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?

Tory YANBU.

Quite the opposite.

I had a similar experience in 2010. To cut a long story short, after repeated visits to emergency dentists, and being maxed out on Paracetomol/Ibuprofen, screaming in agony, I took myself to A&E. I sobbed and cried, for 2 hours waiting to be seen. But I was given PR Diclofenic and IM Tramadol.

The pain subsided after around 20 minutes. This was around 3am. The relief was immense.

I went back to the emergency dentist later the same day, pain free. They could not sort out the problem tooth yet again putting a temporary filling on.

That night I ended up back in A&E with the same pain, around 9pm as the pain relief was wearing off (PR Diclofenic is around 16hrs with 100mg).

I was given similar pain relief (think I had oral Tramadol that time though).

The next day, another emergency dentist appointment was made. It wasn't until the afternoon as that is all they could offer. By 10am I was in unbearable agony. I made another trip to A&E - who I had been honest with at the first visit and told them I had been unable to access effective analgesia from any other source - OTC not effective etc. But this time they treated me like a junkie! I'm a HCP myself. I was aghast at a person being left in such pain. I did write a complain about this incident - and got a letter of apology back.

I left with the pain getting worse than ever, landed 5 miles away at yet another emergency dentist appointment, to be told to immediately go back to A&E as I need urgent analgesia, the tooth needed to be removed, and there was no possible way they could treat me in the dentist surgery.

The lovely dentist wrote me a letter to maxfax, and I headed back through A&E. Where I had just been.... .

I was given 1200mg of Ibuprofen orally, and a local injection in to the roof of my mouth. And referred to the emergency list in another hospital.

We made it to that hospital, analgesia effective... just as I was admitted, it started wearing off.

For 2 days I had IV Paracetomol, IV Tramadol, IM Morphine plus IV abx and bupivicaine injections in the roof of my mouth.

Yes. For 'just' toothache.

While I was at that hospital - in the space of being admitted, and the analgesia wearing off, I was waiting for something to be prescribed. It was the middle of the night, I was alone. I was crying and sobbing on the ward. I was aware of distressing other patients, and feeling embarrassed at myself. I walked off the ward, and howled - and I mean howled - on the corridor. 5 floors up - glass window, I was howling and headbutting the glass window begging someone to end my life now.

For 'just' toothache.

Toothache eased with OTC stuff - I've had it. The toothache over the course of those 5 days? I've never had pain like it, despite giving birth twice. I didn't have an abcess or infection either.

Quite frankly, the whole thing was inhumane. The only real kindness was shown by the dentist who referred me to MaxFax. Everyone else just assumed I was making a fuss about nothing.

I wasn't.

I had tried everything - orajel (said max 4 times a day - try 4 times an hour. Went through 4 of them in 2 days). Clove oil. Biting on cold metal spoons, warm packs, cold packs. Fuck me, I tried everything there was.

Maybe I'm just a big old wimp, eh?!

you need codeine tablets im and expert on dental infections so i know xx you can get it over the counter and the doctor should have been able to prescribe you with a stronger dose

Oh The Detective: That is horrific.

Something needs to be done. 'Just' toothache, my eye.

Diva?

'Pain is what the patient says it is!'

Thank you Dame.

I absolutely agree with this. My sister had an awful time last year quite similarly. She is not a wimp or a diva. It is cruel to provide insufficient pain relief.
Nobody should be in pain like that these days with the effective pain medicines that we have available.

As a complaint email it's pretty poor, far too emotional.

Also not don't really see the problem. Plenty of decent drugs available over the counter.

co codamol and nurofen plus can be taken together and would help considerably

Are you suggesting they alter the NICE guidelines and the DPF? I'm a dentist and tbh there's nothing we can prescribe for paint relief that you can't buy, it's cheaper to buy it OTC...

Who should be prescribing the pain relief when OTC isn't working?

Because someone should. And no one seems to know who it is.

I think that is the point here...?

Thank you for your response Whois. I realise that the email is quite poor. I was aghast at some of the phrasing and punctuation errors when reading it back. I didn't copy it here for a critique as such - it just saved me have to write the background details out. I wrote the email in pain and anger and it shows.

To answer your second point: The problem is that OTC drugs are woefully inadequate at dealing with severe dental pain.

Detective has it. The point of the thread is thus:

*Who should be prescribing the pain relief when OTC isn't working?

Because someone should. And no one seems to know who it is.*

Yes I am suggesting the alter the NICE Guidelines and the DPF - amd why the heck not? They aren't good enough.

But if dentists can't prescribe it because it's not in the DPF, YABU to complain about dentists!

OTC cocodamol in solpedeine max is 12.8/500
nurofen plus is 12.8/200

You can take 8 of each of these per day...they will go a long way to helping your pain

I hope you get a response from your email. It's shocking.
I've had 3 abscess on my teeth! Each time I've ended up in a+e luckily the care I had was amazing and I was given major drugs. I now carry antibiotics everywhere I go.
last time it happened over a weekend I saw 5 dentists and doctors and ended up having emergency surgery. when I got back to work everyone was oh you had toothache! arghh!
detective I understand the pain you went through I tried to throw myself down stairs.
The fact that I am susceptible to them really frightens me!
OP take care.

So you should be complaining to NICE then and not about the individual dentists.

Have you got it sorted now btw?

www.netdoctor.co.uk/diseases/facts/dentalabscess.htm

Please do NOT apply a hot water bottle to the face when suffering from a dental abscess.

You can only take SIX Nurofen Plus in 24 hours.

DOSAGE:
Adults, the elderly and children 12 years and older: Swallow 1 or 2 tablets with water, then if necessary take 1 or 2 tablets every 4 to 6 hours.
Do not exceed 6 tablets in 24 hours.
Not suitable for children under 12 years.

www.lloydspharmacy.com/en/nurofen-plus-ibuprofen-amp-codeine-24-tablets-10530

The NICE guidelines recommend codeine phosphate or diclofenac when paracetamol/ibuprofen combo is not working. I should have been offered this. By who though, nobody knows.

Codeine phosphate isn't in the DPF though. Dihydrocodeine is but you can also buy it over the counter. Like diclofenac.

Your dr could have offered it to you or I suppose your dentist could have offered you a private prescription (on which we can prescribe lots of things not on the DPF).

You can safely take 8 nurofen plus in 24 hrs.
8 nurofen plus goes no where near the max dosage for either ibuprofen or codeine

i thought that you wanted to try to get some pain relief?...also in all fairness you could have had the information on strong otc painkillers in about 10 mins in a Google search
Why didn't you or someone close to you do a search?

I recently had toothache for TWO MONTHS. I was at the dentist once a week and was just told to take ipruprofen and paracetamol, they are as useful as a bike for a fish. After the two months of severe pain and no sleep I rang my dentist in tears and told them you wouldn't leave an animal in this pain you would put it out of its misery. They took it out that afternoon.

Take them with food though and no booze

Your dentist can and should have prescribed adequate pain relief. They just don't want to take responsibility for it and would rather you got a prescription elsewhere.

Dentists can prescribe 30mg dihydrocodeine tablets or 50mg diclofenac. Your dentist should have done this.

Yes those drugs are available OTC but each tablet only contains 7.46mg dihydrocodeine or 12.5mg diclofenac. Even if you take two that's not going to touch severe pain. The codeine you can buy OTC is in similar tiny doses.

I think your GP was trying to be tactful when he said he didn't want to step on the dentist's toes. It's really not his responsibility.

Cocodamol helped me when I had an abscess. I bought them over the counter which suited me as they were so much cheaper without a prescription.

Hopefully the anti bacs will start to kick in Doon and give you some longer lasting relief.

*kick in soon