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to think that dentists should provide adequate pain relief? (LONG)

(102 Posts)
toryalane Mon 17-Feb-14 21:01:34

This is a complaint email I sent to NHS England this evening. I have no idea whether anything will come of this email, but I strongly feel that dental pain management on the NHS is woeful and dangerous.

Dear Sir/Madam,

I'd like to raise a complaint about a number of services I have had the misfortune of dealing with over the past 24 hours. These are:

### out of hours Dental Access

### Lane Health Centre

### Dental Access

I realised that I had developed an abscess on the roots of my wisdom tooth on Saturday afternoon when I had an onslaught of horrific pain.
The site of this pain is a wisdom tooth which in March last year was subject to two failed extractions. The failed extractions had meant that I was left with the roots of the tooth in situ. The gum has subsequently all but grown over the roots leaving a small hole.

Up until the abscess which developed on 15/2/14 I had had no trouble with the roots.

On the morning of Sunday 16/2/14 , after a night of no sleep and hellish pain, I telephoned the out of hours service. They advised that I telephone back after 8am or ring 111. Preferring to deal with a local service, I telephoned the out of hours service at around 11am when I knew I could get there.

I was given an appointment for half an hour later. I paid £18 pounds for 3 minutes of the dentist's time. He prodded my abscess, told me it was full of pus and prescribed Amoxicillan. I requested that he prescribe some pain relief but he refused saying that he didn't do that. Instead I was told to take over-the-counter Ibuprofen and Paracetamol. No advice on dosage was given. I left and collected my prescription.

I believe this is against practice guidelines:

(See British Dentists' Journal article Re: Paracetamol and toothache overdose

I arrived home and attempted to eat some soup so that I could take the ibuprofen safely, but I was unable to open my mouth and cope with the unbearable pain. I had to just take the Ibuprofen anyway as the pain by this point was horrific.

Looking forward to being able to request adequate pain relief from my GP meant that despite having no sleep I managed to make it through the night of 16/02/14.

I telephoned my doctor's surgery and the receptionist seemed hopeful that I could be given help. She told me she would have the GP telephone me back. After an hour the receptionist telephoned me back stating that the doctor had said they couldn't get involved with a dental issue as it might be seen as "stepping on the dentist's toes". I use quotation marks here because that is word for word what was said. I was very distressed by this point and stated that this was why many people had lost their lives due to accidental paracetamol overdose and toothache. The lack of pain management support for dental treatment is appalling. I then rang off very upset, distressed and ultimately still in a world of pain.

(See link provided here for one of many newspaper reports of a death by paracetamol and toothache:

I then telephoned the 111 service and described my problem. They were very sympathetic and gave me the number for ### Dental Access - which they told me to contact.

I telephoned ### Dental Access and spoke to an extremely rude woman who told me that "dentists don't prescribe pain relief".

Please see link below which details drugs that can be prescribed by a dentist:

(I grant you the link is Scottish but I imagine the England guidelines for drugs which can be prescribed by dentists are similar:

I then telephoned 111 again who again were very kind. They put me onto a nurse who was lovely, but at a complete loss of what to do for me. She said that dentists can and do prescribe pain relief and she couldn't understand why my GP surgery wouldn't either. The only advice she had for me was to go to walk-in centre at ### - 3 miles away, or call the out of hours doctor out after 8pm. Both costly solutions for the NHS when compared to the writing of a prescription by a GP, I am sure you would agree.

I am a 30 year old professional. who has at many times during this process, been treated like a child who doesn't know what they are talking about.

I demand a full explanation of the NHS dental policy on pain relief, a full explanation of the NHS policy on GPs and dental pain and guidance as to how this complaint will be dealt with including a timeline of dates stating when I can expect action by.

Should your response not be satisfactory or in a timely manner I shall be referring the matter to the Parliamentary and Health Service Ombudsmen.

Again, I reiterate, the lack of empathy and management of pain by dentists is not good enough and is going to cost more lives if it is not rectified and the whole system overhauled.

So aibu? If so why? If not, what on Earth can be done about it?

Silvercatowner Mon 17-Feb-14 21:03:50

My dentist has never left me in pain. Sounds horrific but not all dentists are like this.

NoArmaniNoPunani Mon 17-Feb-14 21:10:03

The man who died from talking paracetamol did so because he was an alcoholic. Why didn't you just take neurofen plus (or the generic equivalent)?

toryalane Mon 17-Feb-14 21:16:19

I have been taking both ibuprofen and paracetamol. The pain has been indescribable. The trouble with ibuprofen is that the dosage has now been downgraded to every eight hours and you should take it with food. I can't eat.

That link is weak I grant you. I typed in pain and anger. The point stands though that people can very easily find themselves in trouble with paracetamol by taking just a small amount over the recommended dose for a period of days.

MillyMollyMardy Mon 17-Feb-14 21:19:35

OP dentists do not have access on the NHS to all the pain relief that GPs can prescribe.

There is no NHS Dental policy on pain relief for anyone to follow.

Paracetamol and ibuprofen combined are good at dealing with dental pain. What were you expecting to be prescribed?

cakebar Mon 17-Feb-14 21:21:56

YANBU. Your dentist and especially your GP should have helped. It sounds like they couldn't be bothered. I know paracetamol, ibuprofen etc doesn't touch bad pain.

In your case, refused by GP and dentist I would have considered going to A&E. In my experience though, telling the dr that you are going to have to go to A&E for help gets them to be more accommodating. I think a lot of A&E work is caused by GPs being crap.

toryalane Mon 17-Feb-14 21:23:08

The link from the British Dental Journal hasn't worked. It's here:

It presents two cases of accidental paracetamol overdose because of dental pain.

SchroSawMargeryDaw Mon 17-Feb-14 21:23:51

I have been prescribed painkillers by a dentist for an abscess. You are right in writing your complaint as you have had crap treatment.
You should go and buy some Solpodeine plus now though.

NoArmaniNoPunani Mon 17-Feb-14 21:26:19

You didn't answer me regarding neurofen plus. Why didn't you take that?

isisisis Mon 17-Feb-14 21:26:55

The DPF severely limits the analgesics available for dentists to prescribe. It's the way it is.
Who performed the two failed extractions? Weren't you referred to max fax to have it completed if your dentist was unable to?
As for the complaint, if you actually want answers to your questions then you need to raise it with the practices you dealt with. If you just want to blow off steam & be shouty then be my guest.

toryalane Mon 17-Feb-14 21:27:15

Hi Milly - Ibuprofen and Paracetamol combined has not been good at dealing with my dental pain. Not now with this abscess or in the past when I had two failed wisdom tooth extractions and experienced dry socket.

After my failed wisdom tooth extractions I was prescribed Tramadol by a Practice Nurse at my GPs. When I had dry socket I got diclofenac acid from A&E.

Silvercatowner Mon 17-Feb-14 21:29:13

Actually when I had my wisdom teeth out I had diclofenac. You can buy it OTC now - though probably the strength is less. Might be worth trying.

toryalane Mon 17-Feb-14 21:29:18

What is in Neurofen Plus that would have helped over regular ibuprofen?

BlameItOnTheBogey Mon 17-Feb-14 21:31:27

Threads like this are make me want to weep and make me glad that I don't like in the UK. When I got an abscess on my tooth, the dentist here gave me some lovely strong painkillers which made it much more manageable. The NHS in marvelous but it is not ok to leave someone in pain and to tell them that ibuprofen should be good enough. The OP was taking that and it wasn't. She is a grown woman and deserves to be listened to.

mycatlikestwiglets Mon 17-Feb-14 21:31:31

I have never had ibuprofen which states it can only be taken every 8 hours and with food OP - in fact I was on it every 4 hours for pain from an infected wisdom tooth just last week (without food as could hardly open my mouth) confused. Still, YANBU to be annoyed that no one would prescribe you something more effective.

Draughts Mon 17-Feb-14 21:31:38

Well, I'm not sure who should or could have prescribed what for you OP, but I am sure that you shouldn't have been left like that. It was clearly extremely frustrating & I don't blame you for being extremely cheesed off.

Do complain to the individual practices though.

ADishBestEatenCold Mon 17-Feb-14 21:32:54

Unfortunately I can't remember which one, but I received POM pain relief for dental pain that 'killed it' within half an hour, so it's definitely possible to be given something more effective than paracetamol and ibuprofen combined.

Draughts Mon 17-Feb-14 21:33:24

You really should take ibuprofen with food if you can. My son, who has a host of medical problems can no longer take ibuprofen unless desperate as it really irritates his stomach. Very unpleasant.

Elsiequadrille Mon 17-Feb-14 21:33:49

Ouch to failed wisdom tooth extractions.

I was just advised to take Neurofen, and told to take more frequent doses of the antibiotic initially (I think) and that helped, or seemed to help, with pain relief.

NoArmaniNoPunani Mon 17-Feb-14 21:34:43

What is in Neurofen Plus that would have helped over regular ibuprofen?


nennypops Mon 17-Feb-14 21:35:04

I can't see that the dentist has any particular duty to advise on dosage for paracetamol and neurogenic, because it is all given on the packaging.

toryalane Mon 17-Feb-14 21:35:57

Mycat - that was the advice I got in Boots when I bought it and is on the packet - I too thought like you before then.

Thank you for your replies. I know the email is a bit ranty, but it has been hellish for me. If I had an abscess anywhere else on my body I would have been given adequate pain relief no problem. It's like dental pain is second fiddle, when actually it's in your face, jaw and ear and there's no escaping it!

Willdoitinaminute Mon 17-Feb-14 21:36:43

Cocodamol alternated with Ibuprofen are probably the most effective combination for dental pain. Both available over the counter from all pharmacists. Pharmacists are well informed and trained to give advice regarding common types of pain. Dentists are no longer able to prescribe cocodamol. If you ask for the generic form they are far cheaper than a prescription. Or am I right in thinking that in Scotland all prescriptions are free?
Why has your dentist not referred you to have the roots removed?

MillyMollyMardy Mon 17-Feb-14 21:36:49

OP neither of the two painkillers you have been prescribed are on the Dental Practitioner's Formulary. The dentist you saw couldn't have prescribed them.
Your antibiotics should be beginning to work by now.
You can go to a pharmacist and buy a codeine containing medication over the counter (Solpadeine is one of these), these usually contain paracetamol as well so you will need to check that you aren't taking more than 4g of paracetamol over 24 hours. You can also continue to take ibuprofen or diclofenac that you can also buy over the counter with these. You need to read the packets and check that there are no reasons for you not to take them.
Paracetamol is a good painkiller you would be given it if you were taken off the A+E with cardiac pains.
Isis has also asked what is being done to make sure this doesn't happen again as if those roots connect to your mouth the infection has probably tracked down to the roots rather than the other way.

Wabbitty Mon 17-Feb-14 21:39:55

NICE guidelines!scenariorecommendation:3

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