good dentistry - it's like pulling teeth

I read in today's Guardian that dentists are pulling more teeth and performing less expensive measures. About time too.

Let me explain. My brother Asinus's wife Patientia attended a dentist's surgery some time ago as regards a tooth that was giving her, a woman who had all but shrugged off labour pains, hell.

She asked to have the tooth removed, but the dentist replied that a small swelling above the tooth might be an abscess, which she (the dentist) said contraindicated an extraction. So Patientia was sent home with antibiotics, and an appointment made for a fortnight's time.

Obediently, Patientia returned in a fortnight with the swelling reduced but still there. Patientia asked again for an extraction, but was told that the surgery wasn't allowed to do so. She tried to press her case, and the reply was that they weren't allowed to extract without trying to save the tooth.

So the first part of a root canal was done, and the second in another fortnight - upon this second visit, she raised her hand in a pre-arranged signal to warn that she was in distress, and told the dentist and nurse that she was going to be sick. She was informed that the sooner the team started again, the sooner they would be finished. The dentist having started again, Patientia threw up, which meant that the vomitus had to be suctioned out while the dentist and nurse frantically told her to breathe through her nose.

Patientia returned some weeks later on an emergency appointment, as the pain had once more become unbearable and the swelling was back. As Asinus was away checking widgets had the proper thingummies, I accompanied Patientia, having printed out the General Dental Council's Standards for Dental Professionals; it was so well-hidden on the web, finding it was like pulling teeth - sorry...Anyway, para 2 says that dentists should

Recognise and promote patients’ responsibility for making decisions about their bodies, their priorities and their care, making sure you do not take any steps without patients’consent (permission).

Patientia asked me to keep the document in my pocket and only produce it if absolutely necessary.

As Patientia got herself settled in the dentist's chair, I told the lady that my sister-in-law wanted an extraction. The dentist looked at the x-rays then showed one to Patientia (who later told me that this was the first time she'd been shown one of her x-rays). The abscess appeared to reach over three teeth, and the dentist advised another root canal treatment. I reiterated that Patientia wanted an extraction because of the pain she'd been through; after looking up something on the computer, the dentist stated she concurred that extraction would be the best option. The abscess didn't appear to contraindicate extraction any more.

So I held Patientia's hand while the lady tugged, and then...snap! The dentist explained the tooth had snapped (which I'd gathered) and left part of the root inside, because it had been weakened by the root canal treatment.

She went to another room, then returned putting her mobile in her pocket to say that Addenbrooke's hospital would send her an appointment to have the rest of the root pulled out, and in the meantime the abscess would drain through the socket. Because Patientia was in tears at this point, I bit back the question of why she didn't just pull it out the first time. Having learnt that she wasn't going to be charged for the procedure, we left, and I tried to swallow down the anger of seeing the dentist try to persuade Patientia to buy, at the end of the whole debâcle, a false tooth from a range which went up to £1500.

Even though Patientia's registered with her dentist under the NHS, obviously she still has to pay towards her treatment. This is something I agree with - but sometimes one can detect, methinks, a bit of mickey-taking. For example, Patientia suffers from joint-pains which can flare up suddenly. Once this happened the day before she was due to attend the hygienist. She tried to cancel, explaining why, and was advised that the cancellation fee was £50 - the same price as the appointment. In pain, she went.

And then again, Asinus' and Patientia's daughter Perturbata receives orthodontic treatment on the NHS, which could cost anything up to £7000. Given that adolescent girls are conditioned by Hollywood to believe that anything less than physical perfection equates to being pig-ugly, isn't this an easy constituency from which dental professionals can mine taxpayers' money? On the other hand, I have spoken to adults who, because of their financial situation, were genuinely unable to contribute to their dental bill, which was paid for by the state. One who had a condition that sounded remarkably like Patientia's said that he was given an injection of antibiotics, the offending tooth was whipped out, and he left with a prescription for further antibiotics. I'm not suggesting that NHS patients who can't afford "top-up fees" shouldn't get a service, merely remarking on the glorious brevity of the treatment when such fees aren't available.

The NHS Dental Statistics for England 2007/08 states that "53.3 per cent of the population were seen in the 24 month period ending 31 March 2008", this being down from the previous 2 years. This is rather worrying - statistically speaking, almost half of England could be on a roller-coaster to a pain Robert Burns described thus:

Where'er that place be priests ca' hell,
Where a' the tones o' misery yell,
An' ranked plagues their numbers tell,
In dreadfu' raw,
Thou, Toothache, surely bear'st the bell,
Amang them a'!

I'm one of the 46.7% of England's population who haven't been to a dentist in over two years. Faced with the prospect of a pain so bad that I might find my grumpiness mitigated in the dentist's chair, I suspect that should the occasion arise I'll get hold of some antibiotics on the internet, arm a friend of mine who used to be a body-builder with the appropriate implements, and enjoy the post-procedure analgesia.





Related posts:

The Orthodoxy of Orthodonty

Blood, tears and celebrity dentists