65-year old man seeks care from numerous
dentists, without satisfaction and pays no one.
In an interesting UK case, an older
gentleman (Mr. D) went from London dentist to London dentist seeking care for
his “TMJ pain” (temporomandibular joint pain). He was dissatisfied with each
dentist he saw (whether merely consulted or providing treatment). Her moved on
without paying anyone anything, despite running up several significant bills. The
local Dental Association made note of it in their Journal as it had occurred so
frequently! Mr. D was intercepted leaving a dental office and detained by the
Those with “TMJ pain” sometimes find
adequate care hard to find. The resultant frustration and mental stress can
lead some to lose their usual insight and move from dentist to dentist.
Unfortunately, this has resulted in some dentists believing that such pain is
“all in the patient’s head”. While acute pain is useful (moving your hand when
leaning on a hot surface), chronic pain has no such function, it develops a
“life of it’s own” and can result in affective mental disorders such as depression.
In this case it was determined that these factors aside, there was no excuse in
not paying, or at least discussing payment; with the many dentists involved.
These are the factors illustrated in a Dental Expert Witness’ Report that
assisted the court in its determination.
Mr. D. was fined by the court and
ordered to repay all of his outstanding dental bills. A referral to a
postgraduate dental facility was arranged for a reversible and non-invasive
splint as intervention for his pain at the recommendation of the report. While
it is not known if pain management was a success, there is a need for an
independent and impartial opinion in cases where many dentists have been
unsuccessful yet the patient’s involvement is not understood. This benefits
both parties and provides a basis for determinations.
Did the previous dentist give appropriate treatment and an
adequate explanation of the procedure and it’s possible success? Would both sides of the case be illustrated equitably without
a Dental Expert Witness’ report?
Dental abscesses are caused by infection, and often display with a swelling that contains pus, and may be very painful. The pain can be throbbing in nature, and may get worse the longer that the abscess is left untreated.
The pain from a dental abscess can spread to the jaw, ears and neck, as well as making it very uncomfortable to eat or drink. Some people with a dental abscess also experience a high temperature, have difficulty sleeping, problems opening their mouth, swallowing and feel generally unwell. In extreme cases, dental abscesses have been known to partially obstruct the airway, making it difficult for the sufferer to breathe.
If dental abscesses are left untreated, they can cause permanent damage to the bone around the affected area, making it vital to see a dentist as soon as possible if you think that you have one.
Different types of dental abscess
There are two main types of dental abscess that can develop, and both will require intervention by a dentist to treat them successfully.
Periapical abscesses are to be found at the ends of the roots of teeth and are caused by bacteria working their way into the tooth via a hole in the outer layers (enamel and dentine) and infecting the inside of the tooth (the dental pulp), which can cause an abscess to form at the root end. One reason for this could be decay or a cracked or broken tooth, allowing the bacteria inside. Another potential cause could be if a root canal procedure is not carried out to a good standard, leaving bacteria inside the tooth to cause an infection.
Periodontal abscesses are located with the support bone and soft tissue around teeth when there is a breakdown of these structures due to gum or periodontal disease. If the gums become inflamed, this can cause gaps around the teeth that can be difficult to keep clean. If bacteria build up here, a painful abscess in the mouth can be the result.
What to do if you think you have a dental abscess
It’s essential to see your dentist as soon as possible if you think that you have a dental abscess. You may need to get an emergency appointment if your usual dentist does not have an available appointment. Very severe dental abscesses may require treatment at Hospital A+E.
Dental abscesses do not go away on their own, and do require treatment in order to resolve the problem.
How are dental abscesses treated?
When you visit the dentist with an abscess, they will usually use local anaesthetic to numb the area around the abscess. They will often firstly drain away the pus, as this contains the infection. Then the cause of the abscess must be resolved, otherwise the abscess will just return. The specific treatment for this will depend on the type of dental abscess it is.
For a periapical abscess, this usually involves drilling into the infected tooth to make sure all pus and infected tissue is removed. The tooth will then need to be root filled to stop the infection from coming back. Alternatively extraction of the infected tooth may be a reasonable treatment option.
For a periodontal abscess, once the abscess has been drained and the area thoroughly cleaned, this may be the end of the necessary abscess treatment. However, if the gum has been permanently damaged through the inflammation and the abscess returns, it may require surgery to the affected area to treat the underlying condition.
Complications with dental abscesses
On rare occasions, even after treatment has been given, there can be some complications with dental abscesses. In some cases, this could be the result of dental negligence, if your dentist has failed in their duty of care to you when treating your abscess. These potential complications could include:
The development of a dental cyst at the root of the infected tooth, which can get infected. These cysts will require additional treatment, which can include surgery to remove the cyst under local anaesthetic.
Osteomyelitis, which is a rare but significant infection of the bone and can usually be treated with antibiotics, surgery or both.
Ludwig’s Angina, which is a rare but significant infection on the floor of the mouth particularly under the tongue that causes pain and swelling and can usually be treated with antibiotics, airway management and drainage. This can be very serious if not treated quickly.
Maxillary Sinusitis, which is an infection in the hollow spaces or sinuses within the bones of the face including the cheekbones. Whilst not a serious condition, it can cause pain, tenderness around the cheeks and fever. It may resolve itself with no further treatment, but can sometimes require antibiotics.
If you think that your dentist has been negligent in your care, you can contact the Dental Law Partnership for free initial advice to determine whether you may be able to claim for compensation.
Cosmetic dental treatments are essentially any type of procedure or treatment type that improves the appearance of your teeth. They tend to fall into these main types:
Tooth restoration – repairing the appearance of teeth that have been damaged or become worn
Teeth whitening – lightening the shade of your teeth using chemicals
Tooth straightening – also known as orthodontics, adjusting the alignment of teeth, usually with braces
Many cosmetic dental treatments are only available to adults through private treatment, although some tooth restoration procedures e.g. fillings and crowns, are available to NHS patients. The cost of cosmetic dental procedures will vary, depending on what is required and who is carrying it out, but some courses of treatment e.g. veneers, can run into many thousands of pounds. If you’re considering undergoing cosmetic dental procedures, it’s important to understand the risks as well as the benefits, to make sure you can make an informed decision about your treatment plan and will know what to expect.
The most common cosmetic dental treatments
Some of the most popular types of cosmetic dental treatments include:
Tooth-coloured composite fillings
Rather than using an amalgam filling (silver-coloured), your dentist may suggest a ‘white’ or ‘tooth-coloured’ composite filling, especially if the tooth being filled is at the front of the mouth or will be visible when speaking or smiling.
A thin layer of porcelain or resin is placed over the front of worn, discoloured or damaged teeth to restore their appearance. Veneers can also be used to make crooked teeth appear straight or to cover small gaps between teeth.
You can have your teeth professionally whitened by a dentist, using a gel containing bleach. Usually this involves having to wear a mouth tray for a set period of time to allow the chemicals to work.
Teeth are usually straightened over time using a type of braces. There are several different types of braces that work in slightly different ways, and some are more visible than others. They all gradually move teeth by applying pressure to push them into the desired positions. Usually, braces will need to be worn for between a few months and a few years, depending on the treatment type.
The risks of cosmetic dental treatments
Composite fillings are not always as durable as amalgam ones, meaning that they are not necessarily suitable for all types of fillings or circumstances and could need replacing or repairing after a period of time. Your dentist should discuss this with you before you agree to a treatment plan including a composite filling.
Veneers can fail or require replacing if they are fitted poorly or if an appropriate cleaning and oral health routine is not maintained after the procedure. They can last for several years if the procedure is successful, but are likely to need replacing at some point.
Tooth whitening can permanently damage your teeth if the treatment is not carried out correctly. Home whitening kits are especially dangerous, but even professional tooth whitening procedures done by dentists can go wrong if instructions are not followed precisely or the treatment is carried out poorly by a dental professional. Tooth whitening treatments don’t give permanent results; they can last for a couple of years, but the effects of the treatment will wear off eventually. Tooth whitening can also result in increased sensitivity in your teeth and gum irritation, in some cases.
Braces can be uncomfortable to wear and can be difficult to clean and maintain, so they are not for everyone. Some cases of tooth misalignment may be too severe to be treated with braces.
What if cosmetic dental treatment goes wrong?
Sometimes, cosmetic dental procedures can go wrong and your dentist may be at fault if they have not carried out their work to a good standard or have failed in their duty of care to you, the patient. If your dentist did not properly explain the risks of a type of treatment they recommend and it causes you pain, discomfort or means that you require more costly treatment to rectify the problem, you may be able to make a claim for compensation.
A new study published by the Journal of Clinical Periodontology has suggested that young adults who are suffering from sadness, helplessness and other symptoms of depression, are significantly more likely to also suffer at the hands of oral health diseases.
Researchers monitoring the oral and mental health of more than 500 people, from birth until the age of 30, discovered that those who had regular feelings of depression were almost 20% more likely to also have severe gum disease.
How is depression and gum disease linked?
This study not only makes a connection between depressive episodes and the body’s ability to fight off inflammation; which is one of the early signs of gum disease.
There is much known about the association between emotional and mental health and its connection with the immune health and that’s effect on the body’s health. Alas there’s more not known that is known.
it also provides research to suggest that young adults suffering from symptoms of depression could be more likely to neglect their oral health – this is why dentists need to be vigilant.
It is the dentist’s responsibility to screen, share his/her findings, clinically notate and assist in accessing appropriate care. This is Standard of Care. The appearance of disinterest doesn’t remove that responsibility.
“Understanding that mental disorders can influence the health of our mouth is extremely important. It gives us a platform to be able to increase the standard of oral health, it also increases our clinical and ethical responsibilities.
“More effective education, individual treatment plans, better supportive therapy and aftercare, must be provided for those suffering with depression and other mental health disorders.”
We must therefore improve our ability to spot depression, (just as we would do, dental diseases) which often goes undiagnosed.
Did your dentist recognise the early signs of gum disease?
If you’re concerned that issues regarding anxiety, depression or any other mental health-related problems might be affecting your oral health, the first thing you need to do is visit your GP to discuss your options and what support is available. You should also keep a look-out for any early symptoms of gum disease, which can be easily treated. These can include:
There are other causes of bad breath ranging from poor oral hygiene to medical conditions such as some cancers, metabolic disorders or local disorders (ie tonsil/adenoid infection or swelling). Chronic reflux of stomach acids (gastroesophageal reflux disease, or GERD) or snoring can be associated with bad breath too.
Gums appearing puffy or swollen
Your dentist or hygienist should note this immediately and investigate further. It may be superficial or it may be deep and progressed from gingivitis to periodontitis along with the risk of eventual tooth loss.
Gums appearing a dark red colour
The cardinal signs of gum inflammation are – redness, heat, and swelling. The other two sigs of inflammation – pain and dysfunction are usually not present which from a diagnostic standpoint is actually a disadvantage.
Gums bleeding easily, particularly when you are brushing or flossing
Inflammation increases vascularity and the likelihood of bleeding under slight touch or injury. In health -GUMS SHOULD NOT BLEED.
Gums appearing to recede
Gums can recede due to anatomy (either crowding or poorly planned orthodontics) but is also commonly associated with bruxism (tooth grinding) – such damage is referred to as abfraction which often go unobserved or misdiagnosed by dentists and hygienists who simply see them as tooth brush wear from incorrect toothbrushing. Fillings placed without an understanding of cause will repeatedly fall out.
If you have noticed any of the above, it’s important that you also try to schedule a visit to your dentist for a check-up as soon as possible.
“My dentist failed to diagnose gum disease”
If you have already visited your dentist with concerns regarding gum disease and you believe that they have failed to spot any symptoms, or you believe that your dentist may have contributed to ongoing oral health issues through misdiagnosis, poor treatment or negligence, you may be entitled to recompense.
In a recent UK case; Mr. H, 63-year-old man from Kingston-upon-Thames, Surrey, saw his oral health deteriorate after local dentists botched implant treatment. He suffered from excruciating pain for three years and experienced shooting pains when he drank water – he received £36,000 (C$70,000) in compensation.
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