By Finlo Rohrer
BBC News Magazine
Problems with getting an NHS dentist are leading some people to pull their own teeth out. If that's not enough to make you wince, then the potential pitfalls will be.
Periodontitis sufferers have teeth which would be easier to pull
It's the most gruesome image accompanying the allegations that there's a crisis in dentistry provision in the UK.
There are people out there pulling their own teeth out with pliers.
Mark Cowley is a furniture restorer from Wisbech in Cambridgeshire. After travelling long distances to get temporary procedures done, and having suffered the cracking of his tooth, he decided to take matters into his own hands.
He picked up a pair of mole grips, plier-like tools, and pulled the offending tooth out.
"I just got a bit desperate and this tooth was waggling. There's no pain in it now."
His friends and family do "get a bit squeamish" when they hear about his DIY dentistry. But what do the experts advise about tackling your own gnashers?
Professor Liz Kay, dean of the Peninsula Dental School in Plymouth, stresses that anybody who is able to pull out their own teeth probably has extremely advanced periodontitis, a collection of diseases that cause the loss of the bone supporting the teeth.
"Normally a person would just not be able to move their own teeth."
Robert Jagger, senior lecturer in restorative dentistry at Bristol Dental School, says cases of people with periodontitis removing their own teeth are not unusual.
"It can sound absolutely horrendous, but in the case of periodontitis, one of the things is that they become very, very loose. It has been reported very frequently over the years. You could get some pain but I don't know if there's a greater risk of infection [than in a dentist's surgery]."
Of course, if you mess it up, leave a fragment of a broken tooth remaining, and you risk abscess and infection. And, as Prof Kay, points out, the complex anatomy of the head means one doesn't want to be messing around in there for fear of doing something exceedingly bad.
However, while pulling out a waggly tooth is one thing, the reports of people who have used powerful household glue to put a crown back in place are not good.
"It is a very foolish thing to do," Prof Kay suggests. "If you superglue it and there's any problem you are going to lose the tooth."
And if you've done a procedure in a permanent fashion and put your crown or filling in the wrong place, you are not likely to notice until it's too late to get help.
"There are more insidious dangers. Things may appear to be OK but the filling is still leaking," Mr Jagger adds.
At the other end of the DIY spectrum are the dental first aid kits, provided mainly for tourists and recognised as an option for emergencies by dentists, which contain the tools to deal with a dislodged filling or crown until you get back to civilisation.
A kit might contain zinc oxide powder and eugenol, effectively clove oil. Mix it together and you can improvise glue for a crown, or a filling. It can hold for a few days at least with the dentist removing the material and doing a proper job.
As a "very, very temporary measure" such kits are "useful" for people on holiday, says Prof Liz Kay.
'Obey the law'
Jenny Lees, managing director of Dentanurse, says her firm has doubled the sale of kits over the last five years, and suggests they are being used domestically as people cope with long waits for NHS dentists.
Sticking a crown back in place is safe and simple as long as people read the instructions. But they should do it themselves.
"Legally you shouldn't get someone else to do it. If someone else does it for you they are breaking the law by practising dentistry."
"It's like making custard, as long as you read the instructions you are fine," she says.
Rose Matthews, 24, found herself left in the lurch and needing the kits when her dentist stopped a procedure midway and told her it could not be completed on the NHS. Being unable to afford the fee, she endured an 18-month wait for NHS treatment. The hole in her drilled-out tooth was tackled using a kit once a month.
"It was quite difficult and quite painful and because I couldn't do it properly the walls of the tooth were starting to break away."
But despite the less than ideal solution, it was a lot better than plan A.
"Before I discovered the kits I was using chewing gum."