Expectation of formal complaint about dental treatment

welshdent

Couple of things that I would comment on - I may be wrong but I am not aware of any pressure spots from a bridge that would cause an infection meaning the 1st line of attach would be antibiotics? Surely the first line is remove the pressure spot?? Also if the infection is related to the tooth then the first line is still NOT antibiotics in ideal circumstances? Even if they were given then follow up treatment would be extraction or root treatment .... which the dentist was not planning to do in either case hence referral with no remedial intervention? I would agree that pre op radiographs should have been taken though - but we do not know 100% for certain that they were not. Many of my patients do not realised they have had various investigations taken. They swear blind X Y or Z has not occured and yet the results of said investigations are in my hand most of the time

welshdent

Careful_with_that_Axe wrote: »

- bony changes are similar to honeycomb effect in lower right jaw with loss of hard bone and bone density.

That appearance IS something I would refer about. Even just to be on the safe side so I can see the desire to seek a second opinion. Its very difficult to say exactly what is going on without seeing you and your x rays. However IMO there are not that many instances where antibiotics are the first line of attack. I personally am really trying to cut my prescribing down where possible.

Careful_with_that_Axe

welshdent, I would hope you would not cut down by not prescribing antibiotics where they are needed.
The dentist's suggestion for dealing with the pressure spot was to leave the bridge out until the gum trauma had healed. *insert sarcastic roll eyes smiley*.
There is no tooth in that area to extract.
I have no issue with the referral - I am positively in favour of it. My issue is being left with an infection that is deepset and spreading with a refusal of antibiotics, a suggestion of using Corsodyl mouthwash for relief and a +/- 3 week wait for the referral appointment. Given my lack of immune system, the spread of this infection and its effects could have been absolutely dire.
Because of my medical problems, I keep control of my health and am well aware of what diagnostic tools have been used, whether invasive or not. You may have come across patients who aren't but that is not the case with me.

Toothsmith

Careful_with_that_Axe wrote: »

The dentist's suggestion for dealing with the pressure spot was to leave the bridge out until the gum trauma had healed.

Hang on! Bridges are things that are stuck in the mouth permanently.

I think what you've been descibing is a denture. Doesn't really change very much, but there's usually no need to x-ray a patient before providing a denture.

And in 99,999 cases out of 100,000 leaving out the denture would be the way to sort out any pressure ulcers caused by a new one. Even in someone with a compromised immune system.

In fact, in such a patient, you really don't want them on antibiotics very much at all, as the risk of breeding antibiotic-immune bacteria would be very high, and so you really only want to use them when you absolutely have to.

I'm pretty sure I wouldn't have prescribed them for you back in the early stages of the problem either.

welshdent

Careful_with_that_Axe wrote: »

welshdent, I would hope you would not cut down by not prescribing antibiotics where they are needed.
The dentist's suggestion for dealing with the pressure spot was to leave the bridge out until the gum trauma had healed. *insert sarcastic roll eyes smiley*.
There is no tooth in that area to extract.
.

You may think I am being a bit antagonistic, but as toothsmith says - sounds like a denture -- again not a case for antibiotics. Easing the overextended material yes, leaving out the offending article yes; but not antibiotics. ... I suspect what YOU think needs antibiotics and what I think need antibiotics are probably quite different. A tooth infection does not require antibiotics as a first line action for example. Personally the more I hear, the more I think the dentist has acted appropriately especially with your desription of the x ray findings

welshdent

also the more unecessary antibiotics we dish out the more resistance to them we created and also the less we can give within a short time frame when others ARE needed.

Careful_with_that_Axe

Thank you both for your posts.
I haven't had antibiotics for 15 years for the reasons Toothsmith mentions - the risk of resistant infections is too great.

I stress again, I absolutely agree with the referral given the x-ray findings - there are other oncology issues going on and historically. I have been on various doses of steroids for many years - ranging from 20mg to 5pm a day - accompanied by bone protector medication. I am cogniscent with the issues of osteoporosis; particularly with a maternal history of it (although Mum had a similar auto-immune condition and was on steroids for 35 years).

I think (my opinion that I am sure you'll disagree with clinically *grin*) is that I am beyond grateful for the antibiotics for the relief they have given me from the pain which was immense. I was debilitated to such a degree that I was getting concerned that my airway was becoming compromised by the swelling. could not put my neck towards my shoulder on the affected side and had great difficulty in swallowing.

Welshdent - I ws a little antagonised by your post, but I've got some sleep since then *g*

Thanks for your info/posts - I will refrain from making any ill-advised comments to the dentist; I know she worked hard. I remain grateful for the antibiotic prescription, however, for the pain relief although I suspect you will have major issues with it being used for such a thing!

Thank you for making think more rationally about the situation and, if you are interested from a clinical pov, I will let you know outcome of referral.

I have taken on board all you have said and will not make any rash or impulsive complaints to dentist surgery.

p.s. As a female-type person, I have issues with the "D" word and am a little coy about it - hence the use of the word bridge *g*

Toothsmith

Just a little post-script to this thread, with an article from the Liverpool Echo this week.

The dentist prescribing these antibiotics was in no way responsible for the death of this man, and the verdict was 'natural causes'.

But it just shows that a reaction to a medicine can be severe, and can happen at pretty much any time.

Taking antibiotics is not a completely 'risk free' treatment. Like any other treatment, a careful risk/need/benefit analysis should be carried out, and no tablet should be prescribed or taken 'just in case'.

http://www.liverpoolecho.co.uk/liverpool-news/local-news/2010/02/26/penicillin-allelrgy-kills-healthy-wirral-man-100252-25917994/

Careful_with_that_Axe

Interesting. Thank you.
I suppose that has (in my case) to be weighed up against the dangers of cellulitis left untreated in a person with a suppressed immune system.
I suspect we'll have to agree to disagree!

joewa

bear in mind the dentists are the professionals