Dentist or Doctor or Both?

loveandlight · 7 October 2006 at 11:05AM

Hi Guys,

I am in a bit of a quandry and don't know what to do for the best.

About 6 weeks ago I developed Trigeminal Neuralgia on the right side of my face. It lasted about a week. I think it was hormonal related but at the time I was desperate for a good nights sleep as I've got noisy neighbours so it could also have been induced by lack of sleep.

Anyway I went to the hospital as it was a weekend and they gave me strong painkillers. Hospital doctor looked inside my mouth at my teeth saying he wasn't a dentist but they looked ok to him but I should go and see my dentist anyway.

Although the pain has gone now, it has left me with all sensitive teeth on the right side of my face, both upper and lower. The left side of my teeth are fine. I forget that I've got the sensitive problem until I start to drink or eat anything that's hot or cold or needs chewing as it feels like I no longer have much shock absorbency in my teeth on my right side. I have noticed that I have started to avoid eating and am fussing over my drinks being luke warm before I drink them. I have started to use toothpaste for sensitive teeth.

I phoned my dentist for an appointment ( I'm on NHS and tax credit exempt) and my dentist said I will have to pay privately to have them look at my teeth as my last check up a couple of months showed there was nothing wrong with my teeth. However my dilemna is that I can't afford to pay privately. If I could, I wouldn't be NHS exempt.

If I go to my GP, he is bound to ask what the dentist says and I'll have to tell him I don't know because I can't afford the dentist.

I did phone the dental advice helpline but she didn't know what I should do. Other than telling me the dentist was right. That's fine for the dentist but what do I do now?

pboae · 7 October 2006 at 11:14AM

You don't have to tell your Dr that you can't afford to pay private, just tell him the dentist is refusing to see you because you had a check up recently. The fact that he *would* see you if you went private is irrelevant. There must be some system where you can be referred by your GP or something? After all, if you broke a tooth tomorrow, or a crown fell out, would they still refuse to treat you till your 6 month were up?? If nothing else, your GP may be able to refer you to a dental hospital.

MissMoneypenny · 7 October 2006 at 11:37AM

When you say that you phoned the "dental advice helpline", do you mean the NHS Direct phone number? From 1 April 2006 your local Primary Care Trust is now responsible for NHS dentistry in your area. They will be the one to phone for advice. Their number will be in your local phone book or you can get it from https://www.nhs.uk

I was speaking to my PCT yesterday and they told me that under the new rules, your dentist is responsible for you for 2 months of seeing you, then they can take someone else on and don't have to tell you that you are no longer on their "books". I was told that this was done so that everyone now has a chance to visit a NHS destist. Not sure how that works in practice though. I was told to check with the dentist as they are allowed to change those rules within their own surgery if they want to.

So if dentists are allowed to change patients every 2 months, then I guess patients are allowed to change dentists after 2 months (as long as they are not still receiving treatment from the first dentist)? Although it states in the booklet "What you need to know about changes to NHS dentistry in England" page 5 that "Your dentist will recommend a date for your next visit based on your individual oral health needs".

If it were me, I would try the PCT first and if no joy, then ask your doctor for help.

1jim · 7 October 2006 at 11:51AM

you should be able to see any NHS dentist, I cant imagine why a dentist would charge to see you privatly for this as conditions often occur between checkups and just because your teeth were fine then it doesnt mean they are fine now
I would recontact them and explain that you have been to ed (emergency department) at the hospital and that they have advised you to see your dentist........ I would leave it at that and expalin more when you see the dentist, if yo have a problem I would ask to speak to the practice manager and question this policy
A lot of primary care trusts now have emergency dental services....it might be worth calling NHSDirect on 08454647 from a Landline (this way you are more likly to be be put through to your local centre) and they should be able to put you through to an emergency dental service (on NHS)
hope this helps

Toothsmith · 7 October 2006 at 12:21PM

If you developed the neuralgia 6 weeks ago, then that presumably was only a couple of weeks after your check-up?

Have you had Trigeminal Neuralgia before? You seem to know a bit about it.

It is usually a diagnosis of elimination, so you need to eliminate all other possible causes before you can diagnose it.

The after-effects you've been left with do sound quite typical though.

This does highlight one of the problems of the New Contract. There is no longer any registration. The dentist has no obligation of 'continuing care'. he sees you, he passes you as fit, he gets the point towards his funding target, he moves to the next patient.

If he doesn't get his points, he will not get the same level of funding next year. Then you would probably not have an NHS dentist at all.

He 'should' see you and investigate the causes of your pain, but this will not earn him any extra points.

Of course you could find another NHS dentist. The new one will not have seen you before, and so will get a single point for doing a check up. Whether he feels that single point is worth all the diagnostic effort to find if there could be a possible dental cause to your pain will depend upon how well he is doing towards his target, and how ethical he can afford to be.

With only being seen a couple of weeks before the pain started, and if you have had it before, it is probably a fair bet that TN is the problem. If you want to be absolutely certain there is no dental cause, though, you may well have to pay somebody.

loveandlight · 7 October 2006 at 1:06PM

Have you had Trigeminal Neuralgia before? You seem to know a bit about it.

Of course I know about it because the hospital doctor told me about it.

It is usually a diagnosis of elimination, so you need to eliminate all other possible causes before you can diagnose it.

This is what I'm trying to do but a bit difficult when your NHS dentist won't see you unless you are prepared to pay privately.

If you want to be absolutely certain there is no dental cause, though, you may well have to pay somebody.

How am I going to pay somebody if I don't have the money to pay them with? That's the whole point of posting this message. I would rather not get into a discussion about not being able to pay for medical care if you don't mind. I appreciate you replying to my post but your reply hasn't helped me. I need to be able to move forward to a solution given my circumstances and inability to pay private.

My grateful thanks to the other posters. I will follow up on all your suggestions.

MissMoneypenny · 7 October 2006 at 2:23PM

Toothsmith wrote:

IThe dentist has no obligation of 'continuing care'. he sees you, he passes you as fit, he gets the point towards his funding target, he moves to the next patient.If he doesn't get his points, he will not get the same level of funding next year. Then you would probably not have an NHS dentist at all.
He 'should' see you and investigate the causes of your pain, but this will not earn him any extra points.

The PCT told me that the NHS dentist was responsible for that patient for 2 months. I assume from that that he has to look after a patients dental care for that time. He may not get an extra "point" for seeing a patient again in that time, but does his point get taken away if he refuses to give his patient continual care?

Toothsmith wrote:

Of course you could find another NHS dentist. The new one will not have seen you before, and so will get a single point for doing a check up. Whether he feels that single point is worth all the diagnostic effort to find if there could be a possible dental cause to your pain will depend upon how well he is doing towards his target, and how ethical he can afford to be.

Shouldn't that be - how ethical he wants to be?

inkie · 7 October 2006 at 2:31PM

I phoned my dentist for an appointment ( I'm on NHS and tax credit exempt) and my dentist said I will have to pay privately to have them look at my teeth as my last check up a couple of months showed there was nothing wrong with my teeth. However my dilemna is that I can't afford to pay privately.

It may be that you had a check up recently, but you have a new health problem that you need to be seen for. By asking you to pay means that people arn't allowed to be i'll in between check ups. I would go down the pain route rather than asking for a check-up.

MissMoneypenny · 7 October 2006 at 2:59PM

loveandlight wrote:

as my last check up a couple of months showed there was nothing wrong with my teeth.

Surely your last check up showed that the dentist couldn't find anything wrong with your teeth? Not quite the same as nothing wrong. We are all human and problems could have been missed.

I'm concerned that the dentist now wants to charge you as a private patient though, as your problems seem to have arisen on his NHS (two month agreement) watch. I would definately phone your PCT as soon as possible if I were you. I found them very helpful.

elaine373 · 7 October 2006 at 3:10PM

I personally would hunt down another NH dentist and get a second opinion.(If thats possible as there is such a shortage) Did you get an x-ray when you saw the Doc? Teeth can look fine but sometimes there is is non visible problem
.Good luck and i hope you are ok soon.

Dentist or Doctor or Both?

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