If composite becomes the restorative material of choice*…what choice will you have when it comes to filling your private practice?
For 66% of NHS dentists**, the ability to offer composite fillings on posterior teeth for cosmetic reasons outside the NHS contract, is fundamental to maintaining the profitability of the practice.
No longer on the curriculum of some leading European dental schools, the long-term viability of amalgam as the NHS material of choice remains uncertain. Under the old “fee per item” system, (pre 2006 NHS contract change) mixing meant that the dentist would forego receiving the equivalent NHS fee (e.g. doing a composite filling on a back tooth). However under the new banded UDA contract, the dentist will still receive the 3 or 12 UDAs even where part of the treatment is provided privately. In the future, would the Department of Health still be happy for the dentist to be paid twice?
There are already guidelines (cf Lynch CD 2007; 2013***) which encourage the use of composite tooth-coloured materials for a number of common posterior tooth situations. Whilst amalgam will certainly continue as an option (it is estimated that anything up to 75% of new restorations are still made in amalgam worldwide), it’s possible that a combination of environmental factors and the development of ever-better materials could lead to its disuse in years to come. At the same time the public are becoming more aware of their rights to have “all clinically necessary” care and treatment on the NHS.
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*NHS Choices, dentistry: What is available on the NHS? www.nhs.uk/NHSEngland/AboutNHSservices/dentists/Pages/dental-services-available-on-the-nhs.aspx
**Denplan NHS Survey, February 2016