Emergency tooth ache

brook2jack

mal4mac wrote: »

Where does your direct quote come from?

Heck, if you can't get immediate treatment for unbearable, unstoppable pain what kind of country we are living in? Get down to A & E if the pharmacist can't help. Create a scene if they try to turn you away, that should get the adrenalin flowing, which might help with the pain.

Before 2006 dentists had to provide out of hours services and we were on call 24 hours a day. Since 2006 this responsibility for out of hours services rest with local commissioning groups and so has dwindled away to what many of us see as a very unsatisfactory service.

A and E is not set up for dental treatment. They have neither the staff nor the equipment. The policy on dental pain can be found in many places eg http://www.thefreelibrary.com/Aaaarrrgghhh%3B+NHS+DENTAL+HELPLINE+CAN'T+HELP+PEOPLE+WITH+TOOTHACHE.-a0126493816 http://www.wales.nhs.uk/sitesplus/documents/866/Emergency%20Dental%202014.pdf

The local A and E department will routinely turn people away if they are not a dental emergency (trauma, swelling or uncontrollable bleeding following an extraction) . Pain is not seen as an emergency. http://www.ouh.nhs.uk/services/departments/acute-emergency/emergency-department/default.aspx

Of course this is not satisfactory but turning up at A and E where there is unlikely to be the equipment or people to help and shouting will not help. Phoning 111 for advice on the nearest emergency clinics and accepting there will be an NHS charge for those who pay will help and writing to the local commissioning group etc about dental emergency services will do a lot more good for others in the same situation.

mal4mac

brook2jack wrote: »

The policy on dental pain can be found in many places eg http://www.thefreelibrary.com/Aaaarrrgghhh%3B+NHS+DENTAL+HELPLINE+CAN'T+HELP+PEOPLE+WITH+TOOTHACHE.-a0126493816 http://www.wales.nhs.uk/sitesplus/documents/866/Emergency%20Dental%202014.pdf

A newspaper report, a Welsh site, and a regional hospital's "interpretation"?

I quoted the official NHS(England) site, and the OP is in London, so I think he should stick with the official NHS(England) site.

The local A and E department will routinely turn people away if they are not a dental emergency (trauma, swelling or uncontrollable bleeding following an extraction) . Pain is not seen as an emergency. ..

Maybe not, but it's still "something" that NHS(England) says is a reason to visit A&E.

justme111

brook2jack wrote: »

Never,never,never use oil of cloves. It can leave a very nasty burn if incorrectly applied .

It also interacts with many other drugs.

Avoid .

I believe it is insensitive to tell a person in excruciating pain not to use something that could help due to a possible burn.
malmac , please note people responsible for definition of toothache not being emergency are not dentists , they are NHS management. I would like to see guidelines on it as well , I have heard as well about this aberration -" toothache is not an emergency " but have not come across it in written . I guess in Wales it is not. In a few other areas I know it is. Dentists dealing with emergencies get about 20 minutes allocated for a patient and they do maverick work sometimes trying to sort it within that timeframe which I am sure you will appreciate can be very challenging.

brook2jack

A&E departments are overwhelmed with patients and there is a campaign going to stop people going there unless their complaint is life threatening. Phoning 111 is more likely to get an appropriate response.

Here is the policy about dental emergencies reiterated by a London gp clinic http://www.nelsonmedicalpractice.co.uk/services/dental-health/

Here is a London ccg saying don't go to A&E unless it is a critical or life threatening emergency http://www.mertonccg.nhs.uk/Local-Services/Documents/Easy%20read%20leaflet.pdf

And another London ccg saying A&E is for serious problems only. OP should have been sorted by now by phoning 111. But the message all over the country is A and E is not for toothache http://www.cmft.nhs.uk/media-centre/latest-news/ae-not-the-place-for-toothache!.aspx

brook2jack

justme111 wrote: »

I believe it is insensitive to tell a person in excruciating pain not to use something that could help due to a possible burn

I personally have had to take teeth out because of the damage caused by applying clove oil. I have seen burns straight through the mucosa and down to bone. A quick Google will show examples of burns but this extract demonstrates the dangers of clove oil (eugenol) even at low concentration and says people should be discouraged from using it. http://www.nature.com/bdj/journal/v193/n5/full/4801539a.html

This is why it's a problem

Eugenol is generally cytotoxic at high concentrations and has an adverse effect on fibroblasts and osteoblast-like cells.19, 20, 21 Thus at high concentrations it produces necrosis and reduced healing. This effect is dose related and will potentially affect all patients.
In lower concentrations, eugenol can act as a contact allergen evoking a localised delayed hypersensitivity reaction.10, 13, 14
Rarely, eugenol when placed in the mouth, can cause a more significant generalised allergic response.12 One particularly sensitive patient is reported to have developed anaphylactic-like shock subsequent to a pulpotomy in which zinc-oxide and eugenol cement was used.22

brook2jack

justme111 wrote: »

malmac , please note people responsible for definition of toothache not being emergency are not dentists , they are NHS management. I would like to see guidelines on it as well , I have heard as well about this aberration -" toothache is not an emergency " but have not come across it in written . .

You should read the sced guidelines which, although Scottish, classify dental problems in a way that is almost universally used in the NHS. Dental emergencies are rare and include trauma,swelling , bleeding that won't stop after extraction. These are the sort of things that should be referred to A and E.

Toothache is classified as urgent and is more appropriately seen in a dental setting .
http://www.sdcep.org.uk/wp-content/uploads/2013/03/EDC+Guidance.pdf

justme111

The link you kindly given states that severe toothache would be seen within 24 hours if patient does not have access to their usual dentist and they will be seen in a dental setting open on weekends. Public is not just sent away with toothache and told to see/find a dentist. That was the meaning I used the word "emergency" with when talking about toothache. So it looks like toothache is "emergency " in that context , the document just calls it "urgency".
I wonder whether this policy is countrywide, anybody knows ?

melanzana

Clove oil is sold over the counter without prescription.

If Brook 2 Jack thinks this is dangerous s/he should be getting on to the medicines board or whatever the equivalent is. Not just here.

Although I get that the intentions are good.

Clove oil saved my sanity with a toothache. No burns but no pain after a while either. Dentist on the Monday sorted it and never mentioned anything even though I said I had used the clove oil.

brook2jack

If you read the previous link the recommendation is that the general public do not use clove oil (eugenol) to treat toothache because of the possibility of nasty side effects . These concerns are reiterated in this book from page 68 onwards . It can and does cause irreversible damage. https://books.google.co.uk/books?id=XU1sMK1djVAC&pg=PA69&lpg=PA69&dq=nonprescription+product+therapeutics+eugenol&source=bl&ots=o4-W5SDLUR&sig=yvRj-8xlcMRfjIGe9s9gEj1cBhU&hl=en&sa=X&ved=0ahUKEwiJ46n8-Z3LAhXMDxoKHZ12DQ4Q6AEIGjAA#v=onepage&q=nonprescription%20product%20therapeutics%20eugenol&f=false

melanzana

brook2jack wrote: »

If you read the previous link the recommendation is that the general public do not use clove oil (eugenol) to treat toothache because of the possibility of nasty side effects . These concerns are reiterated in this book from page 68 onwards . It can and does cause irreversible damage. https://books.google.co.uk/books?id=XU1sMK1djVAC&pg=PA69&lpg=PA69&dq=nonprescription+product+therapeutics+eugenol&source=bl&ots=o4-W5SDLUR&sig=yvRj-8xlcMRfjIGe9s9gEj1cBhU&hl=en&sa=X&ved=0ahUKEwiJ46n8-Z3LAhXMDxoKHZ12DQ4Q6AEIGjAA#v=onepage&q=nonprescription%20product%20therapeutics%20eugenol&f=false

Why not banned then?

Antibiotics have little or no side effects (unless you are allergic) but they are handed out like smarties.