Decision making (NHS to Private dentist)

dannie

Had an emergency dental appointment for an abscess and got a prescription for penicillin which I told the dentist I might be allergic too.  (Dentist prescribed it anyway).  This was an emergency private Dentist as I couldn't get through to my NHS Dentist.

Reason I was concerned about the penicillin was that in 2019 I had a severe full body rash, 36 hours after completing the penicillin course.  GP thought it was psoriasis and not penicillin related.

Appointment with different GP yesterday, as severe rash appeared again after 36 hours of completing the penicillin course. GP said he would enter on my records for me to avoid this penicillin in the future. 

So, feel in a muddle with all this.  Do I go ahead and change from NHS to this private dentist as previously considered, who I am beginning to doubt?  Or, was the GP at fault for the original psoriasis diagnosis? 

 Any thoughts on how to proceed?

Thanks.

ButterCheese

I would keep your NHS dentist, if you leave you will never get back in.  You could of course keep yourself on the NHS register by complying with their 6 monthly or yearly check-ups just so they don't boot you out, and also seek private medical care.

I would report this to your GP who seems to have mis-diagnosed psoriasis.  But your allergy is on NHS records now so that's good.  Up to you what you do now, but you can safely tell any care provider now that you are allergic to penicillin, and probably allergic to anything ending with "illin" going by relatives who have the same allergy

DullGreyGuy

dannie said:

Had an emergency dental appointment for an abscess and got a prescription for penicillin which I told the dentist I might be allergic too.  (Dentist prescribed it anyway).  This was an emergency private Dentist as I couldn't get through to my NHS Dentist.

Reason I was concerned about the penicillin was that in 2019 I had a severe full body rash, 36 hours after completing the penicillin course.  GP thought it was psoriasis and not penicillin related.

Appointment with different GP yesterday, as severe rash appeared again after 36 hours of completing the penicillin course. GP said he would enter on my records for me to avoid this penicillin in the future. 

So, feel in a muddle with all this.  Do I go ahead and change from NHS to this private dentist as previously considered, who I am beginning to doubt?  Or, was the GP at fault for the original psoriasis diagnosis? 

 Any thoughts on how to proceed?

Thanks.

How long is the course of antibiotics? 

Abscess I would have guessed at 3-5 days but then you say it was 1.5 days after completing the course that the rash came about? It would be unusual for an allergy to be triggered 4.5-6.5 days after first taking the allergen unless its something like DRESS which just takes time for the reaction to show. 

Did the original GP actually see the rash in person or go on your description after the event? Was the rash scaly? 

The dentist doesnt seem to have done anything wrong, they asked if you were allergic, you said no, so the prescribed. 

As to "how to proceed"? Up to you, either tell everyone in the future you are allergic to penicillin and accept the potential consequences of broad spectrum antibiotics, accept you will get a rash and continue to take penicillin or get yourself properly tested for an allergy which you may have to pay to have done privately.  

Voyager2002

Note that forum rules strictly prohibit giving medical advice.

We have a story about a private dentist perhaps making a mistake. Why would that be a reason to move to this private dentist, giving up your place with an NHS dentist?

(I say "perhaps" because in an emergency situation, treating the problem with something that will cause an allergic reaction might be better for you than leaving the problem untreated. I cannot say which was the right course of action because I am not a doctor and I was not there, but do consider the possibility.) 

dannie

Thanks for the replies.

ButterCheese - Informed my GP of previous amoxocillin rash which was examined by another GP in the practice five years previously.

DullGreyGuy - 5 day course completed and yes, rash started 36 hours after 5th day completed.  GP seemed to be saying a delayed hypersensitivity reaction.  
The original GP who diagnosed psoriasis saw the the rash. which did not appear scaley.  I just described this experience/diagnosis to the private dentist. 

Voyager2002 - Since my last NHS dental appointment, the surgery has relocated further afield making access to it more difficult.  The private dentist is in walking distance (30 minutes).  Consequently, had been considering switching to private before recent events.

badmemory

I would have thought that if you mentioned the possibility of a reaction then they would not prescribe that just in case.

Spoonie_Turtle

badmemory said:

I would have thought that if you mentioned the possibility of a reaction then they would not prescribe that just in case.

Risk/benefit though - they will have (or at least should) weighed up how bad the reaction would be, vs the benefit of prescribing it and the risk of harm from not prescribing it.

badmemory

They normally prescribe something else for me, which is what I would have expected.

Undervalued

ButterCheese said:

I would keep your NHS dentist, if you leave you will never get back in.  You could of course keep yourself on the NHS register by complying with their 6 monthly or yearly check-ups just so they don't boot you out, and also seek private medical care.

I would report this to your GP who seems to have mis-diagnosed psoriasis.  But your allergy is on NHS records now so that's good.  Up to you what you do now, but you can safely tell any care provider now that you are allergic to penicillin, and probably allergic to anything ending with "illin" going by relatives who have the same allergy

Voyager2002 said:

Note that forum rules strictly prohibit giving medical advice.

We have a story about a private dentist perhaps making a mistake. Why would that be a reason to move to this private dentist, giving up your place with an NHS dentist?

(I say "perhaps" because in an emergency situation, treating the problem with something that will cause an allergic reaction might be better for you than leaving the problem untreated. I cannot say which was the right course of action because I am not a doctor and I was not there, but do consider the possibility.) 

Technically (in England at least) there is no such thing as being registered with an NHS dentist. Once they see you they must complete the course of treatment but after that they are not obliged to see you again.

Some (many?) may choose to operate by giving priority, or indeed only seeing regular patients, so acting as if they were "registered" but as far as the NHS is concerned they are not.  

dannie

Thanks for the replies.

I think there could have been an alternative penicillin from what the private dentist was saying at the time.  Nevertheless, despite informing him of my previous experience (i.e. rash diagnosed as psoriasis and not amoxocillin related), he went on to prescribe it.

Toothsmith

I would be trying to find out if I were really allergic or not. Ask to be tested? 

I don't know exactly what you told the emergency dentist, but a patient giving me a history of a reaction to a medicine which only showed itself a day and a half after completing a 5 day course of that drug, and was then diagnosed as psoriasis by a Dr - I would not then think I had to avoid that drug.

A reaction developing so long afterwards certainly is not a typical allergic response. 

Amoxicillin is the best antibiotic for many infections, dental abscesses included. There are alternatives, but they are very much second best. To prescribe a second best medication, you need a good reason, and your history, especially with it then being diagnosed as psoriasis, isn't that good. I might just have cautioned you that if an itchy red rash did start to happen whilst you were on it, then to stop - but that would have been all.

The fact the same thing then happened again, a skin rash a day and a half after you'd stopped taking it, is certainly a very strong coincidence, but before I shut the door on possibly the most effective group of antibiotics for the rest of my life, I'd want an allergy test just to see if this really was the case.