NHS Temporary Filling from Emergency Appointment Lasted 2 Days

brook2jack2

If the tooth needs root filling there is virtually no such thing as a NHS specialist and any referral would need to be private. The same goes for any tooth so broken down gum surgery is necessary to expose enough tooth to try to save it. 

Most dental departments will not take referrals for anything but the most pressing cases and even then waiting lists are very long and treatment is not guaranteed. 

Most of the local teaching hospitals near me will not take any referrals at all for restorative treatment , no matter how pressing or have limits on what can be done. This link is typical of the restrictions on the services that are available in some areas https://www.aintreehospital.nhs.uk/media/11745/restorative-referral-guidelines.pdf

The type of case the op describes is not in the remit of NHS referrals and is a specialist case which will be private. 

The NHS business services agency (a link was suggested above) is not the service that provides or can advise on dental treatment , it is a payment service only so pointless to contact for patient information unless it is about patient charges and fines. 

chaotic_j

Hi,

Spoke to NHS services they said to find out exactly what the referral would be for, they thought it sounded like it would be covered.

So in the appointment it was mentioned about a private consultation, gum surgery and crown.

Rang back dentist and I'm told it's 'advance care' which is not covered under the NHS, they can't treat it or give NHS referral.

The decay was under the existing filling below the gum line, so gum surgery would be required to access below the gum line, a filling and possible crown.

Spoke to NHS services again they didn't know what advance care was but mentioned advanced mandatory referral or hospital referral. Seemed to think everything was covered or I should get a referral?

I'm really confused to be honest?

I've got the dressing on one side and a re-done amalgam filling on the other, advised not to eat on dressing side and online it says not to eat for 24 hours with amalgam filling so I've not properly eaten yet..

brook2jack2

NHS business services are not clinicians , they deal with payments side of dentistry. If you look at the links I posted above it gives an idea of what can and can't be done on NHS. 

Advanced mandatory referral is for services such as treatment under general anaesthetic which cannot be done in practice or difficult wisdom tooth referrals which have to be provided by the NHS  It's nothing to do with your situation. 

You will not get NHS treatment for crown lengthening (gum surgery) to restore a very broken down tooth except in very exceptional circumstances ie head and neck cancer , major trauma etc eg see this link https://www.bedfordshirehospitals.nhs.uk/our-services/restorative-dentistry/referral-criteria/

chaotic_j

Hi,

Thanks for the helpful replies.. so basically the surface of the tooth or root has decay underneath the original filling which can't be accessed to fill..

..without minor gum surgery which is a crown lengthening.. which I believe is quite straightforward, more of the crown or root beneath the gumline is exposed which allows treatment.

That's something not offered on the NHS. If I was to get a private referral, I'd have to complete that full course of treatment - consultation, crown lengthening, filling and possible crown all privately which is expensive?

The tooth is my first molar on the left hand side.. is this likely to cause problems if it's removed?

Presumably there is no point getting a second opinion? If I did, they would have to remove the dressing, would they re dress? Would I then have to pay the original NHS dentist band 2 fees if I wanted the extraction?

Thanks in advance.

Toothsmith

chaotic_j said:

I suppose but surprised it can go from being a tooth with a filling and no major issues.. to part of it breaking off on hard pizza crust to now.. there is nothing we can do, extraction or private specialist?

No it can happen. 

It wasn't a tooth with 'no major issues'. It was a tooth that had quietly been developing an enormous hole under the surface for a few years. 

chaotic_j

Hmm so basically from looking online it probably would not have been obvious the tooth was decaying for a number of reasons.

Do you know @Toothsmith the answers to my other questions above please? Really grateful for your help.

Feeling extremely anxious and worked up about my teeth. Apparently I have 4 on watch as well. Been miserable for 4 months now.

Toothsmith

chaotic_j said:

.

Do you know @Toothsmith the answers to my other questions above please? Really grateful for your help.

The other questions you have are a bit to specific for me to be able to answer without being able to see you & your teeth with x-rays as well. Anything else would be a complete guess, which would be unhelpful at best, dangerous at worst.

chaotic_j

Hi,

I went back to the dentist at the next appointment for scaling and 2nd filling redone with a list of questions I wanted to ask - sure no problem that's good you have a list. The dentist's answers were very detailed - probably overly so and we got part way through the list and they said if they were to answer the rest they wouldn't be able to carry out any treatment that day. And that we could have done this over the phone instead of in scheduled clinical time.

Everything was answered, I mentioned about a dark hole on the side of one molar and was told the treatment plan is not usually changed part way through but this could be filled. They said if this goes black it means the tooth decay has stopped (I'm not sure if they got this the wrong way round - as I was of the understanding black is more advanced decay?) so I said if you do not think this needs attention we will leave it.

I had to make another appointment to come back for scaling and the 2nd filling to be redone. When the appointment came round, I stated straight away that the tooth which was not restorable I had decided needed to come out. Then dentist was then encouraging me to keep it in. They said if it was not causing me major issues it could stay in for weeks or months. I would need to come back in 3 months anyway as I was at a high risk of tooth decay.

I found this very confusing as originally the only options were to have it out there and then or be referred to a specialist. Part way through the appointment I said it would need to come out, because I have been eating on one side of my mouth for 4 months now and the tooth has been bothering me a bit. So I had to make another appointment to come back and they said to think about it in the meantime.

When the dentist carried out the scaling I think this was only the worst affected area. My previous dentist would scale and polish my whole mouth, carry out front and side x-rays etc. put fluoride on my teeth and I feel this new dentist is doing the absolute bare minimum. Is it just that my original dentist was exceptional and the current one is more reflective of typical NHS dentistry?

I am very scared about having the tooth removed and feel totally anxious about my teeth, as if the one tooth had a lot of decay underneath what is there to say I don't have more teeth like this?

I was getting some sensitivity in the area of the 1st filling that was redone and some pain with cold foods/drink etc. in the area of the 2nd filling redone and generally some pain and sensitivity. But this seems to have calmed down a bit after some days? However I'm not sure whether the pain is real or imagined as I'm so worked up.

At the lower back side of my mouth I've been biting both sides in my sleep so I have flat bits which has also been making those areas sore which doesn't help. The comments that the dentist has come out with during my appointments I feel terrified and upset by.

Thanks,
chaotic_j

Toothsmith

Good that you feel your questions have been answered

It's right that decay that has hardened up again goes very dark. Active decay is more a greeny/brown colour - but you go on feel as well as colour if you can. Active decay is soft, stopped decay is hard & scratchy to the probe. When it's just a stain you can see below the surface, then it's a judgement call. Your dentist feels that leaving it alone is the right call for now. I'm not in a position to disagree with that. I leave things when I can too - putting a filling in a tooth will damage things more, although if the decay is active, it is the right thing to do. He's letting you have an input too though. He's happy to fill it if you'd prefer it filled.

There's not really a right or wrong here - so long as you keep check ups regular so if the stain is getting bigger it can be noticed and dealt with.