I don't understand
Why do people take so long to seek treatment??? I mean if part of your tooth fell off obviously something is wrong. If part of your finger falls off would you wait till a year later to go to the doctor???
Saw this woman from out of town yesterday. She was 16 weeks pregnant and was complaining about severe dull throbbing ache. She couldn't sleep and had driven 4 hours to get to me to have her tooth pull out. Problem is, she was pregnant, and I don't want to take any radiograph on pregnant woman, without radiograph I don't want to extract any tooth. What if I take a radiograph and something goes wrong with the baby, or what if I try to take the tooth out without a radiograph and shit happens? I live in a litigious society. Who knows what she gonna do, she can come back and become my worst nightmare and sue my pants off.
So I offered to take the nerve out and place medication in the tooth but because her tooth was so broken down (it doesn't even look like a tooth anymore, just a stump buried with crap) the temporary filling might come off easily and she'll have to come back asap if that happens. She just went off at me and said "I'd to drive 4 hours to get here I don't want to come back again! Can't you just take the tooth out?!" Excuse me woman, that tooth started decay more than a year ago that's why the filling fell out, and if you didn't wait so bloody long to seek treatment you wouldn't have to suffer like this! She then went on to complain about the pregnancy causing her teeth and gum to turn bad. Talk about ignorance. Contrary to popular belief, pregnancy DOES NOT cause deterioration of your oral health, bad oral hygiene does. Hormonal changes reduce reisistance to oral bacteria and if you've shit in your mouth your body can't fight back properly.
The gum around her lower front teeth had receded because there was so much gunk around them. I advised her to get her teeth cleaned as toothbrush'll not remove the calculus but she just screamed "there's nothing you can do for me!" and stormed off. She then went to the waiting room and kicked up a big fuss and complained to other patients about how far she'd driven here and I couldn't do anything.
Too bad for her I can't be bothered. My friend took a radiograph for a pregnant woman prior to extraction. He didn't know she was pregnant as she didn't mention that in the medical histroy form. The baby was borned blind and she sued my friend. She didn't win but it was a pain in the arse, and very demoralising. My friend was traumatised. Here we are trying our best to help get ppl out of pain and yet these ungrateful arseholes do whatever they can to sue us. I am just going to cover my ass and not do anything that might come back to haunt me. I don't care if they'll be in pain, I will NOT extract any tooth without radiograph, and definitely not taking any radiograph on pregnant woman, even though the doctors say it's safe during the first and third trimester, I will not take the risk. It's their own fault anyway, serve them right, anyone who waited so long before seeking dental treatment deserve to be in pain.
Oh and one more thing, I gave her a prescription for antibiotics just in case her face start to swell up from the infection, see I am so nice, but she declined because she's pregnant. "I don't want to take any antibiotics, I am pregnant" (but it's perfectly OK to smoke 20 cigarettes a day). IDIOT.
Enough about stupid patient. Makes my blood boils. Sometimes I feel like slapping them. Hmph.
The hydroponic system Matt set up a few weeks ago using some old pipes is working wonders. :D Look at those vegies, they look like they're on steroid. :D I've butter lettuce, 大白菜, 小白菜, russian black tomatoes, big red tomatoes, snow peas and mizuna.
Saw this woman from out of town yesterday. She was 16 weeks pregnant and was complaining about severe dull throbbing ache. She couldn't sleep and had driven 4 hours to get to me to have her tooth pull out. Problem is, she was pregnant, and I don't want to take any radiograph on pregnant woman, without radiograph I don't want to extract any tooth. What if I take a radiograph and something goes wrong with the baby, or what if I try to take the tooth out without a radiograph and shit happens? I live in a litigious society. Who knows what she gonna do, she can come back and become my worst nightmare and sue my pants off.
So I offered to take the nerve out and place medication in the tooth but because her tooth was so broken down (it doesn't even look like a tooth anymore, just a stump buried with crap) the temporary filling might come off easily and she'll have to come back asap if that happens. She just went off at me and said "I'd to drive 4 hours to get here I don't want to come back again! Can't you just take the tooth out?!" Excuse me woman, that tooth started decay more than a year ago that's why the filling fell out, and if you didn't wait so bloody long to seek treatment you wouldn't have to suffer like this! She then went on to complain about the pregnancy causing her teeth and gum to turn bad. Talk about ignorance. Contrary to popular belief, pregnancy DOES NOT cause deterioration of your oral health, bad oral hygiene does. Hormonal changes reduce reisistance to oral bacteria and if you've shit in your mouth your body can't fight back properly.
The gum around her lower front teeth had receded because there was so much gunk around them. I advised her to get her teeth cleaned as toothbrush'll not remove the calculus but she just screamed "there's nothing you can do for me!" and stormed off. She then went to the waiting room and kicked up a big fuss and complained to other patients about how far she'd driven here and I couldn't do anything.
Too bad for her I can't be bothered. My friend took a radiograph for a pregnant woman prior to extraction. He didn't know she was pregnant as she didn't mention that in the medical histroy form. The baby was borned blind and she sued my friend. She didn't win but it was a pain in the arse, and very demoralising. My friend was traumatised. Here we are trying our best to help get ppl out of pain and yet these ungrateful arseholes do whatever they can to sue us. I am just going to cover my ass and not do anything that might come back to haunt me. I don't care if they'll be in pain, I will NOT extract any tooth without radiograph, and definitely not taking any radiograph on pregnant woman, even though the doctors say it's safe during the first and third trimester, I will not take the risk. It's their own fault anyway, serve them right, anyone who waited so long before seeking dental treatment deserve to be in pain.
Oh and one more thing, I gave her a prescription for antibiotics just in case her face start to swell up from the infection, see I am so nice, but she declined because she's pregnant. "I don't want to take any antibiotics, I am pregnant" (but it's perfectly OK to smoke 20 cigarettes a day). IDIOT.
Enough about stupid patient. Makes my blood boils. Sometimes I feel like slapping them. Hmph.
The hydroponic system Matt set up a few weeks ago using some old pipes is working wonders. :D Look at those vegies, they look like they're on steroid. :D I've butter lettuce, 大白菜, 小白菜, russian black tomatoes, big red tomatoes, snow peas and mizuna.
Butter lettuce will be ready tomorrow. :D 
大白菜
The hydroponic system at the side of the house
posted by Dentist Down Under at 7:19 pm
13 Comments:
Haha! I so know what you mean! Tks for dropping by my blog.
Hi DDU!
I had a similar experience with dentists a couple of years back. My wife was about 2 months pregnant when she developed a toothache. We didn't wait long (as I'm a doctor). I told her to go to the dentist if the pain persisted for more than 2 days. And she did.
She went to 2 dentists. Guess what. Both dentists told her they would not touch her because she was pregnant. Her problem was that she had decay below her filling or something like that. And they said that they were scared if the pain of treatment would cause her to have a miscarriage. So they told her to wait till she passes the first trimester or something like that. I did not accompany her that time but I felt the situation was cruel.
So in order to save your asses, dentists want pregnant patients to suffer in pain for 3 months at least? God!
Anyway I called up one of my junior college classmates who is a dentist and she said that usually dentists in Singapore do that because they are scared of litigation. But her father was also a dentist and maybe he might be able to help.
So anyway my classmates dad was nice and he took out the filling, cleaned and put a temp filling. And my wife's pain abated although she had to be careful when chewing with that molar.
I feel that dentists shouldn't be like that. As a medical professional I am fully aware about the risks of litigation especially so with pregnant women. However shouldn't dentists have a form or something that patients can sign to indemnify the dentist? Let the patients decide and take responsibility too!
I mean as a doctor I know of NO situation where I can say, sorry you continue to be in pain even if you have that broken finger because you are 2 months pregnant! We won't touch you!
What the hell?
Anyway that's how it is in Singapore. Looks like it's the same in Oz perhaps worse!
Hey dr oz bloke
If you read my blog carefully I did offer that stupid woman emergency pulp extirpation, just to dress the tooth temporarily, that would relief the pain and doesn't require any radiograph but she declined, reason being she doesn't want to come back after the baby is due. She only wanted the tooth out once and for all, nothing else, and she made that very clear. It's not like I didn't offer her any help at all.
Also if she didn't wait so long to seek treatment perhaps I wouldn't whinge, but that filling fell out more than a year ago, she started getting occassional sharp pain ages ago (she doesn't even remember how long ago!) which progressed into continuos severe dull ache before she came in, well serve her right. If she had a broken finger and she waited until it turned gangrenous before she sees the doc and had to have it amputated does she blame herself or the doctor???
I dunno why the dentists in Singapore refused treatment, I've never heard of pain causing miscarriage. I didn't do my degree in Singapore and can't speak for them, but I always offer emergency pulp extirpation as a temporary solution, if patient refuse there's nothing I can do.
I only said I wouldn't take radiograph I never say I wouldn't treat pregnant women. Pulp extirpation doesn't require radiograph and I've done that many times on pregnant women without any problem. But she only wanted extraction, nothing else, I can't force her, and she can't force me. Simple.
Oh and my DA did tell her that if she signs an indemnity form stating that if something goes wrong with her pregnancy she won't hold us responsible I'll take the tooth out. She said no. Does that ring the alarm??? If you still go ahead and take a radiograph you are either retarded or have too much money.
Sorry about that DDU! I guess it is BETTER in OZ! (I just said that so that it wouldn't be ME saying Oz is better than SG)
Anyway I agree with what you did. Yeah if the woman didn't want to sign the form....what the hell right?
Anyway I'm very thankful to my classmate's father.
dr oz bloke:
I didn't say Oz is better than Sg either ;p each has its own goods and bads but given a choice I wouldn't want to live in Singapore at all ;p
DDU: just read this post of yours.
she's pregnant, so i guess we could blame the hormones :P
i find hormones a good excuse.
but anyway, i do agree that we have to keep our butts covered. if one patient starts to sue us, we will be damned for the rest of our career lives.
and are we going to let all the years of hard work, sweat and tears to just go down the drain like that?
afraid not.
wow, it's amazing how you could do a pulpectomy on a broken down tooth like that.
*sorry, correction:
it's amazing if you could do a pulpectomy like that.
perhaps it's a blessing you didn't.
:P
Sabriba:
It's actually easier to do pulpectomy on very broken down tooth as there's no tooth structure to block your view haha not to mention easier access :D
Oooops it's sabrina, typo ;p
little delay in my comment (i had a terrible time with your page last couple of days, some file that was really big that my tortoise-slow internet connection had a problm with) but here goes anyway.
personally, i would have radiographed the tooth despite her being pregnant. the amount of radiation from a single periapical film is about a thousand times less than the "radiation" one gets from the sun, gamma rays, and other crap that's floating in the air every single day. if you use a double lead apron, high-speed (or even digital, nowadays) film, and a collumated beam, the exposure to the fetus is negligible, if not nil. plus, you tell the patient there is a risk-benefit ratio to the whole procedure - are you worried about a minimal "radiation exposure" with the almost zero possibility of causing harm to the baby, or would you rather walk around with an infection and an even higher risk of pre-term labor and other problems? you decide. most people are actually okay with it, and even the obstetricians i talk to (because i do clear it with them first) agree. now, in no way am i advocating taking an FMS or doing elective dentistry on a pregnant patient, but one film for paliative purposes definitely would not hold up in a court.
if the extraction looked complicated, send it to an oral surgeon who could get it out quickly and easily. if it was a non-RCT treated root tip, break out the plain carbocaine (mepivicaine, or whatever DDU's call it!) and just elevate it out and send her on her way with a script for amoxicillin (the ONLY thing safe to give a preggie lady! oh, i forgot erythromycin is safe, too, but that stuff's nasty)
i once worked with a pregnant women who smoked every day and drank a box of wine a week but didn't take her ADD medicine because "it's bad for the baby". give me a break. as a result, she was distracted and even more a of a bitch than when she was on the meds. then she was all freaked out about the amnio results because she was almost 40 and was worried that the baby would have a "genetic disease". umm, hel-lo! great, so your baby doesn't have down's syndrome, but will be born with a low birthweight, addicted to nicotine, and with fetal alcohol syndrome. nice going. people are just so IGNORANT!
dr. mommy, d.d.s.:
I know the amount of radiation is negligible. We use digital x ray so it's even less than the conventional one. The amt is so small we don't even have lead apron in the surgery. The problem is, no matter how little radiation the x ray machine generates, IF (the big if) something goes wrong with the pregnancy or the baby, I am 99.9% sure she'll try to do something to me. Even though the court will throw the case out, it's still a waste of time and pain in the arse, all those time spend going to court and doing paper work, lost income from time lost etc etc, not to mention a leaving a big scar on my professional life, like what happened to my friend. He sweared he's never ever going to treat pregnant women again. I live in a small town, if anything goes wrong even if it's not my fault the whole bloody town will know and everyone's gonna point finger at me. I can just imagine the local newspaper headline goes "Baby borned deformed because dentist took x ray when mum was pregnant" or "Stillbirth caused by x ray taken by dentist during pregnancy" (even though the ciggies she smoked probably contributed more to that). Media here don't really care about facts, they just want to sell and this'll make a good story. Also, in my family, if something goes wrong it's never other people's fault, it's always my fault, so my dad'll also kick up a big fuss at me and blah me for the rest of my life. It's better to be safe than sorry. After reading about cases of ungrafetul patients suing their dentists/doctors and actually won (not because of the health care professionals' fault, but because they're not careful in keep records etc) I don't want to be the 1 in 3 dentists being sued in my country. It's her own fault anyway, if she didn't wait so long it would just be a simple filling. I did offer her alternative treatment or option to sign indemnity form but she refused. Too bad
hey DDU.
i hear ya, and i understand about litigation worries and definitely sympathize. we dealt with the same kind of crap in the US, too (and i think americans are the most litigous of the lot). my biggest concern was being sued over NOT doing something, and there have been tons of cases like that under the guidelins of "informed refusal". here's a perfect example, not involving a pregnant woman, but close enough in terms of "stickiness".
a 13 year old boy walked into a county hospital in new york city with a toothache and associated swelling on a permanent upper 6, a dx periapical abcess with acute flare-up. he came to the clinic by himself, unattended by a parent or legal guardian. under new york state law, the age of consent is 18 so the clinic was legally unable to treat him. same thing goes in emergency rooms, a kid could be bleeding from internal hemorrhage from a trauma, and he or she can be stablized, but the OR cannot legally perform even a life-saving surgical procedure without parental consent. anyways, they sent the kid home with an rx for abx and scheduled RCT for the following week. two days later, the kid was hospitalized with a brain abcess, the day after that he was dead. parents and constituents went ballistic, "how could you let a child walk out with an infection like that, blah blah blah" "the family should sue the hospital" and other statements of the like. meanwhile, if they had treated the kid, even if the outcome had been positive, the family could have grounds for a lawsuit for assault and battery. for real. and all because of a parent's blatant neglect. what's a doctor to do in a case like that? let the kid go with a raging infection, or do what we were trained to do and risk his or her career?
situations like that, you're stuck between a rock and a hard place. when i've been in situations like that, esp with pregnant patients, i'm thinking to myself, "what will happen if this infection spreads, and even if she refuses and i've explained everything and have done nothing, i'll still get sued." i'm screwed either way, right? that's why i always talk to the obstetrician first, get the green light and then i feel i've done all i can. if someone wants to sue, point them in the direction of the OB-GYN.
what i'm trying to say, DDU, is that i support your decision to make whatever choice you made (not that my humble north-american opinion accounts for much, anyway!) and i don't want you to think that my post was challenging your clinical judgement in any way. i was simply trying to offer you another perspective from across the ocean and share my own personal and professional experiences with you. you were put in an sticky position no matter what, and personally, i think people who want to sue will sue no matter what the outcome or circumstance. as healthcare professionals, we just have to remind ourselves of that every day.
keep drillin', doc!
Aussies weren't as litigous in the past, and ppl're blaming North American influence as cause of change. :p I value your opinions and thanks for sharing your experience. :D It does help believe me. I'm just pissed off at the patient and the general public who would do anything to sue us (for financial gain of course).
In this case I did warn her that the infection could spread, and there is risk of developing brain abscess. We offered her to sign an informed consent form to take x ray (stating if something goes wrong with her pregnancy or baby she can't sue us) but she refused, and she wouldn't want emergency pulp extirpation. I think her refusal to sign the informed consent form is sufficient enough to ring the alarm. I documented everything in the record so if she does die from brain abscess it's from her own ignorance.
Where I live we don't have the luxury of accessible help from medical specialists, even the GPs are so bogged down by work they're refusing to see new patients and when you call them for help it takes hours for them to get back to you, if at all. The closest OB-GYN is 700km away, the maternity ward in the hospital had closed down few months ago due to staff shortage (and there're talks they're closing down the ICU soon). The pt doesn't have a regular GP she goes to, she doesn't even know which doctor she had last seen. But even if the doctor gives the green light to take x ray she wouldn't sign the informed consent form. It's her choice.
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