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?

Dentists don't, as a matter of course, prescribe painkillers. In all my years nursing, I don't think I came across any dentist giving Rx for pain meds.

Doctors rarely get involved with dental issues, as they don't know enough about teeth to do anything.

OTC pain relief is all that most people get for dental pain, unless they have had multiple extractions at a hospital/clinic. You seem overly concerned with the issue of overdose, but all you had to do was ask a pharmacist/read the packet. 1000s of people the world over cope with doing those two things.

One case of someone overdosing due to dental pain & dying is one too many, but considering he had other issues, I don't think you can pin this on the BDA and/or paracetamol.

Do you realise that your first link does not take you to the BDJ?

There are other pain killers available OTC, why didn't you just ask a pharmacist?

Your letter makes you sound quite wound up over a small issue (that of accidental overdose) and I don't know what you expect them to do about this.

Ahh, linked fixed. Thank you.

Those two cases aren't really accidental overdose IMO. They are people being stupid & taking far too many & not reading the instructions.

One left hospital (where he would have got some care) and proceeded to take more paracetamol.

If people are that careless with OTC meds, imagine how careless they would be with some stronger!

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

Well she asked the dentist for advice on pain relief. Perhaps he could have told her what was available instead of saying he doesn't do analgesia? Is that too much to ask of a professional?

He did advise ibuprofen and paracetamol.

It's like dental pain is second fiddle, when actually it's in your face, jaw and ear and there's no escaping it

It's not second fiddle at all. Dentists have limited Rx powers for pain meds, your GP couldn't help you.

I had an abscess on my breast, was give antibiotics, but told paracetamol/ibuprofen for pain. They didn't work, so I ask the pharmacist for something stronger.

I don't understand why you didn't do that!

Perhaps he could have told her what was available instead of saying he doesn't do analgesia?

I was told to take over-the-counter Ibuprofen and Paracetamol

He did tell her. If that wasn't strong enough, or if she wasn't sure, she could have asked the pharmacist.

I agree he could have been a bit more forthcoming with advice re ask pharmacist etc, but the op is an adult, and she could have asked the pharmacist herself.

It be worth noting that NICE isn't saying that dentists can prescribe codeine phosphate, it is saying that it should be advised as a painkilling method.

I did see a pharmacist. I say this in the thread. The pharmacist told me I could only take 3 x 400mg of ibuprofen in 24 hours. I was also taking OTC co-codomol 8/500 - you can take 8 of these in 24 hours - again according to the pharmacist. That's what I was advised to take. It didn't touch the sides. I was in agony.

OTC pain relief does not cut it for severe dental pain. An animal would not be allowed to be in so much pain.

My point about the paracetamol overdose is that when you are in severe pain it gets to a point where you take more than you should because you need some relief.

The OP saw an out of hours dentist who at the time he saw her prescribed antibiotics for the infection, advised on over the counter antibiotics all of which were appropriate for initial management based on the fact that the OP hasn't said what pain relief she was already using.

The OP called the GP practice the following day when analgesia was inadequate and was told they didn't want to step on the dentist's toes. The OP wouldn't have been able to speak to that dentist for follow up advice as they wouldn't have been there so the GP didn't help with analgesia advise or precribe analgesia either.

analgesia prescribe

OP phoned dental access and was told they don't prescribe pain relief. That is not true.

Well maybe they don't, but the point is they could if they wanted to.

The OP only phoned Dental Access as she had already been told by the GP surgery that they wouldn't get involved in giving advice or a prescription for analgesia.

yy don't understand why pharmacist didn't offer solpadeine max and nurofen plus

did you go to A&E in the end or what happened?

I've several abscessed teeth, I know how awful it can be. My dentist prescribes oxycodone or percocet for pain. Percocet doesn't work well for me, but oxycodone does. Can your pharmacist give you one of those?

For everyone saying you can get codeine over the counter etc. - yes - but not the lovely pure codeines you get from the doctor that actually touch nerve/tooth pain.
I think in this case the GP was in the wrong, I would've asked them if they wanted me to go to A+E and tell them I was there because he refused to see me for fear of upsetting a dentist he'd never met...

So why didn't dental access help her MillyMolly? They GP was right to direct her back to dental services. If GPs knew all about dental pain we wouldn't need dentists, would we?

This is terrible, I feel for you op. I had impacted wisdom teeth removed in France (3 hours in the dentists chair) and was prescribed morphine by the dentist, and another wisdom tooth extracted in Asia and the dentist handed me some heavy duty painkillers before I left the surgery, just enough to get through 36 hours. What is it with uk dentists that they can't prescribe painkillers? Dental pain has got to be one of the worst pains there is.

Op if you are still in severe pain, can you see an emergency dentist at A&E? They used to have them when I lived in the uk, not sure if they still do......

steff13 With those meds, it sounds like you are in the USA? There are different rules here for the dentists can prescribe.

I am in the US. You should tell the NHS you want oxycodone. It's awesome. :)

The BNF suggests that in the UK, oxycodone is for palliative care. In any case, it's not on the DPF so OP couldn't hcr got it from any of the dentists she had seen (except on orivate prescription but as it's a controlled drug I think even that would be unlikely).

So, I think the OPs main query is still unanswered. What happens and who is responsible for treating dental pain that is not managed by any OTC pain relief? There's so many horrific stories here about people left to suffer. Is it just me or does it seem completely insane that it seems so woefully covered between dentists and GPs?

That's exactly my point Cuddly.

To everyone who has asked: I am still very sore today but no longer in the grip of all consuming agony. Thank you for your concern and sympathies.

I will update if NHS England ever reply to my rather crap email!