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Antibiotic shots in hip after emergency root canal for abscess?

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Lee Ann

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I never heard of dentists giving any other injections besides the ones used to numb a patient's mouth before working on them. Late yesterday afternoon my 15 year old daughter had an emergency root canal due to an abscessed tooth, one of the lower rear molars. After the work was completed, she was instructed to take her jeans and underpants down and bend over the chair, then she was given two penicillin shots, one in each hip. The dental assistant was present in the room and my daughter says she doesn't feel that anything inappropriate took place, but both of us were quite surprised she was given these shots, and particularly that they were given in her hips. When I asked, the assistant told me this was done sometimes with patients having serious infections from their teeth, and because it was late in the day nearly 8PM there would be no way to have a prescription filled for antibiotics before this morning. Was this OK? My daughter told me not to make an issue of it, but I would like to know if this is within the scope of what a dentist is allowed to do.
 
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letsconnect

letsconnect

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Hi Lee Ann,

she was instructed to take her jeans and underpants down and bend over the chair, then she was given two penicillin shots, one in each hip.
Your hunch is correct: this is certainly not within the scope of what a dentist is allowed to do.

Even though your daughter does not want to make an issue of it, I would strongly advise you to report this incident to both the police and your state dental board. It is important that other (perhaps less resilient) people won't have to go through a similar experience.
 
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Lee Ann

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Hi Lee Ann,



Your hunch is correct: this is certainly not within the scope of what a dentist is allowed to do.

Even though your daughter does not want to make an issue of it, I would strongly advise you to report this incident to both the police and your state dental board. It is important that other (perhaps less resilient) people won't have to go through a similar experience.
Is there a website or somewhere that I could find out exactly what they are allowed, and what they are not? I called a couple of other local dental offices this morning and asked them, they said while that's not something they have ever done, giving a shot of penicillin to someone with a proven infection is really no different from writing a prescription for the same dosage and is indeed more expedient if there was no way of filling the prescription until this morning. Then I checked with a pharmacy and they said penicillin injections are always given intramuscularly, and the hip is the site of first choice.

My daughter is adamant about not wanting to go any further with this and says she did not feel violated or have any issues with getting the shots. We are mostly curious as to whether this is commonly done, or an exception because of the situation and time of day. She says the dentist only saw her bottom and she doesn't consider anyone seeing her bare bottom being a problem at all because that's apparently not even considered a private area by most kids in the younger generation. The dental assistant (female) was standing in front of my daughter, the dentist was behind her so the only person who could have seen anything other than her bottom was the assistant and my daughter is OK with that. Her pants were down less than two minutes while the shots were given.

We've been going to this dentist for about 30 years, I was his patient when I was in my teens, all my brothers and sisters went to him and have never had any issues at all. I still want to believe this was done out of courtesy and concern for her health and because there was no way to fill a prescription.

I thank you for your quick and polite response, and would also like to hear the opinions of others on this.
 
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saralou35

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I have never heard of dentists doing this but I am in the UK? I’m surprised that the dentist didn’t ask you to be in the room or tell you he was going to do it first? I would def write a letter to the dentist asking if this is normal procedure and maybe mentioning that you should have been consulted first as your daughter is a minor?
 
Enarete

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Your question / insecurity has several parts in it. I'm not a dentist and not a health care professional, but this is my opinion:

1. Giving a patient a shot anywhere else than in a mouth is weird and would make me insecure too. Like for you, I would be interested in finding out, what a dentist is allowed to do legally or not. I am also wondering which adult would accept that without any further questions and why there should be a difference for a teen.

2. Antibiotics. Antibiotics is a medication. Assuming your daughter would get it via description, it would mean for her to pick it up in a pharmacy, having information about it, knowing about what it is for, risks,counterindication etc. and she would take it and you would have control over this as a parent. Getting it injected directly without properly knowing why (it sounds like you have found out afterwards) is a very different story for me.

3. I am wondering, who gave consent for your daughter to get any medication in injected form. She? Was she asked? And does it count legally? Did she get an explanation why or was she just asked? And as saralou35 mentioned, shouldn't you get informed about hat there are complications that require this? Getting options?

4. Your daughter being ok with this. Obviously your daughter is not traumatized and seems to trust doctors and it's ok for her. She might be used to getting shots and exams at that age and not finding it unusual. And obviously she wouldn't like for this issue to get any more attention and I could imagine that what she really would like to avoid is to explain this to anyone else, like the police or any health care control institution, which I can understand. However the subjective perception of your daughter has nothing to do with if legality or if boarders were 'objectively' crossed. It is possible to feel violated in a completely legal situation that was appropriate and it's possible not to feel any disturbed in a situation that wasn't entirely appropriate.

Sorry for the long post and this is only my view of things, but something feels not right in this story for me. Maybe it's not about legality but about consent or anything else but I feel like something wasn't right.

I really hope a dentist will reply soon because I am very curious about a dentist's opinion to this..
 
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letsconnect

letsconnect

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Intramuscular administration of antibiotics would certainly be outside the scope of practice of dentistry in the UK (see attachment). Maybe you could contact your state dental board (google for Dental Board and the name of your state) and see what they make of this?

And why would he want to inject twice, once on each side of the hips? :hmm:

I'm really pleased that you've raised this issue, because it does raise questions and it's likely that other people will benefit from this.

View attachment Scope_of_Practice_UK_2013.pdf
 
krlovesherkids777

krlovesherkids777

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Lee Ann,

I don't even know what to say about this .. but want to support you and encourage you to consider what all of the others have said and really at least look into this and what happened.. take it step by step as you feel you are led. There is a reason you asked and maybe you felt something a little questionable.. but then this is someone you trust and that confuses it a bit I would think. Would you think anything different if it was a brand new dentist she had never seen before?

I hope she is feeling ok after the root canal and healing up good.

I second Enaretes thought on I wonder what any dentist on this forum would say about this .
 
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Lee Ann

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Intramuscular administration of antibiotics would certainly be outside the scope of practice of dentistry in the UK (see attachment). Maybe you could contact your state dental board (google for Dental Board and the name of your state) and see what they make of this?

And why would he want to inject twice, once on each side of the hips? :hmm:

I'm really pleased that you've raised this issue, because it does raise questions and it's likely that other people will benefit from this.

View attachment 2658
This morning I was able to speak to the dental assistant for quite some time and discuss this with her. I was not present yesterday evening when my daughter was treated as I was at work, my older daughter who is 18 took the 15 year old in because she had such a severe toothache and I gave her instructions to do that. However, both girls tell me that the dentist explained to her as he was finishing up the root canal a little before 8PM on an emergency basis (they usually close at 5:30) that he would be giving her some penicillin shots to get her started right away on antibiotics due to the pharmacy being closed at that time. The dental assistant explained that the shots needed to be given in her hip and asked if she was OK with that. My daughter said she was, but that her older sister was in the waiting room, so the assistant went out to the waiting room and spoke to my older daughter informing her that her sister would need the shots and she told them to go ahead and do whatever was necessary for her. The assistant asked my 15 year old if she wanted her sister to be present in the treatment room when the shots were given, and she said no, that it would be OK if the assistant was there, so that's what took place.

This afternoon, I called the dental office back and asked the assistant further questions after reading some of the responses on this forum to my inquiry. I specifically asked her how often the doctor gives that sort of shots to patients, and she told me that in the 10 years she's been working for him, usually 4 or 5 times a year they get a patient on an emergency basis with a serious infection such as my daughter that needs immediate antibiotic administration. Waiting until morning could result in the infection worsening further overnight.

She assured me that nothing inappropriate took place and that those shots needed to be given in the hip for maximum effect and the least amount of pain afterward. The reason one shot was put in each hip was because of the massive dosage of penicillin required to start treatment. If it had been all put into one shot in one hip, it would be too uncomfortable afterward so they divide it into two injections, one on each side.

I believe that my daughter is mature enough at 15 to recognize if something inappropriate had taken place, which was not really the concern for either of us. My older daughter says the same thing, she was asked first and both girls gave permission for the shots. We were surprised that a dentist could give shots in the hip, which was why I made the inquiry. Apparently it's OK although it's not done every day.

My daughter is feeling much better today, the only pain in her mouth is from the shots they gave her to numb the area before doing the root canal, and her fever is gone after taking appropriate medication for that. We also got a prescription filled for oral antibiotics which she started taking this afternoon after school.
 
Enarete

Enarete

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Thanks for the detailed explanation, I now can better understand why you are not concerned. They explained what needs to be done to both girls and asked if it was ok several times. They also made sure she was comfortable and offered her sister to be in the room. So far, consent, explanation, making sure she was comfortable, all was given in that situation. They also explained to you that it was an emergency and they do not do it too often but the situation required that. Other dental practices told you that injecting antibiotics is not any different than getting a prescription and that hip is the area of choice when it coms to that shots.

I am still dying to know what our dentists think about this and would love to know if any of them ever administered antibiotics in this way to a patient (and omg, if they did, then 'fear of intramuscular shots of antibiotic' should get added to the common fears section here on the forum, this would absolutely be my nightmare :o).
In my country if this happened, I believe the dentist would have to send the patient to an ER to get the shots from a doctor or a nurse but this might be different in other countries.
 
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Lee Ann

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Thanks for the detailed explanation, I now can better understand why you are not concerned. They explained what needs to be done to both girls and asked if it was ok several times. They also made sure she was comfortable and offered her sister to be in the room. So far, consent, explanation, making sure she was comfortable, all was given in that situation. They also explained to you that it was an emergency and they do not do it too often but the situation required that. Other dental practices told you that injecting antibiotics is not any different than getting a prescription and that hip is the area of choice when it coms to that shots.

I am still dying to know what our dentists think about this and would love to know if any of them ever administered antibiotics in this way to a patient (and omg, if they did, then 'fear of intramuscular shots of antibiotic' should get added to the common fears section here on the forum, this would absolutely be my nightmare :o).
In my country if this happened, I believe the dentist would have to send the patient to an ER to get the shots from a doctor or a nurse but this might be different in other countries.
I'm going to make a couple more phone calls on Monday, since dentists normally don't work on the weekends here. Like you, I would love to hear the opinion of a dentist on this forum.

I can tell you that both my daughter and myself feel a lot better realizing that the decision to give immediate antibiotic injections worked out well for her in this situation. She started to feel better overnight, and if she hadn't been able to get the first dose of prescription antibiotics until after school yesterday there's no telling how much worse the infection might have got in the meantime. My discussion with the dental assistant who was present and spoke with both of my daughters was very reassuring that this was OK and the best thing to do at the time. I see nothing inappropriate as far as giving the shots in her hips or having to lower her jeans and underpants to get the shots since that has been clarified as the location of first choice for giving antibiotic injections. We just didn't know that the dentist ever gave injections anywhere other than inside the mouth.
 
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The scenario you've described seems so outlandish and unthinkable in a UK context that I'm having a hard time getting my head around it.

I'll drop comfortdentist (Ray Kimsey) a PM - he's the only dentist from the U.S. who's frequently on this forum, maybe he'll be able to shed some light on the matter!
 
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comfortdentist

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Okay I got the question so hear is the answer and it isn't simple but it will be complete so you might want to save it somewhere.

There are several questions here as we compare the practice of dentistry here in the states to England or other countries. I will address the USA practice.
The license of a dentist is under a state. The state determines what a dentist may do in that state however there is a great deal of similarity among all the states.
I practice in Florida which has a slightly more liberal dental practice act that some states.
I am allowed to do whatever I need to do to practice dentistry. I also have an ad-on to my license which allows me to sedate patients by whatever means I deem appropriate. Personally I have performed oral, nasal, IV, inhalation, and IM sedation over the years. During my residency the other dental resident would use rectally administrated sedative suppository. This is legal. I'm not doing it nor does anyone I know but he did it years ago. Does it make sense today? No Way! I haven't heard of anyone in many years.
Secondly have I ever given IM antibiotics? Yes but again that was for a protocol for special type of a patient many years ago. So I am allowed to perform that procedure but there is no need.
Next nudity of any form: While patients have exposed themselves to me it has been been on my request. Since I do perform IV sedation it is within my practice of dentistry to listen to heart/ lung sounds if I think I need to. It is also within my practice to place my hand where I need to to place EKG electrodes if I think I need an EKG on a patient. I have needed them but rarely.
As to procedures where does training stop?? Well it depends I have fixed broken noses and sutures faces and ears. Today I will still suture but select my cases mainly for liability reasons(USA).
Arms?- I place IVs and also will draw blood as I need. I have been trained to obtain bone graft from near the knee but I don't.
I do sinus repairs if there is a tear during an extraction and also intentionally open a sinus and graft bone into the sinus. This is done almost exclusively by dentists even though their are ENTs who are sinus specialists.

Now let's talk about the dentist and the 15 year old girl. While legal to do it sounds most creepy and inappropriate to me in general. Today if my teenage patient had such a bad infection that he/she /them needed IM antibiotics I would call the pediatrician where this is a regular procedure. I know of no dentist who does this in there office. I do know of patients who have been molested by their dentist before.
Did this patient have a fever?, large swelling? these might justify IM antibiotics but today generally if it is a bad infection which can occur even if all treatment is rendered well patients will receive IV antibiotics.

So legal yes but appropriate most likely no.
 
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Lee Ann

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Okay I got the question so hear is the answer and it isn't simple but it will be complete so you might want to save it somewhere.

There are several questions here as we compare the practice of dentistry here in the states to England or other countries. I will address the USA practice.
The license of a dentist is under a state. The state determines what a dentist may do in that state however there is a great deal of similarity among all the states.
I practice in Florida which has a slightly more liberal dental practice act that some states.
I am allowed to do whatever I need to do to practice dentistry. I also have an ad-on to my license which allows me to sedate patients by whatever means I deem appropriate. Personally I have performed oral, nasal, IV, inhalation, and IM sedation over the years. During my residency the other dental resident would use rectally administrated sedative suppository. This is legal. I'm not doing it nor does anyone I know but he did it years ago. Does it make sense today? No Way! I haven't heard of anyone in many years.
Secondly have I ever given IM antibiotics? Yes but again that was for a protocol for special type of a patient many years ago. So I am allowed to perform that procedure but there is no need.
Next nudity of any form: While patients have exposed themselves to me it has been been on my request. Since I do perform IV sedation it is within my practice of dentistry to listen to heart/ lung sounds if I think I need to. It is also within my practice to place my hand where I need to to place EKG electrodes if I think I need an EKG on a patient. I have needed them but rarely.
As to procedures where does training stop?? Well it depends I have fixed broken noses and sutures faces and ears. Today I will still suture but select my cases mainly for liability reasons(USA).
Arms?- I place IVs and also will draw blood as I need. I have been trained to obtain bone graft from near the knee but I don't.
I do sinus repairs if there is a tear during an extraction and also intentionally open a sinus and graft bone into the sinus. This is done almost exclusively by dentists even though their are ENTs who are sinus specialists.

Now let's talk about the dentist and the 15 year old girl. While legal to do it sounds most creepy and inappropriate to me in general. Today if my teenage patient had such a bad infection that he/she /them needed IM antibiotics I would call the pediatrician where this is a regular procedure. I know of no dentist who does this in there office. I do know of patients who have been molested by their dentist before.
Did this patient have a fever?, large swelling? these might justify IM antibiotics but today generally if it is a bad infection which can occur even if all treatment is rendered well patients will receive IV antibiotics.

So legal yes but appropriate most likely no.
Thank you so much Dr. Kimsey, for the lengthy and informative reply. I'm rather surprised you would think what took place with my daughter being given antibiotic shots in the hips might be questionable, based upon the things you described earlier.

My daughter had felt a weird pressure in her lower jaw for a few days which rapidly progressed to a toothache, and when she came home from school the other day my older daughter (18) called me and sent a picture of her sister's face, there was clearly swelling there and at first I thought she might have the mumps. But the 15 year old said she was sure it was a tooth because she couldn't stand to touch her face right above the jaw line, so I told my older daughter to take her temperature and then made an emergency call to the dentist upon learning that she had a temperature of 102. It was about 8 PM when they finished up with her, no way to call a pediatrician to do any injections at that time of day as all the offices close at 5 or so.

If a dentist asked me to open or remove my shirt so they could listen to my heart and lungs or attach EKG electrodes, they would be in for a free show, and I would be quite upset. Normally when I go to the dentist I want to be able to relax so I wear things that are really comfortable, like a turtleneck shirt and pajama bottoms, or a sweat outfit. I never wear a bra because I have never needed one, so if my shirt had to be readjusted or removed, it would be a problem since I wouldn't have known ahead of time that was going to take place. I would comply with the request but I wouldn't be happy about it. I'm sure they have seen better bodies than mine. :o

My mother who is 85 came over after church this morning and I told her about what had taken place, and let her read all the replies to this including yours. She says I have nothing to be concerned about in the matter of the shots my daughter was given and to stop making a fuss. Come to find out, we used to attend a dentist who used the rectal suppositories for sedation when we lived in Florida while I was growing up, at least until I was 12. I totally don't remember it but mom says I was horrible at the dentists and every time I went to get my teeth cleaned or get a filling, they used those suppositories on me to calm me down so the hygienist could clean my teeth or he could work on me. She says that the hygienist would put them in if it was for teeth cleaning, and the dentist would do it if he was going to be working on the patient.

She says they used them on her and my brothers and sisters as well so she presumes it was a standard procedure in that dental office back in the 1960's and 70's to sedate patients who needed it. I'm currently 51, so you can see the time frame when I would have been going to the dentist in Florida. Now as an adult today, if you said that it was necessary to use suppositories to sedate me, I would probably be OK with it if that was the best and fastest acting method available, but I would find that a lot more creepy than being given an antibiotic shot or two in the hip. If the suppositories were necessary for my child, I would certainly want to be in the room while they were administered. My mom also says that they used to give antibiotic shots in the hip down in Florida because she had them at least a couple of times and my older sister did as well.

I have a couple more people to talk to tomorrow, but if it's permissible for dentists to insert rectal suppositories or have a female patient open or remove her shirt so they can listen to her heart and lungs or attach EKG electrodes, then I sincerely believe that the dentist is working at the same professional level of being appropriate with the exposure of the patient's body that a medical doctor or a nurse would be, so there's nothing wrong with the shots in the hip if it's discussed with the patient as it was with my daughter. Note that my 18 year old who was present at the dentist's office did not hesitate to give her permission for the 15 year old to be given those shots nor did she think it was necessary to contact me to discuss it. I trust her judgment.

The entire situation boils down to we simply never knew the extent of what dentists are allowed to do while providing care and treatment to their patients. I should have called my mother first before asking online because she already knew the answers.
 
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letsconnect

letsconnect

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Hi Lee Ann, it sounds as if you are very happy with your family dentist, but this is how I interpret Dr. Kimsey's reply:

a) It may be legal in some U.S. states for a dentist to give an intramuscular injection.

However,

b) it is hopelessly outdated and pretty much unheard of nowadays

and

c) it is just plain creepy.

Not being a doctor, I'm also wondering how accurate this explanation for the two injections is:

The reason one shot was put in each hip was because of the massive dosage of penicillin required to start treatment. If it had been all put into one shot in one hip, it would be too uncomfortable afterward so they divide it into two injections, one on each side.
 
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comfortdentist

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"told my older daughter to take her temperature and then made an emergency call to the dentist upon learning that she had a temperature of 102. It was about 8 PM when they finished up with her, no way to call a pediatrician to do any injections at that time of day as all the offices close at 5 or so. "

Okay I hadn't read that part so this is atypical conditions that justifies an IM injection and the buttocks is the appropriate place for that.

By the way when I listen to heart/lungs sounds or place electrodes the patient keeps their shirt on continuously. Now understand that I am not the average dentist. I did a hospital residency including rotation in internal medicine and anesthesia and acted like a resident in those departments during that time. The case that I acted as an anesthesiologist the most for were for gynecological surgeries. I also had to do all my preoperative evaluations which obviously include listening to heart and lungs. I cancelled two planned surgeries because one had a lung problem (about 21 y.o. woman) and the other was a 15 y.o. girl. Believe me I saw plenty of bodies naked of all types during my residency and if you think that I would be getting a free show you have no idea what's in my head during an exam. I'm focused on if I sedate you will you live?

The problem is that people are fixed on their narrow view of what someone with a title does. Different doctors learn different techniques and procedures. What is a important is what a doctor knows what to do and why are they doing it. This may be particularly true when dealing with the popularity of injectable fillers and botox. All and I mean all types of doctors are doing this. SO I ask you who knows the most about these procedures?
Everyone agrees with plastic surgeons and dermatologists and I agree too. Who else knows this area well then add on ENT surgeons and OMS. The next group is dentists who at least in the USA were taught more head and neck anatomy than any physicians during medical school. In addition dentists are constantly performing very detailed work under adverse conditions and regularly alter aesthetics.

I hope this makes sense. The bottom line as a minimum is that whatever doctor you see the doctor should be able to explain why he is going to perform any procedure.
 
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Lee Ann

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I totally agree that the patient needs to be comfortable with whatever medical professional they are seeing, and with the procedures that person is performing on them. You wouldn't attend an appointment with a psychologist for a broken foot, and wouldn't go to a physical therapist if you had a broken tooth. Things that you mentioned like cosmetic treatments using injectables totally frighten me, and not something I would ever consider doing, and I have warned all three of my daughters not to go in that direction.

The explanation of what needs to be done, and the approval of the patient (or someone of legal age who has authority to do that) is very important. In my daughter's case I think that was handled appropriately. I'm glad to hear that with all the details you are comfortable with what took place. Reasonable explanation of the need to give those injections at that time was presented to both her and her older sister who attended the appointment with her, and reasonable explanation that the injections needed to go in her hips was also presented. We simply didn't realize that was something a dentist could do in a case where it was medically necessary for fastest healing. I think it's wonderful that they were able to now that I know more about it.

I purposely created legal paperwork giving my 18 year old the authority to seek and authorize any medical or dental treatment for my other two girls just in case because I sometimes work very late or have to be out of town for a day. My sister also has similar paperwork, which she needed to use a few times while my kids were growing up. Now that the older one is 18 she is proving herself to be quite responsible in that regard and I trust her judgment. She knows that she can call either myself or my sister to discuss anything she isn't sure about. She tells me she was very sure about this, and I totally agree with her decision to let her sister have the shots.

This afternoon I'm contacting a few people to see what else I might find out, but I am actually quite pleased now that the dentist and his assistant handled this in an expedient and professional manner which was carried out only with the best interests of my daughter's recovery from the infection as quickly as possible.

I'll report back later this evening or tomorrow with what I am able to learn from the licensing board and my daughter's doctor about this.
 
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brit

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After the work was completed, she was instructed to take her jeans and underpants down and bend over the chair, then she was given two penicillin shots, one in each hip.
For me (note I did not post though) your description of what she was asked to do to receive the injections was particularly creepy. I would have thought her dignity could have been better preserved with use of a sheet or lying down or something.
I think at the end of the day given that he has been your dentist for 30 years and he did your daughter the great service of seeing her immediately and staying late to help her in an emergency, you are right to give the benefit of the doubt, particularly as both your daughters feel it was appropriately handled.

In UK she would likely have just been given oral antibiotics (tablets) on the spot or a prescription for similar as there is always an emergency pharmacy rota here.

The ancient suppository stuff from 'Grandma' sounds unbelievable though...:scared:...as if you needed anything else to put you off dental appointments, you just found something!.
 
letsconnect

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Sorry, I find the thought of pulling one's knickers down at the dentist's deeply disturbing :o . Has anyone else here tried to picture the scene with their own dentist :redface:? Even with a modesty sheet the idea seems outrageous.

So I take it then that there are no emergency pharmacy rotas in the U.S. like there are in the UK and the rest of Europe?
 
Enarete

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Has anyone else here tried to picture the scene with their own dentist :redface:?
No. No no and no. Actually trying to supress this distrubing image which keeps popping up in my head without a warning from the beginning of this thread :o

Just at the moment when I accepted that going to the dentist doesn't have to be a nightmare there is this creepy stuff coming. I seem to start developing a new phobia: of having a dental emergency in U.S :o

This is a very vivid thread and the insights from comfortdentist are very helpful but I must to admit that this was giving me stomachaches for few days.
 
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