Please help urgent dental issue

[BumbleBeeWineGlass]

I have name changed for this because I'm fucking ashamed and I can't take a flaming in my usual name.

I have a 14 year old child (along 3 others) who had severe health needs, I spend about 4 hours minimum a day getting medication into him in one way or another, one of my other children has dyspraxia and ADHD so need a lot of input - basically I'm exhausted, sprinting to stay still and only just holding it together.
I'm on top of everything usually and everything gets done apart from my eldest child's teeth, they get brushed well once a day (by me) and poorly once a day. He has a crippling fear of the dentist so after toddlerhood has never been. The amount of treatments and medication he has mean his teeth are very discoloured but I've never been able to get close enough to actually look in his mouth. He doesn't complain of pain and doesn't have bad breath, it's been bottom of my 'to sort' list for ever and I know that's not ok. Before anyone asks his father is useless and absent.

Anyway, today during a treatment DS has lost either a tooth or part of a tooth. At the front.
The bit that has come out is very short so after a very stressfully (but had to be very gentle) he's let me look for the first time in his mouth...

I know he lost teeth when he was younger but I never kept count, he claims this one that's come out is a baby one but he's 14 (although physically and behaviourally 3/4 years delayed)
I can see tooth left in the hole but it almost looks like a new tooth that's pushed this old
one out but the old one is so short I assume the root of it might have decayed away or is still in there.
I also noticed one of his molars is completely sideways and there's another tooth above it already come out, he's got teeth everywhere and lots of extras. I know I'm a shot mother for not knowing but you don't need to tell me I know (I'm waiting until they're in bed to cry with shame)

Anyway I obviously need a dentist, tomorrow but our area is notorious for not taking on new NHS patients and when they do the appointments take weeks to get.
I will have to try and pay to get him seen. I think if I play it right and the dentist doesn't scold us about the state of his teeth that I might be able to get him in the chair and open his mouth, he can't be sedated without a lot of intervention due to his health condition.

It's all a mess, he doesn't even eat a lot orally which is the joker he's fed via PEG.

Can anyone offer any advice or at least tell me it will be alright?... I keep looking at this pit of tooth wondering where I can find that bit extra to give to sort this out.

You might want to look into your local community dentists - they see people with special needs/disabilities/phobias if they can't be seen by a standard dentist? For some areas you have to be referred to them by another dentist.

I looked into that but he would need to be referred by another dentist, another dentist wouldn't refer without seeing him first and so far I've never managed to get him to even get out the car at the dentist let along go in and sit down. This has shocked him though so i think I'll have a better chance.

I think the front teeth are the first to come out. My teeth never punched out my baby teeth but the adult teeth grew behind so not likely to be a baby tooth.
Ring your dentist and explain the situation. Ask him to be gentle and then if possible ask your son to wait in reception whilst you get some advice from the dentist.

You can google 'find nhs dentist' and it will tell you local dentists who take and have space for nhs dentists
I think you can report them if they won't take on a new patient when they have space and all children get nhs treatment even in an otherwise private dentist
It can take a while for a specialist community dentist
I think all dentists have emergency appointments each day

No judgement from me. I’ve only got two and they’re both NT and their Dad is about and I’m knackered, you’re a trooper.

Max Fax at the hospital might be an idea- if you can get referred over? They helped me when I was pregnant and had an abscess over a bank holiday weekend.

I would ring local dentists and see who states that they specialise in anxious paediatric patients. It may be that being seen by ENT and having a anaesthetic may be better. They run lists in hospitals and can do all that needs to be done in one sitting.

And please don’t beat yourself up - this doesn’t make you a shit mum at all, rather one that has had to prioritise. It’s not like you’ve ignored his pain or compromised his nutrition.

I think the root possibly has be decayed away sadly, DS says it's been wobbly for months (but has never mentioned it!) I will obviously call every dentist locally tomorrow to see if any can seem him tomorrow.
It will be a huge ordeal if he had to have any out, he's asking what will happen and I don't know what to tell him so he's starting to clam up. This is the tooth. Apologies for the grim picture.

He does seem to have far too many teeth in general and they're all pointing in funny directions so I think some will have to come out eventually.

Thanks for not flaming me. It's the tip of the iceberg tbh we've had a shitty 12 months he's spent over 6 months of it in hospital, we've only just got him home.

In my area (wales) most people without dentist get sent to have teeth removed under sedation in a private clinics but paid for by the NHS. It's so quick, the turnaround of patients is like a conveyer belt. Is this something that could work for your son?

I think you need a specialist dentist. One that is at least set up to deal with behavioural needs.

Does your son have other medical support familiar with his needs you can ask to refer you somewhere?

From your description I think this is probably beyond the skills of your bog standard high st practice, unless you strike very lucky.

First goal is to get him to allow an examination. Take it step by step. From the sounds of it though if he needs anything more he may well need sedation of some sort, which takes you back to a specialist.

Talk to his consultant/specialist nurse and ask their advice.

You are NOT a shit mother, you're a bloody marvellous woman who is doing everything. It's not the end of the world, you will get this sorted and it's all going to be OK. Whilst you won't find an NHS practice for you, you'll find one for the children so you won't need to pay. Google 'Gentle Dentistry' locally or ask on any FB groups you're on if anyone knows any dentists who specialise in kids with different needs. Good luck xxx

www.nhs.uk/Service-Search/Dentists/LocationSearch/3

You may just have to go further if ones near you aren’t taking on. They don’t have catchment areas like drs surgeries.

Is it worth trying to be seen now via out of hours?

“Dental emergency and out-of-hours care
If you need urgent dental treatment, contact your usual dental practice. They may be able to see you or direct you to an urgent dental care service.
If you don't have a regular dentist, contact NHS 111 for advice on where you can get urgent care.
The cost of emergency dental treatment is currently £21.60. You may be advised to make another appointment for a separate course of non-urgent treatment.
If this happens, you'll have to pay a second charge in the relevant treatment band.”

It will be a huge ordeal if he had to have any out, he's asking what will happen and I don't know what to tell him so he's starting to clam up

Tell him they will just look in his mouth. Nothing else. If he does need anything doing it can wait until you have something in place to make it easier for everyone.

I’ve done it with my nearly dentist phobic child. No where near the issues you have but I promised her it would be looking only, unless she gave permission. I have refused treatment before, and gone back after we could discuss exactly what happens, and that she can stop at any time.

Firstly, STOP beating yourself up about this! You are doing the best you can for your children. That’s all anyone can do ( and many do not).
If the tooth is very short with no root then it is most likely a baby tooth. Some people retain deciduous teeth into adulthood, it’s not unusual.
If you can post a photo then we could probably be able to reassure you about this.
I would call your dental surgery and explain the situation you are in. If you get anything other than a sympathetic response and good advice about what they can do to help your son, on the NHS, then keep phoning around dental surgeries until you get this correct response.

He has a huge medical team, I'll call our community nurse tomorrow morning and ask for her advice.
He can't have normal sedation and will have to be sent to a specialist hospital if he needs anaesthetic. He's on over 50 motivations a day, none of them are good for his teeth and funnily enough he doesn't like sweet things so it's not like he's eating tons of sweets and sugar! I've googled the local special care dental service and they have a helpline so I will call and see what they suggest.

I will keep you updated and see how I get on. Thank you again.

It looks like a baby tooth .
The root has been dissolved away by the new one gradually coming up through the bone .
I would not worry too much just now but see a dentist.
Even if he does not sit they can still refer .

I’ve got no idea what you do but you sound like you need a hug.
You sound like a fab mum ❤️

DB has additional needs and gets seen by a special clinic in a dental hospital. They are AMAZING. So gentle and patient. He has to travel across from the west coast to the East but it is worth it. His gp referred him.

Ps your photo is excellent.

Could your GP refer you to the local community dentist, or does it have to be another dentist?

Massive cross post, Op, just seen the photos, that looks like a baby tooth as the root is completely resorbed. Given that he is PEG fed, then the chances are he had other retained deciduous teeth. Agree with pp’s - a dentist needs to assess if he needs any treatment and make a plan.
Best of luck with phoning surgeries. School Nurses might be able to help in regard to services available in this situation.

We paid for private for ours when they were under 18 as our local NHS ones were notoriously bad. It was about £15 per inspection, and they referred us on for orthodontal treatment under the NHS for one of them. A filling was around £45 so it wasn't anywhere near as expensive as adult treatment. May be an idea to see someone private initially as you'll be seen quicker and try to sort an NHS one in the long run.

Don't beat yourself up.... making mistakes is human . Now you know, you can sort it.

The additional needs your child has I would say would merit a direct referral to a Community dentist. If that is absolutely not the case then I would explain the issues to your local primary care trust ( assuming you are in England) and get them to sort an assessment for referral to a specialist. I work in Wales.. if you are in Wales PM me I can possibly help!

Just wanted to say you are being incredibly hard on yourself. That just looks like a normal baby tooth that's fallen out, no decay obvious. The roots will always look like this. You sound like you are doing a fab job. One step at a time. I hope you manage to access the appropriate service without too much trouble. Also no decent dentist will judge/ scold you. They will understand how hard it is and hopefully get a plan in place.

Just to update you all because o know it's frustrating when an OP doesn't come back.

DS saw a dentist this morning, he was brilliant, really good with him, took it slow and spent a lot of time reading through the letter I had given with full details (so DS didn't have to listen in to all his issues)

He said he still has most his baby teeth so they're all now finally falling out and adult teeth are visible which is making it all look worse than it is.
He said his teeth are healthy but could do with better brushing on the bottom but apart from that he's pleased with how things are (considering) and that he's happy to see him in 6 months and reassured DS that he's likely to lose quite a few teeth in the coming weeks and not to be alarmed.

I'm so relieved. Thank you for all your kind words.