Dental query

vbee

Hi - looking for a bit of advice regarding my NHS dental treatment:

I had been with a practice as an NHS patient for several years. During a routine check >5y ago, a filling was replaced in UR6. Some time after this, I developed a sensitivity in this tooth, however the dentist was unable to locate any abnormalities on examination or x-rays. I was advised to use a sensitive toothpaste and to put this direct on the tooth etc. The sensitivity carried on for the next couple of years.

In March of this year, I experienced an acute episode of dental pain, concentrating in the region of UR6. I made an appointment to see my dentist. They performed dental radiographs and reported that they were unable to identify pathology relating to that tooth. I was prescribed a course of amoxicillin (although they could not identify an infection for sure) and advised to get a mouth guard, as the dentist felt I was grinding my teeth (I already had a nighttime retainer following straightening of my teeth). This came under band 3 of NHS treatment and so I paid £256.50.

The pain did subside after a few days and I monitored this tooth as advised. In June 2019, I noticed a bony swelling in the region above this tooth, which was sensitive to touch. I visited a different NHS dentist, who felt the tooth had died and needed RCT. Following her recommendation and reading about RCT on this forum, I went to a specialist endodontist. Radiographs demonstrated pulp stones in multiple teeth and changes in the periodontal space. The tooth was determined again to be dead by the endodontist and root canal treatment to save the tooth was recommended. This took three treatments due to the chronicity of disease present in the tooth (how she described it). Following the first treatment, all sensitivity I had experienced in that area over the preceding few years resolved immediately.

I feel that the tooth was mismanaged by my original dentist and I was left living with a sensitive tooth that has caused chronic problems. The bony swelling in my mouth has stopped progressing but will take a long time to remodel. I was advised to get a mouth guard, which I feel was incorrect advice. I also need to get a crown for this UR6 now, which is likely to mean the mouth guard will not fit and so I have paid for Band 3 treatment I can no longer use. I feel that the underlying problem was not correctly diagnosed and an incorrect course of treatment was recommended. Am I correct to think this, or is it more complicated than I am making out? Is it worthwhile making a complaint and could I get a refund of this Band 3 treatment?

On another note, my new NHS dentist says I can only have a metal crown (silver or gold coloured) under Band 3 for this tooth. The NHS website says that ceramic or porcelain on metal crowns are permitted under the NHS, but presumably these are only for front teeth? (Website doesn't specify).

Thanks in advance
V

Toothsmith

Assuming that nothing blindingly obvious was missed on the x-rays taken (and from what you write, and the other earlier symptoms from that tooth, there is no reason to suppose there was) Then the first real diagnostic symptom you describe is the appearance of that swelling. From then on, it's obvious that there is an abscess, and putting the jigsaw together from the history of that tooth, it's then obvious that these symptoms where all leading up to that.

But the earlier symptoms could have been many other more minor things too that didn't necessitate removing the tooth nerve (which is always a bad thing to do if it's the wrong thing to do).

If you root fill a tooth just because it's a bit sensitive after a filling, or misdiagnose a grinding problem as an abscess, then the root filling is an uncorrectable mistake.

Hanging on and trying other, easier, reversible things when symptoms and tests are giving inconclusive results is good practice. I think your previous dentists did the right thing, and would have continued to do the right thing and sent you for the root filling had they seen the much more conclusive symptom of the swelling later on.

Undervalued

vbee wrote: »

On another note, my new NHS dentist says I can only have a metal crown (silver or gold coloured) under Band 3 for this tooth. The NHS website says that ceramic or porcelain on metal crowns are permitted under the NHS, but presumably these are only for front teeth? (Website doesn't specify).

Thanks in advance
V

That is my understanding.

I also believe (maybe one of the dentists on here will confirm) that metal crows are stronger and involve less grinding down of the original tooth than would be required to fit a nice looking ceramic one.

Toothsmith

That's true UV