In August 1955 I was diagnosed with carcinoma in the mouth.  My symptoms were toothache in the left upper premolar.  The carcinoma was eradicated by radiotherapy followed by surgical removal of my left maxilla and a major portion of my palate, and further irradiation inside the cavity.  I had permanent loss of the roof of my mouth requiring a special denture referred to as an obturator which fills the antrum.

In making obturators, skill and patience is required to emulate the shape, size and curvature of the removed palate and bone structure to allow successful functioning without friction between soft tissue and hard materials.  They have to be anchored in the mouth so that they are stable and do not damage any remaining natural teeth.

If an obturator does not fit properly it can damage other teeth, cause soreness and bleeding, severe pain, slurred speech, dribbling from the mouth and the nose, and difficulty with eating and swallowing.  Without an obturator it is impossible to eat, drink, swallow or speak and causes painful dryness of the throat which disturbs sleep.

The obturator must also work well with the lower teeth, bearing in mind that without supporting bone structure above one cannot get sufficient pressure to bite or chew and this can restrict eating to a very limited area of the mouth.  As the mouth configuration changes with passing years, obturators have to be renewed periodically.

My first obturator was made and fitted in Roehampton Hospital.  I was able to return to work in April 1957 at an office in Bloomsbury which was close to the Eastman Dental Hospital and was able to get my dental treatment transferred to them.  The Eastman conserved and crowned the remaining upper teeth and used them as an anchor for a new obturator.  Over the next 35 years their treatment was excellent and always readily available.  They made, adjusted and repaired several obturators.

In early 1996, the Eastman decided it was time for me to have a new obturator.  It was completed in November just before my wife and I moved from London.  They assured me that in our new location there was a good consultant should any problems arise and they said they would write to him.

In February 1997 the anchor tooth broke due to the rocking motion of the obturator leaving it without any restraint.  The Hospital could not find the Eastman letter and refused to see me until my NHS Dentist referred me.  I was seen in March and told they could nothing for 6 to 7 weeks and that I would have to travel to a hospital 36 miles away.  The Consultant worked two days a week at our local hospital and three days at the distant hospital and said he did not have the back up locally.  I had to wait with an unstable obturator until May before treatment started, by which time the loose appliance damaged my lower teeth, including bridge work on the good side of my mouth.  They had then to repair the damaged tooth, extract the broken anchor tooth, remake the bridge, and make a new obturator.  The obturator was made, rejected and remade, experimenting with various methods of retention including implanted magnets, eventually using only clasps around adjoining teeth as before.  By December 1998 after 54 visits to the distant hospital the appliance was reasonably acceptable.

In September 1999 whilst in Dumfries, the right side of my face became swollen and extremely painful.  The doctor who had not seen a maxillectomy for years simply prescribed a mouthwash.  After returning home my GP said I should phone the distant hospital where the Consultant’s secretary was very off-putting, this call resulted in an appointment at the home hospital on the 14th December.  I was seriously worried about a possible return of cancer, although by now the swelling had subsided and there was no pain.  The Consultant told me he would no longer be working at the home hospital but a new Consultant would be starting on January 1st 2000 and would take over my case.  The obturator had by now become less stable causing dribbling from the mouth and nose and I pointed out this out, asking for an appointment to be made.  However, I had to wait until 4th July 2000 for an appointment with the new consultant at the home hospital for a review.  From hereon treatment has been locally done.

In August 2000 the front crowned tooth used as the main anchor for the obturator snapped off whilst eating.  The hospital cemented it back, but 2 days later it broke again and the hospital cemented it back.  However, the next day, a Friday, it failed again and the hospital refused to do anything and said I should see my registered NHS Dentist, but he was reluctant to do anything.  After the hospital spoke to him he agreed to see me at his second practice 11 miles away on the Monday morning.  At the meeting he said it was useless to try and cement the crown back and that the obturator had to be extended.  He made arrangements for a dental mechanic back near home to do the work immediately.  Ten days later an adjustment was needed due to soreness caused by the extension, and the root and stump of the tooth had to be taken out.

Although the upper and lower teeth have to work together the hospital will only deal with upper teeth and jaw and the outside practices will only deal with the lower teeth.  Nobody ever checked the integrity of the upper teeth, until I insisted the hospital did a comprehensive review which I will refer to later.

From October to December 2000 I had severe pain in the lower jaw and was again seriously frightened about possible cancer.  Due to the split responsibility mentioned above I had to fight to get the hospital to investigate, but nothing was done until April 2001 when a C.A.T. scan was carried out and I was given clearance.

During this period the Consultant had been endeavouring to make a new obturator, without success, and suggested starting yet again, having it retained with implants in the zygoma and the right hand gum, I agreed.  This of course meant being an inpatient.

In July 2001 the implants were put in with the zygoma implant being covered over and the gum implant being left exposed.  Then there was a period of waiting for the wounds to heal and in March 2002 the zygoma implant was due to be exposed by day surgery.  After waiting at the hospital for several hours this surgery was cancelled because my INR was too high.  (I had a quadruple heart by-pass operation in 1987 and am now permanently on warfarin).

Usually before surgery I am advised to stop taking warfarin for two days prior to the operation in order to lower the INR, but in this instance I had not been so advised.  The implant was not exposed until May followed by another wait for healing.  In July I was in great pain and so visited the hospital where it was found necrosis of the zygoma had started and I was rushed in to have the die back cut away.  My obturator was adapted to suit the new situation, but still did not function well.  It was then decided that the zygoma implant would not be used and a new obturator would be made with a partial metal palate.  This took sometime because the hospital mechanic did not have the equipment for doing metalwork and the models were posted to a London Laboratory.  During this time under pressure from me the Consultant agreed to do a comprehensive review of my whole mouth after the obturator was completed.  The appliance was fitted in March 2003 and the Consultant left the hospital for a position elsewhere that afternoon.

A new locum Consultant was appointed.  The previous consultancy was 2 days a week, the new consultancy was 3 days per week.  As always there were problems with the new obturator requiring adjustments mainly due to difficulty with swallowing and biting.  The shortcomings were brought to the hospital’s attention and minor adjustments have been made but have not been successful.

In June 2003 I had extreme pain in my lower jaw.  I phoned my NHS Dentist and was told I had been removed from his list because I had missed two check ups.  I found looking back that on both due dates I was actually in hospital having the upper implant done.  The emergency dental centre did one minor rough filling but did not really help.

I contacted the Government dental helpline and was told the only NHS dental practice accepting new patients was 40 miles away.  I was in such agony I visited the hospital A and E Department for painkillers (again it was a Friday evening).  I showed them my heart medication and they gave a prescription which they said was compatible with Warfarin.  I spent the weekend in bed taking the hospital prescription along with Warfarin and on Monday informed my GP’s surgery of the additional medication.  Tuesday morning I noticed I had put the phone back on its stand the wrong way thus blocking incoming calls, this was of course due to the stress, so I then placed it correctly.  It rang almost immediately it was my GP who said that under no circumstances should I take the hospital medicine because it could cause internal bleeding particularly with warfarin patients.  He prescribed stronger and safer medication.  Due to this I searched for a private practice and found one near home who gave me instant attention to make me comfortable for our forthcoming Golden Wedding Anniversary Cruise in August 2003.

After the cruise it was found that the lower bridge work was unstable and had to be removed and reformed also four lower front teeth were loose and had to be removed.  This surprised me because in all the visits to the hospital and to the NHS dentist nobody had mentioned any lower teeth problems.  I now therefore had a new lower denture made privately.  After a while due to the pattern of eating forced upon me by the obturator I found the lower denture constantly being pushed out of place and decided to investigate lower implants.

The local hospital told me they would not do lower implants.  The Bristol Dental Hospital said they do not do implants on the NHS nor privately and would refer me to a Bath practice.  My private dentist said they would not do implants but would refer me to a practice 20 miles away (the owner of the private practice I attend also works at the local hospital).  I arranged a consultation at the local ‘Capio’ private hospital who advertise they can do implants.  I found that the consultant I saw was a Maxillo/FacialSurgeon I met in the NHS local hospital.  He confirmed implants were possible and suggested I should go to the NHS for them.  I told him the NHS would not do the implants.  He said he would talk to the Surgeons’ Committee at the local hospital and would let me know the result.

January 8th 2004 a front tooth on the obturator broke in half.  I visited the hospital and the Consultant said they could not help because their mechanic was fully committed to finish his existing workload before departing on holiday at the end of the week.  I asked my private dental practice and their mechanic would not do the repair saying it was the hospital’s responsibility.  After much phoning the hospital did the repair nearly 4 weeks later on 11th February.

At this time the dental consultant wanted to use the zygoma implant to make the obturator more stable, but the Maxillo/Facial Surgeons still advised against doing so.  3rd August 2004 had discussion with the Maxillo/Facial Surgeon and Dental Consultant and handed over a written list of questions and problems regarding the zygoma implant and the obturator.  The Dental Consultant wrote his comments on the list and handed it back to me.  Nothing was done to the obturator.

I was called to the hospital in November 2004 and told by the Maxillo/Facial Surgeon it had been agreed to give me two lower front implants with an attached denture, but I should have any conservancy work needed carried out by my private dentist first.  This I did because the existing adjacent bridge put in by the distant hospital in 1997 had become unstable and had to be redone.

Nothing happened until 19 May 2005 when the lower implant posts were put in after which there was a pause while the gum healed.  I was then given a series of appointments with the first being on 27th October and the last on 5th January when the implant work should have been finished.

On 27th October the Dental Consultant expressed surprise that the implants had been covered over with tissue.  He took X-Rays and impressions.  On 10th November he exposed the posts and put healing caps on.  On 24th November the gum had overgrown the healing caps because they were too small so again the gum was cut and larger healing caps put on.  The next visit was cancelled because the Consultant had ‘flu.  On January 5th further work was done but teeth not attached.  Comment was made that the implants were at an awkward angle.  I was told the hospital would write to me with further appointments.  The letter arrived and the first of the new appointments was for 14th April 2006 leaving me with unfinished work and no front teeth for 14 weeks.  I was told this was due to the Consultant’s commitments abroad.  I complained but got nowhere even with the help of the Independent Complaints Advocacy Service (ICAS).  At a meeting with the Consultant, Hospital Administrators and ICAS the Consultant became quite heated, and said they were only doing this lower implant for me as a favour because they were not using the zygoma implant to steady the obturator, and it was unlikely any other NHS hospital would take me on.

On April 14th the teeth were fitted to the implants.  They had to be cemented onto the post due to the awkward angle not allowing for the usual screw fixing.  The Consultant at last acknowledged that the bite between the obturator and the lower teeth was bad, as I had been saying for years.  He said he did not bring the lower teeth forward because it would look unnatural.  The problem of the bite not being good is that it makes eating difficult.  He said he would try to ease the problem and I was given an appointment for 7th September 2006 at 9.00am and 12 noon.  An impression was taken and the obturator given to the mechanic.  At 12 noon the adjustment was not completed and I had to return at 2.00pm.  The obturator was fitted and found to be very loose because the restraining clip in the back of the obturator which holds onto the maxilla implant had pulled out.  The Consultant arranged a new appointment for the clip to be reset.  This was 19th October, so yet another delay leaving me with an insecure appliance for 6 weeks.  I wrote to the Consultant asking if the date could be brought forward because the loose obturator was causing me severe distress.  He wrote back saying no and that he was surprised it was causing me distress, implying that the fault had occurred before September 7th.  I wrote back to him saying that the fault had arisen whilst the appliance was in the hospital care on the 7th September 2006.  He replied saying we should “agree to disagree”.  The clip was refixed on October 19th and I told the Consultant I wanted to be treated elsewhere and that I had asked my GP to help find another centre for getting my problems with the obturator sorted out.  My GP has said in a letter to the Maxillo/Facial Surgeon that he has witnessed my ill fitting obturator falling out of place and has sympathy for me, and asking for guidance as to where I may get better attention.  I am awaiting the outcome.  In the meantime the obturator is more stable, the adjustment to improve the bite has not done so, and the problems I raised in 2003/2004 are still with me i.e. difficulty with eating, swallowing and dribbling and with the upper front teeth too far forward.

I know there are more serious case than mine, but unless I have good treatment, all sorts of stressful problems are encountered which have knock on effects.  My files clearly show the gaps and inconsistencies in my treatment over the past 10 years and my struggles to get it.  The hospitals locally appear to lack the capacity or experience to deal with prosthetic dentistry as such cases as mine are not frequently seen and in any case they are overloaded with orthodontic work.