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

[toryalane]

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 www.nature.com/bdj/journal/v203/n1/full/bdj.2007.583.html)

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: www.wirralglobe.co.uk/news/10572341.Wirral_man_died_after_taking_accidental_overdose_of_painkillers_for_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:
www.1000livesplus.wales.nhs.uk/sitesplus/documents/1011/1000%20Lives%20PB%2002%2002B%20-%20SDCEP%20Drug%20Prescribing%20for%20Dentistry.pdf)

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?

Ah Noarmani - I had codeine in the form of over the counter co-codomol - although at 8mgs per tablet though not 12mg admittedly. But you can only take 6 neurofen plus in 2 hours whereas you can take 8 OTC co-codomol.

I retract my statement about there being no recognised Dental Pain Relief pathway as Wabbity just linked to one.Fortunately I would appear to be following it anyway

Thank you for the NICE guidelines - I genuinely don't think they are good enough though.

And yes, I definitely need to resolve the underlying issue of these roots. I am not lying when I say the OTC medicines have not worked.

Hopefully the antibiotics will take effect soon.

just spoke to my dh, a dentist, who would have also suggested you buy otc paracetamol and ibuprofen. It would have been best for the pain you detail. it's much cheaper for you to buy it otc than to pay for a prescription.

I really sympathise OP. dental pain is hellish. I had an abcess two years ago after a botched root canal. I could cheerful have cut my head off after taking the maximum dose of over the counter pain meds. I really don't understand the inability of doctors or dentists to get to grips with pain management whilst abs kick in. Hope you feel better soon.

But it wasn't best - It didn't touch the sides!

I've had gallstones, appendicitis, kidney stones, a late miscarriage and an ectopic pregnancy - I'm not soft. It was pain which required more than OTC drugs.

Its interesting that Nice advise codeine phosphate which is no longer allowed to be prescribed by dentists.

Thank you, Cuddly.

Dh says can you get the tooth removed? (sorry if I missed that in op).either removal or draining.

I dread dental pain,I can't take ibuprofen or anything codeine based.

You poor thing OP

I've just read again and seen that point Will:

"consider adding codeine phosphate or switching to an alternative nonsteroidal anti-inflammatory drug (NSAID) such as naproxen or diclofenac."

I will take that up with NHS England if they reply.

I had a wisdom tooth out last week and the only thing that worked was prescribed cocodamol (so 30/500 strength as opposed to the OTC 8/500 strength). Paracetamol and ibuprofen were about as much use as smarties to me. I was very very lucky to have some of the cocodamol left over from previous prescriptions. So you have huge amounts of sympathy from me.

Hope the antibiotics work (although should metronidazole not be the drug of choice for gum infection? I have just had a course of it for my remaining, infected, wisdom tooth, to try and calm it down before it's also removed) and you feel better soon.

I've had a dental abscess before which was probably the worst pain I have ever experienced. My dentist didn't prescribe any painkillers and I had to rely on otc painkillers. I ended up just watching the clock until I could take more! I did find that a hot waterbottle helped.

I have to admit that I hadn't even realised that dentists prescribed painkillers.

Oohhhh I feel your pain. I have had no end of problem with one tooth including a abscess that I thought I would die from the pain! I'm not a wimp but it was like someone drilling holes in my head with no relief.

Clove oil is an absolute life saver for me when i have toothache. I know it's the rankest tasting stuff ever but it does bring a certain relief that painkillers don't.

Goodness, you're a diva. Definitely YABU.

You were clearly well aware of the limits of paracetamol (as most people are who can read the back of the box) so were in no danger of taking an overdose.

As others mention, otc painkillers are available, as well as simple measures - lukewarm water with salt. It's amazing how many people complain of severe unbearable pain when they are not even taking the recommended dose - 1g paracetamol at 6 hourly intervals plus 400mg ibuprofen at 8 hourly intervals and allowing a suitable level of analgesia to build up.

The pain is caused by irritation of the nerve roots and pressure pain caused by the abscess the most effective treatment of which is antibiotics which you received.

The situation where people OD on paracetamol analgesia because of severe pain is very rare. The situation where harm is caused because of medication interactions or unnecessarily potent painkillers is on the contrary very common.

You can go ahead and submit your letter. You'll get an apology for the service "not meeting your needs" but in the end, a dentist would far rather you managed a self-limiting condition with OTC medications for a few days then carry the responsibility of prescribing potent and more dangerous drugs.

Tory if you are still determined to complain once your pain is settling, address your complaints to the individual practices. Please tell the GP practice who didn't want to step on the dentist's toes that we aren't able to prescribe lots of different types of pain relief, likewise the nurse at 111. Your 111 call is logged so they can look up who you spoke to.

Pharmacists are best for advice on pain relief, which I hope you get soon.

There really does need to be joined up care between gp and dentist.

I had my wisdom teeth out in hospital due to them being severely impacted. They no longer prescribe pain relief. They no longer give you even a single dose of pain relief post surgery. You have to buy your own bloody painkillers over the counter to take in.

I do not know of any other surgical department in which that would be acceptable.

The gp will not prescribe painkillers or antibiotics for dental issues. It is not bloody well on. I managed on solpadeine max, but by god could I tell when a dose was due. (I cannot take ibuprofen.)

Im empathise op. Dental pain is the worst. I was 9m pregnant whenmine reached its peak so they would hardly give me anything. I found hot water bottles on my face helped. Or frozen ice pops wrapped in a tea towel. After id evicted the child I was given 30/500 cocodamols from my dr. Id go back to th gp and demand something stronger. The old paracetamol/ibruprufen thing has never worked for me either.

I also smothered my gums with this adult type bonjela in a little tube, ive forgotten the name but it has clove oil in it and ig worked wonders

Straighttalker - I WAS taking the recommended dose of of the OTC drugs. I couldn't open my mouth for long enough to swill lukewarm water. I think Diva is a bit harsh - YABU.

I completely disagree about dental pain. It is completely second fiddle to all other types of pain and it shouldn't be - it can often be some of the worst pain one can experience.

Thank you Milly. I have already sent off my email to NHS England.

You poor thing OP Ive been in a similar situation so can feel your pain.

I found an adult strength version of Bonjela in Boots (cannot recall the name of it now) and I found this worked better than tablets. I sort of squirted it into the top of hole and rubbed my gums - instant relief.

YY willdoitinaminute for alternate cocodamol and ibuprofen for dental pain. I have a wisdom tooth that often gets infected so am well versed in controlling the agonising pain that results, along with antibios from the dentist.