Dental specialist lied on letter of referral

[Greysowhat]

OK, I've been having a problem with a tooth since it had a regular filling in it around 18 months ago. Turned out the dentist left decay underneath it. That was all sorted after 6 months and 2 root canal treatments (RCT) later it's still giving trouble. AS I was still having pain I had x-rays that showed nothing, no pathology as they say An endodontist did the second RCT so I went back to him as I was still having pain and asked for a cone beam CT scan which would show more detail than an X-ray. That also showed no pathology so he has referred me to a specialist in trigeminal neuralgia despite the fact that my symptoms are nothing like those of trigeminal neuralgia. He must have told me 3 times about this being much more common in women of my age than in men. It seems he's using that at the main reason for thinking it's this neuralgia.

But the problem is that in the referral letter this guy states that I asked him to do the second RCT, that I "was very keen" to try it. This is just not true. I remember specifically the appointment where he took an x-ray and showed me a dark area in the bone at the tip of the root. He said it was a periapical granuloma (a sign of infection in the tooth) and I should sit in the chair and he'd "open it up now" to do the second RCT. I said I'd prefer to wait if I could so that I could be mentally prepared for the procedure. He said "thank god, it's late Friday evening, hahahahaha!" so it was rescheduled.

He seems to me to be a deeply unpleasant arrogant type of person so I won't ever be going back to him for anything. He dismissed my symptoms and didn't listen fully to what I was telling him, I got the impression he felt he knew better. And then he completely misrepresented me in the referral letter, it's almost like he is trying t suggest I have a mental health problem like Munchausen's Syndrome or something. There are other things in it like I "insisted" on the CT scan. I didn't, I just asked for it, no insisting. He says that I "think ibuprofen helps the pain". I have always told him that it definitely helps, no doubt about it.

So am I being unreasonable to request a meeting with the practice manager to complain about his misrepresentation of me or should I just let it go and forget about him?

Yanbu. I've complained about medical staff before and it felt good to know that I was helping others avoid what I'd gone through.

Do what you need to do but what do you think it will change?

He obviously doesn’t agree with your assessment of your pain which is clearly utterly bonkers because how could he have the first clue.

These types don’t have any empathy and you complaining will just cause him to dig in further in his toxicity.

Go to the new specialist and deal with them instead. Speak about your pain and say in spite of 2 RCT, one of which you were very unenthusiastic about getting and feel like you were unnecessarily cajoled into getting you still have the pain and take it from there.

Personally I wouldn’t waste a second of my life on the first guy.

Thank you, yes I was thinking I'd just forget about him but then I think why should he get away with trying to paint me as a slightly unhinged person. At one point I asked him if it was indeed trigeminal neuralgia I had, would ibuprofen help the pain. He said no but seemed taken aback that I made him say that to contradict his neuralgia theory. I don't think he likes being contradicted!

Dentist here. I don’t think he’s written anything too bad. It sounds like you have tried everything, then nothing helped so was suggesting that trigeminal neuralgia is possibly the cause of your pain. It likely is in these cases, especially if a ct scan hasn’t seen anything unusual
I hope you get it sorted. Trigeminal neuralgia is very often mistaken for dental pain.

I think you’re taking his comments on the letter a bit too personal - you obviously must have agreed to the second RCT because you had it. You wanted rid of the pain you were complaining about. He didn’t perform the procedure against your wishes did he?

Nothing you do will change this man in any way. The situation isn’t serious enough to warrant significant investigation because I’m sure he will be able to justify a way not listening to you and suggesting further treatment.

You are not slightly unhinged and honestly the best way to move forwards is to leave him in the past and deal with someone else. I would, once I’d had successful treatment elsewhere, share my experience of him with the person he referred you on to and let them know what he is like.

That will mitigate the letter he sent on. I’m sure that specialists do have code between each other for batshit patients but I in general find that people judge others for themselves and once you sit in front of someone and behave competently with them they won’t put much value on that letter.

I don't think he's "completely misrepresented you" or that he trying to "paint you as unhinged". I didn't get any of that from what you wrote.

From my experience, Drs write these letters to present key facts but, for some reason, they write them narratively. So, "patient agreed to treatment" becomes "the patient was keen to try this approach". You wanted to be "mentally prepared" but it wasn't like you needed loads of persuasion.

I doubt any medical professional is reading that letter and taking it as literally as you are.

I wonder if he said you are very keen to get it prioritised. May be his behaviour wasn't the best or he is socially awkward and over compensates. Or may be he is just a terrible human being but what he wrote does sound bad. More like he didn't want you on 39 week waiting list. You told her ibuprofen definitely helps and he used the term "you think it helps" not definitely. That doesnt sound like a big deal. However, if you are not keen for another RCT or scan call the number in the letter if provided and refuse/cancel.
Then try not to overthink this.

Thank you but the main issue is that he states in the referral letter that I was keen to try another RCT when it was in fact he who was very quick to want to do it within minutes of him seeing the x-ray showing a periapical granuloma. Then there are the other subtleties such as my thinking that ibuprofen helps when I reported on several occasions that it does help. The whole thing misrepresents me and my symptoms that is what I have a problem with.

But he’s an Endo specialist? I presume first dentist did rct. Then you were referred to him and asked to redo? So he did that ( possibly based off the periapical area noted on the radiograph.
then it didn’t settle, and he suggested reffing you on to another specialist who manages trigeminal neuralgia. Is that correct?

I still
dont see what he did wrong in terms of treatment. I still
dont really see what the big deal is regarding the wording of the referral letter.
at the end of the day what are you hoping to broadly achieve by complaining?

Yes general dentist did the first RCT. I was referred to endo as I was still having pain from the tooth which all started 24 hours after the initial filling. There was no request to have the RCT redone as general dentist could not understand why I was having pain. The endo was not considering redoing it until he looked at the x-ray. Then he wanted to do it straight away, there and then. At no point did I ask for it or show any keenness to have it done. So why state that in a referral letter?

The pain continues despite the second RCT. I have no issue or problem with the treatment he has done, only with the misrepresentation of me and my symptoms in the referral letter.

I suppose I would like an explanation as to why I have been depicted in this way. It might not seem much to you or to him but it does to me because if you were to read the whole letter you might see that there is an intimation there of some sort of psychological element to my issues.

You had dental treatment by a dentist 18 months ago and they left caries behind? Does this happen? Could new caries have built up during that time? If not then it sounds like this is when your problems began and you should ask for your money back,

There’s loads of arrogant, incompetent, cowboy dentists out there who ruin people’s teeth. Not worth complaining. You will be fighting a losing battle as they’re well protected. It’s a business at the end of the day and they only care about the money. Are there any online reviews about them? If I were you I would find a new dentist/ endodontist.

This. I think you're reading too much into the referral letter, I can't see anything remotely suggesting yoyr mental health is being questioned. Insist in dental speak can be the sane as asked for in order to push for that to happen with the referral

Look up diagnostic overshadowing in dentistry. Loads of information available online.

I don't think he wrote anything that bad, he probably wrote it up days later from rough notes. If the nerve has been damaged by all the work then you could be left with 'nerve pain' which is pretty much defined as neuralgia, I don't know which pain killers are preferred for that, there may be better ones than ibuprofen, so he may have just been saying you're happy with what you are using. You might have asked what he would suggest taking for the pain.

Yes first filling had decay underneath, it was not removed before filling. I went back the same week because of the pain, had an x-ray and dentist said it was looking fine despite there being decay right there in front of her! Then it seems the nerve died so I had the first RCT with general dentist. I did not know there was decay in the tooth at this stage. Then pain continued so referred to the endo who x-rayed and found the decay, told me to go back to general dentist to get it fixed. Did that but pain continued. So months later back to the endo who x-rayed again and found this apical granuloma so he said he's "open it up" there and then. There was not keenness on my part!

Pretty sure all the decay has been removed now. I think the pain could be from something that happened during that first filling. But nothing showed up on the CT scan. Unless something was obscured or was too small to show up.

Thanks for that. Very interesting because I am autistic which he knew as I told him at the first appointment. I'll read up more about it now.

OK, had a super quick read of the main points and I think this is definitely what has happened or at least greatly contributed. Thank you so much again. I'd never heard of it, only diagnosed a few years ago.

Look up Selective Caries removal. It’s not something that I was taught at dental school ( I’ve been around a long time and try and remove it all!)
But it is a thing, and pretty common, especially with more recent graduates. The rough, soft infected caries is removed, and on occasion some caries is left close to the root, usually with a lining placed. The theory being is that the minimal caries can sometimes harden, hence preventing the need for more invasive procedures such as root treatment.
so original dentist may have thought to do this?

That's interesting but unfortunately not because when I went back to have the filling replaced and decay removed she said it was translucency on the x-ray and not decay! Then she removed it.