NHS dentist did more harm than good...

Bowline

Hope this isn't in the wrong place!

I've never had a problem with dentists until the last few weeks where I've seen many, and I have lost so much confidence.

Long story short:
1 month ago - terrible toothache while at work (on ships), saw foreign dentist,said there was an abscess in the gum but no root involvement, sent me away with some Corsodyl

3 weeks ago - saw normal NHS dentist - told I would need root canal - x-ray he took didn't show full root and he was very blas! about it so took a prescription for amoxicillin and...

2 weeks ago - saw a different NHS dentist with good reviews - told I would need root canal - booked in for...

1 week ago - she performed the root canal and seemed very stressed because there was a lot of blood, she took an xray and while it developed she started getting a permanent filling ready, after she looked at the xray she said it was bleeding too much and that she would just dress it for now, placed temporary filling and sent me away with metronidazole for "if the pain comes back".

Went back to work a few days later and abscess started to flare up. Got so bad that I had an emergency appointment for incision and drainage and was signed off work on amoxi and metronidazole.

Today - went to a private dentist with an interest in endodontics (I even got a dental dam this time, and he had a microscope-type-device). He reopened tooth and found that the NHS dentist had drilled through the side of the tooth and found some gum, assumed it was nerve tissue and performed root canal treatment on my gum, leaving the actual root canal untouched. He has now performed the root canal properly, cemented the hole and says the tooth's worth another chance. He has taken pictures.

My question is how do I approach this issue with the NHS dentist. I have lost time at work (and pay) and it has put myself and my partner through a lot of suffering. The total cost of private treatment (including the initial full examination and root treatment and restoration with composite filling) will be over £700. Do I write it off as part of the risks of seeing an NHS dentist or do I take it further?

Thanks for your advice

Finefoot

I would ask the most recent dentist to write a report on his findings and treatment, and go back to the other dentist with it, and ask for a refund of their charges.

donnac2558

No expert but a dentist giving Corsodyl for an abscess sounds the most stupid thing ever.

welshdent

Pressed post too soon. See below

welshdent

It's not a risk of seeing an NHS dentist. It's a risk with seeing ANY dentist. The general public are not aware of just how difficult root canal treatment is. Sure the NHS say it's mandatory service and we should all be able to do it. But that is disingenuous. Sure. Once the root canals are found it's more straightforward buy locating canals that may be less than 1mm in diameter is extremely hard. It's slightly less hard when using a microscope. But still hard. It is one of the reasons I do not think the average dentist particularly those working within an inadequate NHS dental contract should be obliged to do them. They provide no funding to do root canal treatment. They say they do but they don't. However to stand a good job of finding these canals requires at least loupes which for a decent set cost a couple of thousand or a microscope. A decent one will cost over 10k more like 15k.

It is worth remembering that when a root canal treatment is "needed" it is because the tooth would only be able to be treated with an extraction as the only other alternative. It's the last chance saloon in many instances and is by no means a guarantee. So a perforation yes is absolutely something we would try and avoid but no dentist would try and do it actively. Also. If your tooth ended up with one then it may have been you would have needed the more skilled practioner anyway in the first place. So in summary drop them a line if you are concerned. Buy I would not use such a hard tone. It's a very complicated procedure and they could just have easily told you they would have just taken it out which actually would have paid more! They were trying to help in the first place by avoiding the extraction. I know it didn't go to plan but that's not because they are an NHS dentist. It's because it is a difficult procedure.

brook2jack

A root canal has a 80 % to 90 % chance of success (higher with a specialist) in other words 1 in 5 to 1 in 10 will fail.

Common problems are breakage of instruments, failure to find or get down all canals, perforation (coming out of canals) , overfilling . These are common risks which are not necessarily someone's fault. They happen to us all. The only 100% guaranteed way to get rid of the infection is to take the tooth out.

The fact that molar endodontics is much more likely to have one of these risks is the reason many dentists ,not just NHS, will not do them any more and refer straight away to a specialist. There are virtually no NHS endodontic specialists generally available so that referral is normally private. Endodontists have expensive kit and postgraduate qualifications to pay for so the cost is normally in the hundreds .

An NHS dentist , after expenses but before tax, will have earned around £23 in total for the course of treatment (check up X Ray's root filling other fillings) if it was successful.

By all means write to the surgery explaining what has gone on. The dentist (who has a good reputation ) may have to work on their explainations and use of rubber dam.

Whether you also ask for money for the cost of your private treatment is up to you. £700 will be a full set of treatment for 28 NHS patients or around 90 check ups and will be payable by the dentist alone.

Bowline

Thanks everyone.

It's very easy to be angry when you've lost nearly a month of your life to pain and discomfort.

Welshdent, thanks for your detailed reply. I appreciate it and I appreciate the constraints of NHS dentistry.

My concern is that the dentist in question actually seemed very confident about the prognosis for this tooth (first premolar, lower) and said it should be quite straightforward. At no stage was extraction really mentioned as an alternative, though of course we knew. She did mention that not all root canal treatments are successful but she said she had a high level of confidence. (Strangely, at the end of the first part of the treatment she gave it 70% chance)

I'm also confused about how gum could be confused for nerve and how she didn't realise her mistake considering the amount of blood. I'm also concerned that she may have realised but tried to cover it up, particularly considering her change in demeanour after seeing the second xray. It was only when she looked at that xray that she decided that it was too wet to place the root filling and restoration.

brook2jack

You cannot see down a root canal and you rely on the prescence or absence of symptoms to tell you if the tooth is ready to fill. So if you can smell infection or see blood or pus coming out of the canal you dress the tooth and wait.

A heavily infected tooth will pour out blood or pus. In general the worse the infection the more difficult it is to settle and may take several visits to clean out. It is surprisingly easy to perforate out through a tooth and not realise it as there are many little canals and you are essentially working blind relying on x rays and apex locators which give you an incomplete idea of the anatomy

welshdent

I have seen people training to be specialists perforate a tooth before. Specialists themselves do it. I obviously cannot comment on YOUR tooth but can all have a rough idea about how things will go but until we start it is impossible to say for sure. If a nerve is "vital" i.e. still has some blood supply then the tooth will bleed. With a lot of bleeding it is difficult to tell structures apart and also the gum would bleed, think a drain continuously overflowing with dirty water. It is entirely possible that they just couldn't see for looking.
What I hope you may find reassuring is nowadays we have some excellent materials for repair of perforations which work extremely well. MTA cement and biodentine have a good evidence base behind them and are well tolerated by the tooth. If the specialist has used something like this then I would be happy. I have repaired some large perforations and the teeth are still there.

Bowline

Thanks again.

It's been repaired with MTA cement (basically once he removed the temporary filling and some cotton wool he said he could see a flap of gum at the bottom where she had drilled through and entirely missed the pulp chamber). He has cleaned the canal under microscope and it's been dressed and temporarily filled. So far so good, came off antibiotics Friday and no hints of infection yet though there's been some jaw pain and referred pain in the ear. Not constant and has settled down today so possibly just after effect from the treatment. Returning for the root filling, core build up and filling in a week.

Thanks again. It's very difficult not to be frustrated when you've lost much of your January to pain and discomfort, had to let down people at work because of infection and end up paying a lot of money for it. I'm happy to have found a dentist who I can be confident in and, to be honest, I'm happy to pay to keep my own teeth for as long as possible. Just a bit bitter that I had to go through everything else before and that, had I not decided to see another dentist, the tooth would probably be lost and the infection could have caused more damage in the jawbone or beyond.

welshdent

Glad it is getting sorted and you are clearly in good hands