"Hygienist" as opposed to clean?

Moon_Eyes

Hi

I know there are millions of these threads lying about, apologies for starting a new one but I need an answer if anyone can give me one.

I attended a dental clinic for filling treatments and my PRSI covered some of the treatment. However the dentist does not perform cleaning and referred me to their in house hygienist for 2 sessions at a cost of 80EU each. Can they do this without offering you the entitled scale and polish that you are allowed via PRSI? I just don't get it at all. This was my first time to attend this dentist, my last dentist cleaned them himself as part of the treatment. Is it just a money making scam and do I have any pliable arguement with the dentist about it?

I feel ripped off, when I questioned her she said "well our hygienist specialists are there to give guidance and oral hygiene counselling as well as cleaning your teeth so it's not just cleaning they provide" WTF?:eek: The hygienist cleaned my bottom teeth in one session and the "counselling" referred to was, she told me I should quit smoking (thanks Sherlock) and showed me how to use Tipi brushes I already knew how to use, it all took about 20 mins and I was told to come back for the second session to do my top teeth a week later but I didn't go back. I am really frustrated and annoyed that they push this service on you and don't give you the choice of the alternative, a clean that you're entitled to. I don't know what to do and I feel railroaded about it and bullied into paying for something I probably could have gotten free from another dentist if I hadn't been so naieve. Can anyone advise? thanks if you can. I also have to go back to same dentist as the filling they put in, in September fell out, going tmw...should I pay for this? thanks if you can answer me on it.

davo10

The Dept of social welfare unfortunately does not agree contracts with hygienists, so they are private clinicians. Some clinics do provide cleanings with hygienists under PRSI but I bet you would be surprised to learn that after the Prsi payment is devided between the dentist (who owns and pays for all the equipment, supplies, staff, insurance, utilities for hygienists surgery) and the hygienist, each gets approx € 11 euro per cleaning. Hardly a fortune. So that is why most do not offer this treatment on PRSI scheme.

Clytus

Thats weird. I was at my dentist 2 weeks in a row...needed a filling first week...then went back the next week to have a my teeth cleaned...and had it all done in about 15 mins....

davo10

You may have hit the nail on the head there clytus, hygienists tend to spend longer cleaning teeth than dentists and therefore arguably do a more thorough job as it is their speciality.

By the way fee is gross, not net of expences.

In case you are wondering how that breaks down.

The PRSI pays € 32.60 to the dentist for teeth cleaning, less 20% withholding tax = € 26.08. One visit per 6 months.

Split this between dentist and hygienist = € 13.04.

Now deduct tax at 41% = € 7.70.

Now deduct practice expences and you get a net loss, not a profit.

(figures available on welfare.ie)

earlyevening

Withholding tax of 20% AND income tax of 41%???
You're not a tax expert.

PSWT) is not an additional tax. It is a deduction on account, made at the point of payment, of the final liability of the person who provides the professional service. PSWT is deducted at the standard rate of income tax.

http://www.revenue.ie/index.htm?/leaflets/it19.htm

davo10

Tax deducted is against amount paid by to dentist, the hygienist has to pay 41% tax on their half.

taram

PRSI doesn't apply to me, but my hygenist does a full hygenist service, as opposed to a dentist's check up. She checks my teeth as normal, answers any questions about dental things (such as how to floss with my brace etc), checks my gums, checks my tongue (as I have dry mouth and my tongue sometimes cracks), takes an updated medical history, does a specalised coating on my teeth after using a water pick for deposists and a full polish, and if there's anything untoward (like I had a weird stain on a tooth), the dentist gives that problem a quick check all included. You've paid for the dentist basics and that's pretty poor value tbh. Can you attend another dentist for purely a scale/polish?

davo10

You can ring around and ask for a dentist who does scalings on PRSI. From my own experience, the reason i employ a hygienist is to free up time to provide restorative/emergency treatments. Prior to her joining practice there was a 6 week waiting period for treatment and we had to squeeze in emergencies. Now wait for treatments such as fillings/fractures/extractions is no longer than 2 1/2 weeks. Emergencies are seen today or at the latest tomorrow. I check the patient's teeth, then they visit hygienist if required. I do not scale/polish teeth. Most people who attend regularly and have a good diet/hygiene require only a scale and polish.

Moon_Eyes

Thanks for all your kind responses. I don't mind paying for a service at all and actually think that paying for a longer hygienist treatment seeing as I hadn't been in about 2 years is fine. However I felt that I wasn't informed properly of my options and because the hygienist herself looked a bit miffed as to why I was scheduled in for two sessions then, as an afterthought, decided to do bottom in one session and top in next.

Now because I didn't get my scale and polish that I am entitled to through social welfare, (I called them yesterday and they told me you have a right to insist your dentist does a scale and polish, however as you have already stated this is a much shorter fast once over cleaning and I accept that), if I do go back for the second clean I will only be able to claim one receipt through my health plan (as on my health plan it says thast PRSI will cover one clean and health plan will cover another one but I have missed out because of not asking and doing my own homework)

I have been told by various people that their dentist clean their teeth as part of their dental treatment (which is not cheap regardless of the poor dentists having to pay tax, I am out of pocket € 400 already for two fillings and a clean, WHO is benefiting from this then if not the dentist, the tax man? forgive my tone of angry sarcasm, I am genuinely interested to find out why though, and it's infuriating when you hear about the costs abroad and how much cheaper it is). And those I know who do go to a Hygienist only go once, pay the seventy or eighty it normally is, and have their whole set of teeth done. I don't have fabulous gnashers but they're not that bad at all to be honest. So no, I don't fnd it acceptable that my yearly cleaning was, I feel, drawn out to make more money out of me. I'd rather go to another hygienist and pay the €80 and get the full set done again instead of paying them their second session, and I'll be telling them that too. I wil be shopping around and ask more questions at the start too, lesson learned! Thanks for the advice.

davo10

Moon eyes ask your dentist to put total cost down on one receipt and submit that, they will not mind. Also did you know that you can submit cost of this treatment (periodontal) on a med 2 form as a medical expense and get up to 41% refunded against tax (less an excess which can be exceeded by other medical expenses submitted).

Lastly, different people have different amounts of plaque on teeth, some have only a little and require a short appointment to clean them, others have more extensive deposits which require a more invasive treatment which takes longer and more appointments. The benefits of having it done correctly are beyond doubt. There is nothing worse than having to tell a patient who brushes their teeth regularly that xrays show extensive bone loss and the longterm prognosis for some of their teeth is poor. This may be a result of a wide variety of factors such as poor hygiene, smoking, abcess, SLE, diabetes etc and sometimes there are no aetiological factors, it just happens.

Your hygienist may have measured pocket depth with a special probe ( feels like it is being pushed gently down between teeth), this shows if there is any bone loss between teeth, if there is some minor loss it may indicate early periodontal disease and a two visit comprehensive scaling is the recommeded treatment to prevent its progression. ( on the second visit the hygienist can gauge the improvement in the condition of the tissues scaled in the first appointment).

It sounds to me like the biggest problem was the lack of info given to you, communication often prevents misunderstandings

Moon_Eyes

Thanks again Davo10

I rang my dental health insurance company yesterday, they will cover up to 2 cleans a year, which considerably drew my horns in! Can I just ask you though woud you know if I claim on that, I take it that it makes me exempt from the Med2 form then for revenue? Does one exclude the other? I think I read somewhere that you can claim the excess amount you pay after health insurance but I'm not sure because if I submit all receipts to health insurance they don't return originals and I don't know if you can just keep photocopy receipts should an audit be requested. Just wondering anyway. Thanks for the advice though I appreciate it. I am going to go back now for the second cleaning. If they are going to do my two cleans per year in 4 parts as it were, going forward I will ask them to issue me one receipt for the two-part sessions as you suggest. Thanks again.

davo10

Mooneyes ask dentist for 2 sets of receipts, it will be no problem. your dental insurance is a voluntary private scheme you pay into for just such expenses, the Med 2 is a tax break and it is no concern of the revenue what type of private insurance you contribute to/claim from. Make use of this now, the minister capped the tax relief on medical expenses at 20% from January 1st, sneaky so and so

Moon_Eyes

Hi Davo10

Thanks again for answers. Just to note though, technically speaking, you can't claim tax relief if you have private insurance, it's on the Med 2 form (actually sorry, page 4, I think of form Med1), and fillings and cleaning are not covered, period, so it's not worth my while submitting anything to the tax man. Unless you get crowns, braces, root canals or periodontal treatment, extracted wisdom teeth... in other words, bigger more complex work, there's not a lot of point trying to claim tax back. At least I know now moreso the ins and outs of it all. Thanks once more, take care. Moon_Eyes