AIBU to be pissed off with my inappropriate dentist.

[MurkyMo]

I asked my private dentist for a referral letter to a specialist as I have longstanding pain from a tooth that's had a lot of work done. I think the filling is bad or the tooth has a micro fracture, pain started the day after it was done. Decay was left inside and then I ended up with root canal treatment. Then a second RCT. My new dentist thinks there's nothing wrong with the tooth hence my move to an endodontist. But that's not the problem, the problem is the referral letter he wrote.

I gave him a document with a diary of my symptoms and treatments thinking it might help him find the problem and he says about it "tellingly, she references her own autism in it." Tellingly???? wtf?!

He says "I am not convinced that this is a dental problem, but appreciate that her dental fixation might be provoking a response in an already sensitised area"

Fixation??? WTF???? He's not a psychologist, why is he putting that in a referral letter to an endodontist. Surely it should be a clinical letter simply pointing out my symptoms and his clinical findings, not some amateur psychological assessment of me that dismisses my symptoms and alludes to my autism being part of the problem.

Any dental or medical professionals think this is off??

And what will the endodontist make of it?

I'm raging!

I have been in a similar situation as dentists don’t like to pull teeth unless they absolutely have to.
I can understand why the dentist has written what they have written as it’s important and yes, I have ASD and have also had a few awful teeth to have treated.
The mouth, jaws and whole surrounding support area are a complicated dance. I absolutely understand wanting the gnawing pain dealt with. I also understand the desire to have a tooth pulled.
However, contemporary dentists will take in all of the information you give them, as would a doctor. It’s not what we want to hear sometimes.
Go to the referral and/or get a second opinion. And I’m sorry you are in such pain it’s awful.

Despite your rude and ignorant retort, OP, I also don't understand why you referenced your autism. Why presume that everyone understands the ways in which it affects you?

Oh gawd, that's awful. How did that appointment go? Did you ever get your dental pain sorted?

I've been referred to a face pain specialist too but I'm convinced the tooth is fooked. I'm in a smallish town and all the dentist know each other and the one who did the filling and left decay in is a referring dentist to the one who wrote this letter for me. Also the endodontist who did the RCT would get referrals from my current dentist. It's all a bit incestuous. And I suspect he didn't want to find anything wrong with the tooth. He took and x-ray but didn't examine the tooth at all. There's actually discolouration around the filling too which is a bad sign.

I can understand why it’s angered you.

I can also understand why he’s included it. You’ve essentially asked him to make a referral he, as the qualified medical professional, doesn’t feel is warranted.

I don’t think you can argue he shouldn’t have mentioned it. You mentioned it, because you felt it was relevant, so why shouldn’t he?

It's not old-fashioned, it's fact. The letter was about OP, not written to her (although I appreciate the practice did send her a copy for her reference) and as such the dentist has written a letter to another HCP including relevant information. OP may not like or agree with this information, but it doesn't make it unprofessional or inappropriate. Phrases like 'I am not convinced' and 'I appreciate' make the dentist's opinion clear without stating it as fact, and leaves it up to the specialist to draw their own conclusions. A totally normal medical letter.

The dentist doesn't see a problem with your tooth, he has attributed the issues to your autism. That is what he has said in his letter.
I think that is pretty reasonable.

No shade from me, I have an autistic dd and she is a nightmare when in pain/ill.

I would have thought more tact would be required. It’s certainly desirable. I’m not autistic myself, but I can see it may be offensive to read that. I think that “fact” can be expressed well or badly.

I'd be making a complaint to their professional body, for starters.

The dentists clinical assessment is there is nothing wrong with the tooth to be causing your symptoms, so something else is.

Ultimately the absolute easiest thing he could do is remove the tooth. Root canals fail, and he wouldn't be "protecting a colleague" by doing this. The reason he isn't is because he can't find a reason to and doesn't think it will solve your problems.

If a filling is very deep sometimes decay is left over the pulp to try and prevent a root canal treatment. In your case it sounds like you needed a RCT anyway, again extracting a tooth that has had decay to pulp in the past is reasonable and there's no justification for holding onto it other than he can't find anything wrong with it

In this case it may mean that:

3.The dentist disbelieves her due to autism and thinks the pain is psychological rather than due to failed dental treatment.

Also DD2 has AuADHD and rather a high pain threshold.

@MurkyMo It was a complete waste of time. She kept telling me things to do to distract myself from the 'idea of the pain', which clearly none of them believed was real! I was so, so frustrated and upset. They just thought it was all in my head. Unfortunately, I am just living with it! I am used to it now so it's always there but doesn't bother me as much. I'm guessing one day when I have future stuff done on this tooth (currently root canal with crown on which was done twice after two failed fillings) the pain will either go, fingers crossed, or it will be more evident what is wrong.

I know exactly what you mean about the incestuous nature!! ( i know that's not the right word but still) all of my 'people' knew each other. I do feel like the letter you have seen will impact how you get treated at the facial pain clinic, as I feel that's what happened to me. Mine started by talking about my anxiety! so if you can get it changed in any way, I would.

YABU. You say you included autism because it is relevant to medical assessments then you are angry it is referenced. Maybe your dentist could have worded his letter slightly better, but he seems to be indicating that it could be sensory - but he cannot find the cause.

You need the second dentist to have the whole picture - that nothing looks like it is a problem but YOU are feeling it.

I really do not see why you would mention autism to a dentist.

It's true that it isn't remotely relevant. So maybe that's why they said 'tellingly'?

But the fact is they've x-rayed it presumably and if they cannot find anything wrong they're not going to pretend they can just to appease you.

I don't like the tone of it much to be honest, but they must have reason to believe as far as they know they can't see the problem.

?? Apologies but I also have no idea. My dentist doesn’t even know about my ASD, and same for my children.

He's a dental professional who doesn't agree with your non-dental professional opinion of what you think is wrong.

He's advising the next dental professional on his opinion. Since you referenced your ASC he had also done so.

You've really not got anything to complain about other than victimising yourself.

Which may or may not be anything to do with your ASC but since you thought it significant to bring up, professionals will respond to that or I'm sure you'd accuse them of not including that.

If you've got any concerns email your practice in a nice way and ask them to read and reply.

And I apoologise for being so curt. I'm beginning to think I shoudln't bother telling these people that I'm autistic. I imagine it might help them understand why I will go off on many tangeants when explaining the problem or won't mind that that I have researched a medical condition for hours and hours and know that's what I have and tell them in order to save everyone's time! It seems most don't have any real appreciation of what being autistic entails and it ends up being a hindrance to me rather than a help

It might be relevant, but the dentist hasn't said, "the patient has autism, which affects her perception of pain," or anything that indicates why it might be pertinent to the referral. I think it's fine to mention it; I don't think the wording is helpful, though.

If they don't want patients to read referral letters, they should communicate directly with whoever they're referring to, and not cc the patient. I don't think it's unreasonable to read your own referral letters, though.

I dont think its inappropriate.
I think its relevant information that you referenced in your own assessment.

Given the sensory issues and fixations that can occur with autism - i actually think its very signficant information to pass on, particularly given the circumstances that you describe.

YABU.

It seems most don't have any real appreciation of what being autistic entails and it ends up being a hindrance to me rather than a help

But it doesn't affect everyone the same way. Unless you explain to them what it entails for you, they might assume it means you steadfastly refuse to listen to any detailed medical information, because that's how it was with another autistic patient.

No worries. And I agree with you BTW, the referral letter is infuriating.

Yes fair point, I'll work on it! I'm not too long diagnosed. I just assume a medical person would be au fait with the condition and all it entails. But that's a lot! No, they don't know eff all really!!

Name changed for this because of how outing it is but the implication that this is not real and a fixation would drive me mad.

I was passed from pillar to post for 6 weeks while medical professionals pondered if symptoms I was experiencing were all in my head/psychological - I had broken my neck ffs.

Ohmygod! I hope you've recovered now. Yes it seems to be a problem for women, there is a fair bit of assuming that we are imagining up a lot of what ails us.

Yes, continue with that attitude that because you have Autism all the professionals don't know anything.

You know better.

That'll work.