Or was my dentist being unreasonable?

[FlatsInDagenham]

I had an emergency appointment today as a large filling has fallen out. He had a quick look and then told me that there isn't much tooth left and the options were to do a new filling or extract the tooth.

Our conversation went something like this:

"Which option do you think is best?"
"I can't tell you which one to choose. We can fill it but it may come out again."
"So do you think removing the tooth is best?"
"You're asking me to make the decision? I can't do that."
"No, I'm asking for your expert opinion. I can make my decision based on that."
"I don't know how I can put it any more simply for you .. we can do either."

This went on and on, much along the same lines with both of us getting more and more frustrated and him refusing to recommend one course of action over the other.

I don't get it. I'm an English teacher and if a student or parent asked my expert opinion on, say, whether to sit Foundation or Higher papers at GCSE, I would do exactly that - give my opinion one way or the other after weighing up all the pros and cons.

He was really frustrated with me and I must admit I'm quite upset about the whole thing (I'm a sensitive soul - must toughen up).

Is it me getting it horrendously wrong or are dentists supposed to tell you what they think needs doing?

If he told you to have the tooth removed and it went badly (infection etc) or you didn't like how it affected you eating, then you could have reason to be upset that you were badly advised.

That is why the choice is with you.

no i dont think uabu.
I was in the same situation and my lovely dentist said if it was him he would have it out as if he filled it again it was likely to come out again at some point but as im a big Jessie he would fill it again if i prefered.
So, I sucked it up and had it out!! The tooth that is.

I don't think he's been unreasonable actually.

He tells you your options but that one option (the filling) may have a risk of failing down the line.

It's up to you whether or not that risk is worth taking.

Some people will do anything to try and save a tooth. Others won't be bothered and will just have it taken out. Some people may be terrified at the thought of having a tooth pulled.

It doesn't mean one option is better than the other. The dentist would probably have their own personal preference if it was their tooth but it doesn't mean their preference is the right one.

Drs are the same if there are options, they will tell people its their choice and that they can't recommend one ver the other.

Obv if one choice is very bad and one very good then they can and do. I'm sure if your dentist thought there was no way a filling would work they'd have said so.

Well, I suppose only you know which you would prefer so as long as he gave you the options and told you the risks, then I don't see what more he could do. You asked him which was best, he basically said neither was 'best' per se, so you have to make a decision based on your personal preference.

I think he is being unreasonable. It seems unlikely to me that he has no opinion - what would he tell a member of his family to do?

I've found that dentists can be pretty open about these kinds of things. The best thing is to ask them lots of small specific questions such as likelihood of x or y happening then make up your own mind.

Whilst I can see where he was coming from, let me tell you what happened with my dentist in exactly the same scenario just last week.

Me: the tooth has crumbled more since you saw it, so is a filling still viable?
Dentist: hmm, just about. What do you want to do?
Me: what would you do?
Dentist: I'd always want to save a tooth, luckily it's at the back so you can't see it but you'll find chewing a little harder if you have it removed.
Me: great, lets go for the filling.

I felt informed and trusted him. As it turned out once he looked at it further it was in a worse condition and there was no option other than extraction. Good news was it was a lot cheaper and didn't hurt. So far no problems with chewing.

YABU. I thought he was very clear. You could pay for another filling which would be less traumatic but might need redoing, or just lose the whole tooth which would be more drastic but more permanent.

It's too personal a choice for them to advise.

Ok, it seems that whilst opinion is divided, it is slightly more on the side of the dentist.

I guess I got it wrong then. Dentists don't recommend courses of action, they just give you choices.

He must have thought I was a total twat then, pushing him for an opinion.

I'll know better in future.

YANBU Was he a private or NHS dentist? A private dentist has much more incentive to help you decide to keep the tooth as you pay him directly for the course of treatment you agree - whereas an NHS dentist is time-pressured and so the easiest quickest option for THEM could well be extraction.

Extraction of a saveable tooth is never in your best interests.
It is perfectly reasonable to ask a dentist what they would do for themselves and the answer given would usually be the most tooth-saving one assuming you can afford it (specialist root canal treatment or whatever).

There are lots of cons to extracting teeth unnecessarily and you are supposed to give informed consent - it seems to me your dentist was too rushed to run through pros and cons of the two options options properly.

What did you decide? I would have left at him being visibly frustrated at your trying to obtain sufficient information to make an informed consent.
The GDC's own SMILE leaflet for patients says:
'Don’t be afraid to ask
simple questions during
your appointment if
treatment is to be carried
out immediately or do some
extra research if there is time
before your procedure. Talk
to other patients who have
received the same treatment
or visit another dentist for
a second opinion until you
feel confident enough to go
ahead with treatment.'

LOL yes your dentist complied with that...not.
www.gdc-uk.org/Newsandpublications/Publications/Publications/Smile%20FINAL%20Dec%202010.pdf

www.gdc-uk.org/Dentalprofessionals/Standards/Documents/Standards%20for%20the%20Dental%20Team%20-%20web%20PDF.pdf

New GDC standards for dentists coming into effect at end of September.

I just posted a dentist- question on the general health board - I was given the choice between leaving a root canal treatment potentially dodgy or going private to get it done properly. I was shocked.
To my mind, the OPs dentist was unreasonable. They can see the tooth and say for example how long it would last with a filling, what problems might occur etc. Also, tooth extraction can cause problems with other teeth starting to move etc. i can only presume the dentist knows all this, so why not be friendly and caring to the patient and share this info? Don't get it at all.
I am fairly new to dentistry in the UK, and I find it very harsh and discriminatory so far. I would expect that fairly standard procedures like root canals and crowns and bridges are available on the NHS and will be carried out fully to a very good standard! I would also expect a measure of kindness and patience from a nhs dentist; i would think that being uncomfortable during dental work happens more often than not and should not lead to being told off.

There's a whole section on 'obtaining valid consent' in the second document.

brightnearly - if you can afford it go to an experienced ethical private dentist who wants your repeat business. The difference can be chalk and cheese. Don't go to a Chain practice though.
At many NHS practices the dentists constantly change and they are often newly qualified...this is why they are allowed to do root canals - to get the experience but a properly done root canal needs a lot of time and often a microscope - even specialists can take a couple of hours over one and General dentists who like doing them can take even longer...they have to charge for this to make it worth their while for the time expended so an NHS one will tend to be a bit more cheap and cheerful.

Quote brightnearly 'I was given the choice between leaving a root canal treatment potentially dodgy or going private to get it done properly. I was shocked.'

Actually if your tooth is not painful and it just doesn't look perfectly done on the x-ray most ethical dentists would say leave it until it infects/gives you trouble, then get it properly re-done privately by a specialist endodontist for the best chance of success.

The problem with your General dentist leaping in and re-doing the root canal now is that it could well go wrong and you will end up losing the tooth prematurely.

Thank you uk, I will look into that. OP, what did you decide to have done (if anything yet)?

uk The x-ray didn't show the tip of the root, the dentist felt a blockage and reckoned that about half a milimeter of root was not cleared out. She washed the root though and sealed it with a temporary filling.

I decided to have an extraction. Booked in a fortnight.

What will be in place of your tooth? Can you get a bridge?

He can't make the decision for you, but he wasn't informative enough.
He should have told you more about the costs, risks and benefits of each course of action, e.g. 'there is so little tooth left there is a high risk another filling will just fall out' and 'extraction has the following drawbacks...' .

That's what I'd expect a responsible medical professional to do. No one would be happy if their oncologist said 'lumpectomy or total mastectomy? You decide, I can't tell you what to do' and left it at that with no further information.

I had a similar issue with my dentist, it's been an ongoing discussion for 3 years now. I have a root canal where the filling breaks off every so often, and they wanted to extract it under a general anaesthetic.

Politics mean that they can't redo the root canal, nobody in the salaried dental service does endodontics, if I had the choice I'd go to a private dentist specialising in endodontics, but they wont see me.

FlatsinDagenham you should get a second opinion from an experienced private dentist if you can afford it.
I really doubt it is as bleak as it has been painted. It may not be possible to save it with an NHS 15 minute amalgam filling but some different materials and a longer appointment could well do the trick.
The NHS dentist alas even though they are supposed to do - does not actually offer you the best modern dentistry can do for you in 21st Century.

An implant is always better than a bridge as a bridge affects two other teeth on either side.

Snowymouse
Privately there must be an endodontic specialist somewhere in UK who would see you. If you need sedation they can employ a separate anaethetist.
Look on the Dental Fear Central website for dentists recommended for nervous patients. Dentists with an interest in endodontics or actual specialists are usually listed on the British Endodontic Society website.

Is there any reason why a crown wasn't suggested? I have a root filled tooth were the whole tooth is now a filling. I asked my dentist whether it should be taken out and she said absolutely not. There is enough of the root left to put a crown on. Taking out the tooth might cause adjustments to your bite.