NHS, Wisdom tooth extraction, and free treatment - probably one for toothsmith

kiwichick

Hi All,

Apologies for posting but I see from previous posters that we have dentists amongst us. Was hoping you could give me some insight to an extraction I had done recently.

A molar (3rd from back on lower right) had preiously been heavily filled and cracked. I was in agony and dentist said, after checking it out, that the crack went below the gumline and the tooth needed pulling as there wasnt enough above gumline left to crown.

She did it there and then which I was initially fine with but anesthetic appeared not to work. I was still in as much pain after 3 vials as I had been to begin with. After much pulling, whilst her assistant held me down the dentist put in 2 more vials (5 total) and sent me to the waiting room to see if it would kick in. I was in shock by this stage, couldnt stop shaking, had to hold on to the wall to walk. Dentist gave me a sugary drink. After 10 mins I was back in the chair, still no relief from pain, being held down, screaming and crying and shaking with pain while she pulled out the molar.

I'm wondering what was different this time, having had an extraction under local before with no bother? I'm no stranger to dentists and am by no means a whimp but this has scarred me. I had nightmares (embarrassing as I am 32!) for a week and despite ongoing pain in the socket was too scared to go back.

The only thing I can think of is that I was taking Champix (prescription only smoking cessation medication) at the time. Dentist did not ask if I was on any medication. Nor did she offer to stop the extraction and sent me elsewhere to be put to sleep to continue the procedure. She told me it had to be done there and then. Is that right???

Sorry for the rant!
Allison.

brook2jack

First off well done on stopping smoking. Champix will not have caused problems with the treatment but is probably the cause of your dreams(its a well known side effect http://www.pharmadoctor.co.uk/quit-smoking-questions/ ) but if you only recently stopped smoking or still have the odd sneaky one you are at high risk for dry socket, an infection of the tooth socket. If it is still sore go back to the dentist as it may need treatment (easy stuff!).

In general dentists should always update medical histories before treatment , and patients should always let them know if they are on a new medicine or seeing the doctor for something even if they don't think its relevant.

A tooth that is very painful can be very difficult to numb up for a variety of reaons, it may have a "hot pulp" (inflammed nerve) , it may be abcessed and often injections don't work in the acid of an abcess and finally when a patient gets distressed the signals for pressure and pain get confused and a patient feels pressure as pain. Add to this people haven't often eaten for some time and are quite wobbly due to low blood sugar (thats why you were given a sugary drink and probably why you felt wobbly.)

There is a limit as to how much anaesthetic you can give and then everyone is in a difficult position because the only way to get the tooth numb is to send the patient away for a few days with painkillers ,antibiotics and to give them a dose of an anti inflammatory painkiller to take an hour before the extraction. This is almost always successful.

There is no option to put someone to sleep to take the tooth out in this situation , toothache is not classed by the nhs as an emergency and if you go to a and e you will be given antibiotics and painkillers , waiting lists for general anesthetics are months long and unless there is severe swelling they will not take a tooth out as an emergency with ga.

What happens next should happen with the patients consent. Many people in so much pain will say go ahead take the tooth out anyway, will go with it knowing it will get rid of the pain. Many people will go away with the medication and come back a few days later and have the tooth out successfully. It is a difficult situation because the only way to get rid of the pain is get rid of the tooth and it is difficult to say to someone in pain they need to wait a few days to get the tooth out .

It is important that treatment is done with consent and you have the right to say no but in this case there was no easy solution to get you out of pain.

StevieJ

brook2jack wrote: »

In general teeth or roots that are completely under the gum and have no connection with the mouth cause no problems.

I have one of them, bottom left.

Ladywriter1968

brook2jack wrote: »

The point is the root is very close to or even involved with the nerve. By taking only the crown off you

A remove the problem because in general what causes problems with wisdom teeth is gum infections where food/ plaque gets lodged around the top of the tooth and can't be cleaned out

B allow space for the root to continue erupting (move upwards away from the nerve) so if it causes problems it can be removed without damaging the nerve.

It is a modern and trusted technique to try to avoid permanent nerve damage.

In general teeth or roots that are completely under the gum and have no connection with the mouth cause no problems.

My tooth is completely under the gum, has not come thru at all as no room to come thru, so they would have to cut the gum open to get it out. As the next one molar next to it, that one has filling in.

brook2jack

Well then that is why the hospital are so keen to investigate other causes of pain, as unless the wisdom tooth has a connection to the mouth and food/plaque gets caught there setting up infection , it in general can't cause pain. That is why unerupted wisdom teeth (ones completely under the gum) are left where they are.

Ladywriter1968

Hi again all.

I would like to add extra info now. Earlier I found these blister things around my gum and its hurts, between my molar and gum I can see very slight bit of wisdom tooth looks like its jarred up again molar. Its like its trying to force its way thru as seen a bit of broken skin.

Ladywriter1968

Hi again all.

I would like to add extra info now. Earlier I found these blister things around my gum and its hurts, between my molar and gum I can see very slight bit of wisdom tooth looks like its jarred up again molar. Its like its trying to force its way thru as seen a bit of broken skin.

Ladywriter1968

I received letters about my situation of my teeth. Can some one please explain these medical terms,

clicking of the left temporomandibular joint???
bilateral hypertrophy of the masseters and masseter to palpation???
occlusal amalgam which is mildy TTP and grade 1 mobile???
buccal tenderness???
DPT showed no periapical pathology ???
There was a distally ungulated, unerupted lower 8 - distally ungulated???
DPT???
the apices of which crossed the superior boarder of the inferior dental canal???

Temporomandibular joint disfunction
Micro leakage of occlusal amalgam - I assume this means possible filling leak.

Thanks

Ladywriter1968

brook2jack wrote: »

Well then that is why the hospital are so keen to investigate other causes of pain, as unless the wisdom tooth has a connection to the mouth and food/plaque gets caught there setting up infection , it in general can't cause pain. That is why unerupted wisdom teeth (ones completely under the gum) are left where they are.

Its starting to push thru the gum now as can see it slightly and causing more pain. but has no room to come right thru

welshdent

Ladywriter1968 wrote: »

I received letters about my situation of my teeth. Can some one please explain these medical terms,

clicking of the left temporomandibular joint??? - your jaw clicks on the left side.

bilateral hypertrophy of the masseters and masseter to palpation??? - badly worded but - both masseter muscles are enlarged and I am guessing they are tender when pressed/palpated.

occlusal amalgam which is mildy TTP and grade 1 mobile??? - Makes no sense because you are stating a filling is ttp and grade 1 mobile. I think you are missing part of the sentence out. It may say X tooth is restored with an occlusal amalgam (biting surface, metal filling), the tooth is slightly tender when tapped and there is a small degree of mobile.

buccal tenderness??? something is tender bucally

DPT showed no periapical pathology ??? the panoramic radiograph showed no pathology on the apex of whatever tooth/teeth are being looked at although it is not a good image for looking at those areas.


There was a distally ungulated, unerupted lower 8 - distally ungulated??? - the unerupted lower 8 is tipped backwards.


DPT??? x ray (panoramic)

the apices of which crossed the superior boarder of the inferior dental canal??? - the tooth is close to the canal holding the nerve

Temporomandibular joint disfunction - Pain the jaw
Micro leakage of occlusal amalgam - I assume this means possible filling leak. - yep

Thanks

I have annotated your words with some comments. Its hard to say exactly what is going on because I can not see you or the comments - but in laymans terms see above