridge work and extractions are only carried out once the tooth is so badly damaged that it's structure is undermined and weakened, it is actually regarded as unethical to prepare a tooth unless there is something significantly wrong with it (for example, crowning a perfectly healthy tooth just to make it look better). Many cavities as also 'monitored' for long periods of time, because a cavitys activity status can be HALTEd with the correct oral hygiene regime, meaning that there is no need to drill and fill a tooth. The idea being that as long as you're keeping a keen eye on the inactive cavity, if it were to progress you can tackle it more invasively then, having bought some years of a natural tooth. When you change dentist, it is imperative to carry forward your DENTAL HISTORY to the new dentist, so that any cavity that was being 'monitored' as such, will not be regarded as poor dentistry.

    It's also quite unkind to tasnish all dentist practices with the same brush about cleanliness, as I am sure you will find good and bad businesses in any country and profession.

    In regards to the NHS v.s private debate. You may be surprised to learn that many dentists operate as NHS AND private dentists, often running their own private practice and also working part time at an NHS practice. Why? Because an NHS dentist can earn a lot more money (Shocking, I know!) as they see many more patients in a much shorter space of time, while a private dentist charges each patient more money because they have much longer appointments.

  7. having experienced both sides of the coin, dentists in the USA are just over aggressive with treatment. most patients in the UK are being treated on the NHS, its purpose is to maintain function, and health. That does not include cosmetics. for £50 odd pounds should the nhs dentist a mouth full of white fillings and bleaching?

    I think some fundamental understanding of both healthcare systems should be understood, before making judgement.

    At the end of the day, you get what you pay for

  8. please also learn the difference between a dental nurse and dental hygienist

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