"For me it was a waste of time"

About: The Eastman Dental Hospital

What I liked

Staff nice and polite, especially the junior staff member I saw before the consultant was asked for further consultation.

What could be improved

If the waiting times are so long consultants should spend as much time with the patient as needed, do not rush, Effective treatment depends on the right diagnosis.

Why to expose patients to ionising radiation if they have their own x-rays taken somewhere else recently?

Listen to what the patient is saying . If sth is not clear enough why don't you do further tests?

Anything else?

I was referred to the oral surgery dept to get help with the TMJ problem. During the time I waited for the appointment, however, my condition deteriorated and I presented with additional 2 problems. That apparently seemed for the consultant too much to deal with and he decided to refer me to pain clinic where I can be helped to deal with the pain with the use of medication.. Apart from TMJ I also have had recurring acute pain in the bone after the removal of a tooth 3.5 years ago - which the consultant attributed to another condition (which I have only developed 3 months ago!), - the consultant had the attitude - if there is nothing wrong in the X ray it does not hurt - well it does. I brought my own X-rays but the consultant was not interested in looking at them at all.

Although the pain is not very severe I have more and more limited opening of the jaw and and it clicks much more often and much louder ( that wasn't the case 3 months before when I was referred by the dentist). I was told nothing can be done and instructed to apply heat packs and not to chew too much (totaly ineffective is that what I was waiting to be told for the last 2months??).

Bottom line is- waiting to be seen at orofacial pain clinic (not holding out much hope to be helped, rather afraid to get disappointed again).

I have been on painkillers for 3 months now and therefore have gone both for national health service abroad for private consultation - where I have been told I have TMJ disc displacement, flattening of the condyle, muscle spasms and that the jaw visibly veers to one side and that should on no condition be left untreated as otherwise it will simply deteriorate.

I would have asked my dentist to refer me somewhere else had I known my visit would go the way it did.

Story from NHS Choices

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Response from The Eastman Dental Hospital

UCLH-EDH is a secondary and tertiary referral centre for orofacial pain management.

Patients referred to UCLH-EDH for the further management of temporomandibular disorders (TMD) or orofacial pain are mostly seen in the Oral & Maxillofacial Surgery Department or the Facial Pain Service. The Facial Pain Service is a multidisciplinary (MDT) team including chronic pain specialists.This set up is important and advantageous as evidence-based medicine has shown that pain conditions can be influenced by both physical and psychosocial factors. These factors are explored at initial consultation and management arranged in the appropriate service.

TMD patients who present with associated pain usually of more than 3 months duration (chronic) +/- co-morbidities are seen in the Facial Pain Service. This group tends to comprise complicated cases and usually require an MDT approach which may include medical therapy.

TMD patients who present (1) with associated pain of less than 3 months duration without co-morbidities, (2) without pain and (3) degenerative changes are seen in the OMFS Department. The vast majority of TMD patients seen in the OMFS Department and Facial Pain service who fall within category (1) are managed with reassurance and or conservative advice such as a soft diet, analgesics and heat massage as shown by evidence-based medicine. A suitable TMD advisory leaflet devised by the Facial Pain service is also provided. A very small group of TMD patients may benefit from surgical intervention on exhausting conservative approaches and on clinical grounds. Orofacial pain cases diagnosed as attributable to pathology amenable to surgery are treated with appropriate surgical procedures.

Triaging of newly referred patients is done on the basis of the information provided in the referral letter and appointments arranged in the appropriate service. However, in some cases at consultation it may become apparent after taking the patient history, clinical examination and imaging that they are better managed in the other service in which case this is explained to the patient and referral made. Understandably, this can be frustrating for patients who may initially not appreciate the benefit of a holistic approach to their pain management. The two services work together to help ensure triaging to the appropriate service and improve patient experience.

Radiographs are used to evaluate the bony morphology of the TM joint. In situations where the referring clinician sends diagnostic radiographs or the patient has such radiographs these are used for the consultation. Further imaging is then arranged as necessary. The wide range of conditions that present to the Department as well as those that fall under the umbrella of TMD disorders can result in consultations taking longer than expected and unfortunately may result in longer waits for patients with later appointments on that clinic.

If you would like to discuss your concerns further please contact our Patient Advice and Liaison service on 020 3447 3042 or by email to pals@uclh.nhs.uk.

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