"NHS 24 Call - out of hours dental care"

I recently called NHS 24 in the middle of the night as I was in excruciating, sudden jaw pain from a wisdom tooth. I had been struggling all day and hadn’t been able to eat any food in > 24 hours at the point of the call. I had tried to self manage with analgesia at home and was going to seek urgent dental care in the morning during 9-5 hours. 

The pain built up to a point where Ibuprofen and Paracetamol were not effective and I had taken the maximum dosage of both in 24 hour window. The pain was worse than fractured bones I had experienced in the past and was truly the worst pain I’ve ever experienced, with no relief from anything I tried. It was far from the usual wisdom tooth pain I get.

My jaw was swollen and I could hardly open my mouth my at all by late evening. I was in excruciating pain and could not even think about sleep or eating. I made both call handler and dental nurse explicitly aware of all above. I put off calling as long as I could as I knew it was unlikely to be seen overnight by dental staff. I got to a point I had to call as I was hunched over in pain and was not coping at all with the level of pain. 

I was triaged by NHS 24 call handler and referred to a dental nurse for a call back. The dental nurse called back within 30 minutes (of which I was lying in a ball in utter agony). The dental nurse assessed me in a professional manner and decided that I should call my registered dentist and get an emergency appointment within 24 hours (at this point it was a minimum of a further 7 hours until they opened - who knows when my appointment would be in the 24 hour window).

All seemed a very reasonable plan except there was no mention of any pain relief,  I expressed very clearly I was not coping with the level of pain I was in, I had not been able to eat any sort of diet in >24 hours, tolerating light fluids only. I had explained I had taken 4 doses of paracetamol and 3 doses of ibuprofen and had been icing my jaw and had no other pain relief options at home. I could hardly open my mouth. I was very distressed and tearful on the call.

I was utterly shocked to find out that apparently under no circumstances would analgesia be available to me at any out of hours facilities. I enquired about 24 hour pharmacies, my local hospital is the QEUH and I asked if there was any way I could even collect stronger analgesia such as codeine from there. I was told that was not an option as it could only be a dentist that would be able to offer that and there was no out of hour facilities for that. The dental nurse I’m sure is correct in what she told me, so if that is the case I find it utterly abhorrent that someone is expected to be in debilitating pain, unable to manage any sort of diet or sleep and be left to deal with that for another potentially 24 hours.

I am disgusted at this practice from our amazing NHS. In no other area of healthcare can I understand someone in the worst pain they have experienced in their life be left with no option for further pain relief until able to be revised by a dentist. This seriously needs reviewed and a policy or guideline in place for analgesia options to be available in our of hours times in such circumstances, without a full assessment needed from a dentist.

As an NHS professional myself, I am truly disappointed in my experience and it has left me wondering how often this is happening to people.

I personally did not want to bother very busy A&E staff although very tempting given the circumstances, but can totally understand why the A&E department is massively overwhelmed and contributing to this must be, what I believe is, the inadequacies of the guidelines and policies from their dental colleagues. I have found my treatment to be totally unacceptable and inhumane and my partner has even expressed how angry they are after watching me writhe around in pain all night with no sleep.