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!

So then say I personally have not found anything wrong dentally, could you look into this from your side. Not insinuate it's all in her head because of her autism.

Dental fixation means tooth stabilisation after trauma. I think you might have misunderstood the letter.

No I don't think it is dental terminology.

And if it was then surely it would be the dental fixation, not her dental fixation.

I am a retired Audiologist not dentist and had to make many notes amd comments on patients behaviour, as to attitudes and self google diagnosis ideas. I was required to make all correct comments on an ongoing consultation basis to protect my professional status
We were heavily regulated ie permissions etc

write an official complaint, he must have a boss. Otherwise he’s a doctor, and you might not be believed and cured appropriately

Many medic types give up subjects requiring lengthy writing after GCSE level. Many also dictate rather than type their letters so I would read less into 'her fixation' vs 'the fixation' than if similar terminology was used by a lawyer / accountant type.

@MurkyMo it's a long shot, but could it be possible that the 'tellingly' sentence was intended to highlight that autistic people often have a more pronounced pain response to certain stimuli?

I am autistic and have in the past been prescribed gabapentin for pain that has no observable physical cause.

I have also (for a different pain issue) had psychological intervention to help me recognize the context of periods of increased sensitivity and take steps to mitigate the pain.

I'm sorry you're going through this. Pain in the mouth is so horrible 😥.

Why do you need a referral letter to change dentists? Ask for your records and just move. Or is it NHS dentists requirement? If so I would complain. If he had to re-do the RCT he’s a shit dentist, he has no right to criticise you or ignore your pain, what a twat. Is the PALS equivalent complaint process?

Also never go back to a dentist who missed a tooth decay or did a shit job with RCT that it has to be re-done

Sometimes root canal treatments fail. It’s usually not the fault of the dentist. It can be extremely tricky and complicated. There may be a micro fracture, a hidden canal that cannot easily be accessed, a sclerosed root… all sorts. Actually the only way really at this point in the OP’s case is to get it looked at by a specialist. Perhaps they can take a ct scan which might show up something that a traditional radiograph won’t.
honestly if you can’t get to the bottom of it, it might be worth just extracting and moving on.

when I would write a referral letter to a specialist I include an overview of the patient’s social, dental and medical history. An Autism diagnosis is relevant. At the very least it is worth a conversation with the patient as to how best to approach treatment.

i once had an absolute mare with a patient who had failed to disclose her diagnosis. If I had known I would have handled things better. Her dentist had left the practice so she was moved to a colleagues list. She went crazy about this. ( we found out later that she cannot handle change well, but we obviously did not know this at the time)
She Was really angry. When she calmed down and sat in the chair and I was called in to give a second opinion, and ( with consent) started probing around her tooth. She hit the roof again and started getting really upset because she “didn’t appreciate being prodded”

I was absolutely baffled, and the torrent of abuse and unreasonable behaviour that was fired in my direction made me ask her to leave the practice.
She later stated her diagnosis ( when making a complaint).

regardless, she was pretty rude, but I think in hindsight, if I had been made aware of her autism, I might have handled things differently.

dentists do actually get training in behavioural sciences, communication skills, equality, diversity and neurodiversity. But we aren’t mind readers.We are trained in techniques and tactics to help support individuals. We CANNOT diagnose this though, and we can certainly not suggest to a referring specialist that Autism is the reason for pain. That is very wrong.

I would have kept that letter factual, but included a full Medical history, and waited for a response.

here’s a thought though… what if the Endo specialist investigates, finds no dental concerns. What conclusion would he reach, or be qualified or “allowed” to reach?

I agree the referral letter comes across as judgmental (“tellingly”) and would probably say something about this.

You will be able to present things in context when you have the appointment,

Sorry - still can’t see what your autism has to do with a root canal.

So sorry to hear you have been in so much pain with your tooth for such a long time in spite of having root canal treatment etc. If the xrays show decay then that is the reason for your pain and the nerve must still be live. Root canal treatments, drilling and fillings are not always successful as the decay can go into the bone or cause abscesses. I know as I have had several teeth removed which my dentist had tried to save for me. Your autism is only relevant in that it MAY cause you to be more sensitive to pain or trauma, but I can honestly say in my experience toothache is the worst pain ever, and perhaps the best option for you is to have it removed and regain your quality of life.

"Tellingly" is not actually telling anything, so as well as coming over as judgemental, it's poor communication. It's like someone saying, "and we all know what that means," without elaborating, and it leaves some people thinking, "do we? What does it mean? Why don't I know?" and others thinking, "yes," but actually thinking the meaning is something quite different from what the first person intended.

Make a sar and get all the informtuon of what the dentist wrote etc and make a complaint to nhs or whatever dental place they work for

Autism is relevant because it is a condition that affects the entire brain and body. It is not evidence that a person is imagining things. Hope that helps.

Just go for an extraction. Everyone I know who has had root canal treatment has been back and forth afterwards.

Why on earth did you reference your autism ABOUT A TOOTH?!
YABU

I feel so sorry for any professional service provider suffering from the current tsunami of complaint culture, because complaints have to be dealt with, investigated, responded to, and this takes time away from actually providing a service.
I swear many complaints are founded on ignorance and attitude rather than founded grievance, and this thread is a perfect example.

OP, look up the meaning of fixation ffs!

Not okkkkkk

“Dental fixation” is a medical term . In this instance it does not mean you have a “fixation” about your teeth

No, you are wrong

I think it’s an arrogant and presumptuous referral OP

Hopefully if it’s gone to someone decent they will see it is an attempt minimise your lived experience and they will despise that as not working with patient concerns (and do better).

Good luck with a more helpful opinion 🍀

Oh how funny, I worked as NHS Complaints and Litigation at Director Level and think this referral is rude and unhelpful..avoid that avoid a complaint …simple

The fixation is definitely related to the treatment that was done not a psychological fixation, as the fixation now belongs to you it is written her fixation. They are saying that the filling/treatment that was done could have caused pain in an already sensitive area.

Leaving decay behind is not going to cause pain the day after a filling is done. For a tooth to react like that the day after a filling the nerve it is already compromised, decay being left behind which would then lead to a root canal being needed would take longer to present. If you have had 2 root canals and think you have a micro fracture an endodontist would probably be limited in what they can do. But of course they’re going to take their own findings, whether this dentist regularly refers to them or not.