Sir, we saw a 40-year-old male heavy goods vehicle driver of middle class background via an access centre in Airedale Primary Care Trust complaining of dental pain in his upper left quadrant. His medical history was clear, his periodontium healthy and he had last visited a dentist some four to five years previously, since when his general dental practitioner (GDP) had discontinued NHS dental services and the patient could not afford private dental care. Despite multiple attempts he could not re-register with another GDP.

The patient had suffered severe pain occurring randomly, lasting between 30-60 minutes, which could not be localised, with associated sleeplessness for the previous two nights. However, he disclosed that he knew exactly the tooth which could be the culprit, since he had a history of a lost restoration in the upper left seven (27) three years previously with minimal discomfort. The tooth had been treated twice in the past three years, by the patient himself!

On questioning he revealed that to debride the cavity he used a holiday-dental-kit comprising of plastic mirror, forceps and probe combined with an electric toothbrush with a small round head. For convenience, the patient had trimmed the bristles to fit into the cavity. He had used tactile senses for plugging the filling material into the prepared cavity, using a material called Quick Steelâ„¢ (Fig. 1) bought from a DIY motorcar parts retailer. Clinical examination revealed the skill with which the patient had maintained this self-applied restoration (Figure 2) for over two years.

Figure 1
figure 1

Quick Steelâ„¢

Full size image
Figure 2
figure 2

UL7 (27) post-extraction

Full size image

On investigation the tooth had classic symptoms of irreversible pulpitis and a radiograph revealed a very deep restoration with possible pulpal involvement but no obvious periapical pathology. According to the patient, since the loss of the DIY restoration the self-debridement of the cavity had been aggressive and may have been enough to cause an exposure and symptoms of pain. It is impossible to confirm whether the exposure was due to gradual progression of caries or was self-inflicted. The patient decided to have the tooth in question extracted under local anaesthetic, as he was unable to seek continued care for it elsewhere. However, recently he has registered with a GDP in the local area under the NHS scheme.

The instruction leaflet clearly stated that Quick Steelâ„¢ was dangerous to ingest, and the patient revealed that he was fully aware of the unsuitability of this product for intra-oral use. However, as his father owned a motorcar garage, he had been familiar with the material for a long time and chose it because of its easy workability, mechanical properties and its rock hard set after kneading. The tensile strength (TS) of this material is 4.1MN/m2 which is comparable to zinc phosphate1 and its compressive strength (CS) is 12.41MN/m2 which is closer to the CS of zinc oxide-eugenol.1 This case report clearly reflects the national shortage of NHS GDPs and the bizarre lengths that patients go to in order to have dental treatment.