The Dental Topic Thread: I'd like to be a resource if needed

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micronut

Trad climber
Topic Author's Reply - Apr 11, 2013 - 08:11am PT
Sorry everyone, haven't tended to this thread lately. I'll look upthread and try to answer the recent questions as soon as I have time.

Phil B.
Good question. Things like Arestin and other antibiotics that are "shoved/injected" under the gumline have a place in dentistry, but honestly I don't use them much at all, and I'm a gum specialist. The reason is this.

1. Even if you "kill" all the bacteria in the mouth lets say, on a monday, several days later the majority of them are back within 40 days. The body tends to re-populate, just like in the gut. There is a natural "flora" that is established and maintained. You take an antibiotic to reduce specific types of bacteria, and those "under the gum" antibiotics are good in killing some of the more potent "bad" players, but there are limitations to how long and how thorough.

2. The dose of Doxycycline is often really low, and the ability of the medication to stay below the gumline for very long is an issue.

3. There is a positive hydrostatic pressure under the gumline that "percolates" fluid called gingival crevicular fluid, up from down inside the pocket. when you inject down into the pocket, there is a tendency for the medication to just "float" back up to the top and out.

4. If there is something down deep under the gumline trapping bacteria...a big old filling, a crack, a furcation.....or tartar/calculus, you have to go get it and fix it. Putting antibiotics down there is just putting lipstick on a pig.

So, in isolated cases, where the deep scaling and root planing hasn't worked all that well, but the patient cannot afford surgery or the disease isn't deep enough to warrant surgery, I use it sparingly in the deeper sites. I charge about 40$per site, just to cover my costs. And I see pretty nice tissue results.

But many dentists use it as a sales pitch and to make money. You have to look out for those guys.

Good luck. AND FLOSS EVERY DAY!

Scott
Crimpergirl

Sport climber
Boulder, Colorado!
Apr 16, 2013 - 10:36am PT
Micronut:

Thought I'd follow up regarding my earlier tooth questions in case you were interested.

Recap: Tooth 20 (lower, left all the way back molar) was cracked so the dentist recommended a crown.

I started the procedure for a crown. A couple days later, the tooth is killing in a way I know means it needs a root canal. I get the root canal.

Dang thing never quit hurting though everyone kept telling me I couldn't feel it (which angered me).

Whined about it for almost two years. Finally, days before I left for a 3 week out of town trip, my lower left jaw really started hurting like I need a root canal. I went to a new endodontist and he thought the problem could be #19. I got a root canal on it.

That was Nov. A few days into my trip, a good part of the partial filling comes out. Boo.

Get back to town, get the crown. Nothing much had changed. Oddly though #20 was feeling better. But #19? Felt like I want to pull #19. Throbbed. Woke me up at night.

I didn't make another trip to the dentist as I was tired of all the trips and being told all was well and that I couldn't feel the tooth since I'd had a root canal.

Hit the dentist a few weeks ago for a standard cleaning. They ask how all is. I tell them the same thing that I'd been saying for three years: my lower left jaw hurts and I want to pull my tooth. Also inform that I can no longer close my mouth properly and that #19 feels like it's lifting out of my jaw during the night. Thought I sounded like a crazy person.

They take a new x-ray and comment on such change in less that four months. Infection. Bone loss. Tooth Reabsorption. (I thought only cats got tooth reabsorption!)

So I'm in bed right now with a seriously swollen face after #19 had to be cut out yesterday. Got a bone graft and stitches and other fun stuff that accompanies all that.

While my mouth is throbbing a bit, I can say that the feeling that I want my tooth pulled has gone away which I'm very thankful for. I am a hillbilly now and will remain that way until I get the implant in 6 months or so.

I brought the tooth pieces home. They are gruesome! There are three pieces: crown, and each root. Figure I'll mount them as jewelry as the little devil cost me 5k total.

micronut

Trad climber
Topic Author's Reply - Apr 16, 2013 - 11:17am PT
Callie,

WHat a drag. I'm so sorry you had to go through all that. Not just the dentistry, but the feeling that you were hurting and nobody was listening. In my opinion, without x-rays or other diagnostics, this is what happened.

1. The tooth was indeed cracked, not just up around the crown, but down deep, vertically along the root.

2. The dentist could not see the fracture because they are often hairline and not in the visible plane of the x-ray beam, being a 2D image of a 3D situation.

3. Though you had a root canal, it never felt right, and even hurt, because the periodontal ligament still has pain and "feeling" fibers, and bacteria can re-infect the site slowly along the fracture line, like a mini highway for bacteria.

4. I ALWAYS suspect a vertical root fracture if somebody has lingering, persistent pain after dental treatment that does not go away and "feels just not quite right."

5. The x-ray finally showed some darkness after the thing finally "blew up" and bacteria and abscess and resorption caused significant bone loss.

6. I may have recommended extraction of that thing long ago, right off the bat, and replacement with an implant, since they are so predictable, good looking, and definitive, but no need for me to Monday morning quarterback here. The thing is, they should have listenedwhen you siad it wasn't right.

7. You might be a hillbilly for a while while the bone graft repairs and an implant integrates, so I'd recommend some Daisy Dukes, pigtails and paint on freckles. Go for the Farmer's Daughter look, you could pull it off.

Say hi to Dave and I hope your episode with this tooth is soon over. E-mail me if you ever have any other issues, and maybe consider another dentist if you have lost some trust with him. Or talk to him and tell him how you feel. Maybe this one was just one of those tough to diagnose situations.

Scott
Don Paul

Big Wall climber
Colombia, South America
Apr 16, 2013 - 11:18am PT
I just had a molar pulled out last Thursday. (in Colombia) Cost nothing at all, just like medical care. Dentist gave me something called diclofenaco, to reduce inflamation and pain. Three 3 ml doses. In Colombia they just give you the syringe and you have to find someone to inject it. Do you have any friends who can inject this? he asks. Not sure if they really want to, can I inject myself? He looks at me funny then agrees, so I get a handful of syringes and ampules, but pretty quickly find a friend who's injected lots of cows on the family farm. Problem solved. That drug worked great, by the way. No narcotic effects and really did eliminate the pain.
Crimpergirl

Sport climber
Boulder, Colorado!
Apr 16, 2013 - 12:11pm PT
Thanks Scott - you did indeed call the vertical fracture and need to extract a while back. BTW, I mentioned this possibility to my dentist after you mentioned it but she did not flinch.

Weird thing is that she didn't even recognize the infection/bone loss/reabsorption from the x-ray. Rather she had someone else look at it. I find that a bit scary. I would think even and "ordinary" dentist would know what that looks like. Maybe time for a new regular dentist.

So happy to have that pest out of my head!

The swelling is absolutely spectacular! I look like elephant man. Hope that goes away soon. I have to teach tonight so I'll be scaring people on public transportation and in the classroom. :)
micronut

Trad climber
Topic Author's Reply - Apr 16, 2013 - 12:16pm PT
Don Paul,
That stuff is made for getting rid of Tapeworms! Stop it now!

Just joking. Its Diclofenac, a fairly effective NSAID, like Motrin, Ibuprofen or Aleve. I think you might get better pain relief from 800 mg of Advil, Motrin or Ibuprofen in tablet form....and you don't have to have a buddy inject you. Which is probably kind of fun for your friends though. I don't want to rob them of the experience, but you may not even need it if you do some warm salt water rinses and keep ice on it for a couple days. Good luck.

Vaya Con Dios!

Scott
dirt claud

Social climber
san diego,ca
Apr 16, 2013 - 12:17pm PT
Hope you get better Crimpie. Thanks for this thread Scott, just noticed it. Very cool of you too offer this to the taco tribe. Now, if we could get a lawyer and physician on here who gives free advice we would be set,lol :-)
Crimpergirl

Sport climber
Boulder, Colorado!
Apr 16, 2013 - 12:22pm PT
Haha! I totally took the tapeworm hook. Good one!
Don Paul

Big Wall climber
Colombia, South America
Apr 16, 2013 - 12:36pm PT
Thanks Scott - Im fine but its cool you're helping people out like that. If I had a tapeworm I would probably leave it alone since its always so hard to lose weight.

All that's left now is to cut out the sutures after a week, scissors will probably work fine and I wont need a cattle rancher, just a paper pusher of which there are many around here.
skywalker

climber
May 9, 2013 - 02:58pm PT
Hi Micronut/ Scott

I just went to the dentist for a tooth I broke a couple days ago. Let me premise that it had a root canal 20 yrs ago and has been slowly ground to a pulp (no pun intended). Its the far back lower molar. The dentist gave me several options two of which require bone removal to make room to fix. The other was simply removing it and that its not that bad because its the 1st molar.

It was interesting that he noticed my bite was not correct and there was some discussion about me breaking and dislocating my jaw (break at the joint) 20 years ago. He didn't tell me what decision to make but hinted that due to lack of space in the back and an incorrect bite that it maybe better to correct the bite and cut my losses.

I had it pulled (not pretty for me) today. Afterward he said I was better off without it. I'm scheduled for a full evaluation in a month. Its the first time I saw this guy but he was super confident in his abilities and seemed like my super hero in this problem.

So....might I be better to call it good and rather than an implant in that small space and the bone restructuring required, use the effort to correct the bite and move on. I'm 40 by the way with a full set of teeth otherwise.

Thanks for offering! I felt he wanted to give me my options but wanted me to decide and I would like advice as a non patient. I know it all depends but any thoughts would help moving forward.

S.../Dan
Sewellymon

climber
.....in a single wide......
Jun 12, 2013 - 08:51pm PT
Hi Scott,

Having crowns put on 6-12. Sleep grinding when younger = my 56 year old teeth are ready. Plus me a businessman professional so need a nice smile.

My dentist went for the “rapid treatment” timeline. 2 sessions a week for 3 weeks = molds are now made so now just awaiting the permanent crowns.

So here is my Q's? Was this too aggressive? 2 – 3 hours in the chair for 6 sessions in 3 weeks? Lot of Novocaine, too. Am asking because I also have come down with a raging ear infection that likely is no correlation to the treatment other than maybe my immune system beat up from the shots and drilling?

And for that matter, are placements of the cords used in making mold supposed to hurt like a mutherf*kr?
climbski2

Mountain climber
Anchorage AK, Reno NV
Jun 12, 2013 - 09:29pm PT
I think Micronut is on ElCap at the moment. Or perhaps just getting down.
micronut

Trad climber
Fresno/Clovis, ca
Topic Author's Reply - Apr 18, 2014 - 11:30am PT
Skywalker and Swellymoon. I just checked this thread for the first time in almost a year. It kinda fell off my radar.
micronut

Trad climber
Fresno/Clovis, ca
Topic Author's Reply - Apr 18, 2014 - 11:37am PT
Skywalker. How you doing with that molar gone? If it really is a "first molar", which means it is the closest molar to the front...2nd molars are behind that and 3rd are your wisdom teeth.....you should look into a replacement.

If it is indeed your first molar you probably really want to look into replacement with a dental implant. The first molars are somewhat the cornerstone of the back teeth and it really helps long term to avoid other issues with your bite down the road if you have a good first molar. Especially if you have a history of issues with your occlusion, you may want to consider a consultation for an implant. They are wonderful and very predictable and typically less painful than the extraction. Have a surgeon do it, not a general dentist who also "does implants."

Let me know if I can help in any other way.

Scott

micronut

Trad climber
Fresno/Clovis, ca
Topic Author's Reply - Apr 18, 2014 - 11:39am PT
Swellymoon. How is that work in the upper front teeth holding up?
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