Is this ethical behaviour?

[brit]

I was so shocked by the reported conversation in another thread (see below) that I'd welcome clarification that (if this is what was actually said) that such behaviour would be unethical 1. by virtue of not being in the 25 year olds patient's best interests to have all her teeth extracted just because of dental fear (a few years back someone worked on her when she wasn't numb) and 2. by incorrectly further giving her the impression she'd be unlikely to find anyone else willing to do anything differently? (Private sector/CDS?/nicer NHS dentist lol. )

Finally (to Gordon especially) if she had accepted his referral to an NHS hospital, how likely is it that they would have whipped out all of a 25 year olds teeth under GA even though most could have been saved with treatment under i/v sedation?

QUOTE OP from other thread:
I cant thank you enough for your support messages it really does help. Anyway today i went to my 8 yr old daughters dentist and i thought he would be ok with me hes lovely with her and i was wrong he seemed to be rushing me he looked at the xrays said i would need 5 teeth out and lots of reconstructive work but that he would recommend i be referred to hospital have all of them out and then i will never have to worry about the dentist again! This from someone who is supposed to be good with phobics not bloody likely. I got home in a right state i felt like i had hit a brick wall i really want this so much once im determined to do something thats it and although im terrified i don't see why if my teeth are savable i have to have them all out. Anyway he said they can be saved but i would have to find a dentist who is prepared to take time and patience with me and its unlikely i would! I got home and started looking through the phone book eventually my mum came across a private clinic in the next town who specialize in phobics and iv sedation they have fited me in next wednesday the girl on the phone was so unbelievably nice shes had iv herself she is even sending me the forms to fill in before i go so i dont have to worry about filling them in on the day if im in a bit of a state im so happy to have found somewhere where people understand im 25 if i can save my teeth i bloody will!

 

[hdf2]

brit, I dont know if this will help.............. but from experience, I can only say, at the beginning of my dental journey 4/5 years ago, i was referred to an nhs dentist at the local hospital for iv sedation. i pleaded with her then to remove all my remaining upper teeth, but was told there was no need, i could have fillings etc done under IV sedation and that they could be saved for a few years ( even tho I have gum disease).
As you know, I have a private dentist now, and i have asked the same thing, but been told that some could maybe be saved. ( will find that out thursday)
So, yea, I think the dentist in question is wrong.

 

[Gordon]

Finally (to Gordon especially) if she had accepted his referral to an NHS hospital, how likely is it that they would have whipped out all of a 25 year olds teeth under GA even though most could have been saved with treatment under i/v sedation?

Not a chance in Hades.

If it isn't in the patient's best interest to remove all the upper teeth then it won't happen.

I would hesitate to comment on the dentist on the basis of what the original poster wrote though, it's been my experience that patients are very unreliable with their comments. I'm not suggesting that they're lying, but recollections are very variable in stressful situations like that.

 

[brewer734]

hi
im the patient that wrote this post originally those were his exact words my mum was in the room with me as im too terrified to go in alone and she was absolutely stunned by what he said

emma

 

[brit]

Not a chance in Hades.

If it isn't in the patient's best interest to remove all the upper teeth then it won't happen.

I would hesitate to comment on the dentist on the basis of what the original poster wrote though, it's been my experience that patients are very unreliable with their comments. I'm not suggesting that they're lying, but recollections are very variable in stressful situations like that.

That's what I hoped you'd say..an NHS oral surgeon would have some ethics (and fear being sued for inappropriate treatment)....and hopefully would get her sedation for restorative treatment?....

 

[letsconnect]

I've been reading the thread in the support section and now the journal entry... I was under the impression (after reading the support thread) that the dentist recommended taking out 5 teeth, but that these might be saveable (by a private dentist) . But after reading the journal, it sounds as if he said to remove *all* teeth? I can't imagine an oral surgeon would agree to remove teeth "prophylactically", for want of a better word. Maybe the dentist didn't communicate very well and phrased it in a way that could be easily misinterpreted? Just wondering out loud here because it would be quite baffling if he really suggested taking them all out .

Unless his comment was designed to make sure you seek out a private dentist so that the oral surgeon wouldn't send you back to him after removing the teeth that can't be saved? It seems unlikely that a dentist would use that sort of manipulation, but not impossible...

I'd be inclined to write a letter to the practice, outlining the conversation as you and your mum understood it, saying that you were really upset by what was said, and asking if they can comment and clarify. That might shed some light on the matter, and also hopefully ensure that something similar won't happen to other patients in the future .

 

[brewer734]

hi again ok let me try and clarify what happened sorry it sounds confusing i was very upset but ive checked with my mum who was with me to make sure i heard him right and she says def yes so when he first examined me he said i would need 6 to 8 teeth out and a lot of restorative dentistry he had to look with me standing up i don't like dentists chairs. Then i went back a week later with the xray he had sent me for he said i need 5 unsavable teeth out and although the rest are savable i would need lots of restorative dentistry but as im so terrified and its unlikely i will find a dentist who has the time and patience to treat me with all the treatment i would need he would recommend i let him refer me to the hospital then i can have them all out and i wont have to worry about the dentists ever again. I still have his phone number cause he said when ive decided what to do just give him a ring if i decide i want to be referred
im trying a new highly recommended private dentists which offers iv next week see what he can do first .At first i thought he was trying to help as even im not sure if i can manage so much treatment ! sorry if theres confusion with this even i didnt think they removed them all anymore.

emma

 

[Gordon]

OK, I don't like speculating on what other people are thinking, but this may be a possible scenario...

You have experienced rather a lot of decay in a relatively short time span, are you prepared to heavily modify your diet and tooth brushing routine in order to preserve your teeth in the future?

If you get a lot of treatment such as crowns, partial dentures and fillings, that is going to be much more difficult to maintain than your natural teeth, which (forgive me!) you haven't maintained at all so far...

If it is necessary to resort to a general anaesthetic for you to have your treatment carried out, then probably several more teeth will have to be extracted than the original 5 or 6. Root canals and crowns can't be done under GA.

If you gave the dentist the impression (and here I'm speculating a lot, sorry) that you weren't likely to change your habits, then it would probably be more ethical to go straight to a clearance under general anaesthetic than having a GA every 12 months or so as the teeth continue to deteriorate. GA is a slightly risky procedure and it would actually be unethical to put you through 3 or 4 of them instead of just 1.

I'm sorry if that sounds uncaring, I genuinely don't mean it to be, I'm just trying to rationalise why the dentist has told you what they did.

 

[letsconnect]

It probably wasn't mentioned in this thread, but in the support section, it sounds as if the problems were mostly due to an eating disorder in the past which is now under control . Not sure if the dentist knew about this though.

 

[brewer734]

hi again ok i should explain my teeth went really bad after two serious episodes of anorexia last year i had just weeks to live i never eat anything sugary or bad for me in any way i religiously read packets and things its not the reason my teeth are bad its because i got so thin my body was losing everything and it was then my teeth just started to collapse and get bad and weak i brush my teeth after everything i eat cause i also have body dismorphia and check my apperance hundreds of times a day this includes redoing make up and brushing my teeth although im not sure i should brush my teeth this often i cant help it im still struggling to win this fight and all this with my teeth isn't helping at all

emma

 

[brewer734]

i should also say the dentist was fully aware of what i have been through and what caused my teeth to go so downhill so fast

emma

 

[brit]

If you gave the dentist the impression (and here I'm speculating a lot, sorry) that you weren't likely to change your habits, then it would probably be more ethical to go straight to a clearance under general anaesthetic than having a GA every 12 months or so as the teeth continue to deteriorate. GA is a slightly risky procedure and it would actually be unethical to put you through 3 or 4 of them instead of just 1.

Good point but how can she give 'informed consent' if he doesn't explain his logic because surely it is her right to try to save her teeth instead with i/v at least once, and turn all those other issues around potentially working against her.
Sounds to me more like, he doesn't want to treat her himself on NHS so is fobbing her off to 'easiest option for him', potentially worst option for her..it's amazing he would do this with a witness in the room (her mother) and what he says isn't true anyway because you still have to visit the dentist when you have dentures.

I'm sure you're right and an NHS oral surgeon would have been the backstop and would have explored less drastic options and probably had the power to refer but if the dentist had referred her to a cheapie NHS i/v sedation clinic (as happens in some areas) where we have had reports of only extractions being done, the NHS could have had one hell of a lawsuit on its hands down the line...not to mention more bad publicity.
I'd rather my tax money went on providing i/v sedation for restorative treatment for dental phobics and not on lawyers bills .

Reading GDC Conduct Reports I've come to the conclusion they are actually very hard on dentists and uphold them to the highest standards of informed consent and appropriate treatment/provision of written treatment plans - but the GDC cannot take action unless patients actually register complaints...and everyone (me included) is too intimidated by the dental environment to do that very often.