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

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rottingjohnny

Sport climber
mammoth lakes ca
Dec 1, 2012 - 11:02am PT
Thanks locker...I'll get that credit card number to your secretary as soon as i dig it out of my wallet...RJ
tooth

Trad climber
B.C.
Dec 1, 2012 - 11:28am PT
Baking soda is the additive in some toothpaste that is equivalent to the sand in sandpaper.

You need it on your toothbrush as badly as you need it on your floss.


In reality, just the physical disturbance of smooth floss between your teeth, or nylon bristles massaging between your teeth and just under your gums will do the trick.


Toothpaste helps with all sorts of things (it's big business - bigger than actual dentistry itself) but those things aren't needed if you just brush and floss.





I can recommend it just for the simple reason that it won't cause problems other than excessive abrasion on your enamel if you go overboard with it.
rottingjohnny

Sport climber
mammoth lakes ca
Dec 1, 2012 - 11:38am PT
Locker...You get the one finger salute for that excessive charge of 165...Thanks tooth ...that makes sense with the baking soda...less is better..RJ
Crimpergirl

Sport climber
Boulder, Colorado!
Dec 1, 2012 - 01:51pm PT
I think it's been implied, but I want to make sure I understand something about flossing.

Like so many products, there are now a zillion types of floss to chose from. Are they equivalent? Or are certain kinds better? Some of friggin' ropes...who can get those between their teeth? Or worse, how do they get the stuck rope out?
Crimpergirl

Sport climber
Boulder, Colorado!
Dec 1, 2012 - 01:51pm PT
Oh, and by reading this thread, I was prompted to get up and floss right now.

(wipes floss projectiles off screen)
Crimpergirl

Sport climber
Boulder, Colorado!
Dec 1, 2012 - 01:58pm PT
Okay, one more question...

I have a fizzy water problem (e.g., club soda). I have a penguin (love it!). So is this as bad as coke? Less bad? Benign?

Thanks for this thread. It's terrific!
micronut

Trad climber
Topic Author's Reply - Dec 1, 2012 - 02:11pm PT
Hi Crimper,

SO HERE GOES........THE DEFINITIVE FLOSSING POST.

Floss is floss really from a "does it work" perspective.

I like waxed because it feels a little more "grabby" in my mouth, and it tends not to shred. Un-waxed is totally fine too.

The thickness just depends on your contacts. If you have really tight contacts between the teeth, Glide (brand) is awesome. Gore tex if I'm not mistaken. Or some NASA type teflon, that stuff is super strong and absolutely will not shred.

If you have larger spaces, like pretty big, I like the "waxed dental tape". I use it in a couple spots, or I double up a regular strand to get in between where I have some slightly open contacts.

Day to day, I use floss picks. My wife buys the cheapo 100 pack and I floss while in my car. Theyre nice 'cause you don't have to get your fingers dirty and the dexterity required is far less than with fingers.

Lastly, there's a bit of an art to flossing that many people don't do. YOU GOTTA WRAP THE FLOSS BACK AND FORTH A BIT ON EACH SIDE OF THE CONTACT SO YOU COVER THE WHOLE SURFACE OF THE TOOTH. Ie: you need to think of it like you towel off your back. Teeth are convex. if you just snap it up and down, you aren't covering enough surface area to remove all he plaque. It doesn't take any longer. Just gotta do it with a little "wrapping" side to side. NO SAWING.

Remember...............

"You don't have to floss every tooth. Just the one's you want to keep."

micronut

Trad climber
Topic Author's Reply - Dec 1, 2012 - 02:26pm PT
Big Mike,

Sleep apnea is a real kiler and it messes with your other systems on a cellular level. Oxygen is your friend in a big way and the cumulative effect of hypoxia are a real issue for folks long term. See a sleep apnea specialist and start conservative. Then work toward more and more aggressive means. On the left side of the spectrum would be a dental appliance that oens/holds the lower jaw open and thus opens the airway a bit while you sleep. A major improvement for many people. The next step is a CPAP machine, then perhaps some combination of the two. On the far opposite end is surgery to open the airway and remove excess tissue that collapses on itself whle at rest. All of these can be great options.....BUT YOU NEED A GOOD DIAGNOSIS! A dentist is a great start......but somebdy who has training in sleep apnea and has been making appliances for quite a while and can tell you about his extra training and his success failures in treating apnic patients. Dental students do not learn enough about the art of treating sleep apnea in school.

A sleep study is the definitive way to get a diagnosis. You need to be measured for o2 intake and CO2 blow off. Over time. The numbers tell your story. How many episodes of "holding" breath....how long each episode, etc. Your skeleton and soft tissues of he airway also play a big role. So does neck diameter. Actually, there are great studies that show a direct correlation between neck diameter, weight, sleep apnea and sudden/premative death. Scary.


There's a great guy who is doing great things for people here in Fresno actually. If you really are BIG, Mike, PM me and I'll get you in to see him.

Lastly, sleep apnea stuff/treatment is often covered by medical, not dental. Cool eh?

Chinchen

climber
Way out there....
Dec 1, 2012 - 10:35pm PT
Where Can I find a great, FREE dintist? I need help.
MisterE

Social climber
Dec 1, 2012 - 11:01pm PT
Nobody's said "diastema" yet.

Tee Hee.
Ken M

Mountain climber
Los Angeles, Ca
Dec 4, 2012 - 12:32am PT
On the issue of Sleep Apnea:

I've treated many people with this, and have struggled with it as an issue when I was medical director of a group. Seemed like most everything was a waste of money.

It was accurately said that CPAP is the gold standard of treatment. It is also accurate that >90% that people who start on CPAP stop using it within 9 months.

It's as bad as flossing!

I think there are no great answers. When Niteguards help, that's great and simple.

I'm actually trying to put together a study on a novel approach: Use of Diamox. There is some evidence that it does change the numbers in studies, but not enough evidence to make recommendations. Wouldn't that be ironic?
JOEY.F

Gym climber
It's not rocket surgery
Dec 6, 2012 - 10:35pm PT
How's it going Tarbuster?
I am having all 4 quadrants surgically cleaned, on #2 now.
Effen painful, long overdue.
Question to the Docs.
Do you prescribe/advise a stool softener with the viks?
I know it's kinda gross, but, no one told me....
I have appreciated this thread Micronut and Tooth and your advice since you started it. Thank you.
Crimpergirl

Sport climber
Boulder, Colorado!
Dec 6, 2012 - 11:17pm PT
Okay, a question.

About 1.5 years ago, at the suggestion of my dentist, I had a crown put on my back, lower left molar. It didn't bother me at all, but she said it had a big crack. I thought I'd be a responsible adult and get it fixed before it became trouble.

(I won't do that again!)

After the temp crown was put on, it started hurting. I've had a cracked tooth before that needed a root canal and I know what that feels like. That is what this felt like. So I had to go off to the must surly dentist in Boulder to get the root canal.

After it's done, my tooth still hurts. I get the permanent crown. I tell my main dentist at that time it still hurts. And every time I've been to the dentist since, I tell her that my tooth still hurts. Every time she tells me it can't hurt because it's had a root canal. Frustrating.

Finally, on my own after the pain had worsened greatly, I went to a new guy to get him to look at it and redo the root canal (or what ever needed to be done). The tooth had become increasingly painful. I had to go out of town for 3 weeks in a row and didn't want to get caught on the road suffering. This is about 4-5 weeks ago.

He pokes, he squirts water, pushes air - all that good stuff and announces I have a "complex" case. The tooth I'd had a root canal on was pressure sensitive ("duh" I'm thinking! - I'd pay someone to pull it for the instant relief!). And he says the sensitively (I call it slobber sensitivity since everything makes it hurt) is the tooth in front.

He does a root canal on the tooth in front (he was good!). I think that is tooth 19.

Since them, the very back tooth still hurts and I still feel like it'd be great relief to have it pulled. And the tooth in front of #19 now hurts like a mo-fo: it is now slobber sensitive. Sigh.

Is there such a thing as a chain-reaction tooth sensitivity. I suppose I can go back and get yet another root canal on the tooth in front of #19, but will that make the next one hurt too? I feel the sensitivity all the way into my front left teeth. It is primarily cold sensitively, though wind hurts a lot too.

Would love your thoughts on this. Hope it makes sense.


Tarbuster

climber
right here, right now
Dec 6, 2012 - 11:57pm PT
Joey. F,
I'm following Tooth's lead on Dr. Jim Beck in Pueblo for a detailed workup on bruxism. This means more than sleep studies for apnea. Dr. Beck's wife told me they are no longer taking new patients and furthermore wouldn't do the workup on me without also doing the rest of the work I have slated. Interestingly, she said their 2 visit $1500 sleep and postural studies workup would produce records which may not be readable by another dentist and they're not interested in "teaching" my dentist how to follow suit with implementation according to the findings. Understood. I didn't ascertain the extent of said implementation beyond my need for multiple onlays and an implant. My dentist is a prosthodontist and farms out sleep studies to a lab but doesn't do any postural observance.

I asked Dr. Beck's office (his wife, who was quite helpful) for a referral in the Boulder Denver area for a dentist who does a similar postural workup (you may remember there was some mention by Tooth that a link to my long-term arm problems may be uncovered or elucidated somewhat by these postural studies: i.e. the Holy Grail of my musculoskeletal health issues). Meanwhile, it was suggested I look up dentists who belong to the American Academy of Craniofacial Pain (AACP) in my own area, which I have done and I'm meeting with one next Tuesday, who does some postural workup. Whether or not he'll do the level of detail on the postural side of things which Dr. Beck would do is something I have yet to determine.

Tooth: you following this?
I'll have some feedback next week.

(Good luck with that Callie)
micronut

Trad climber
Topic Author's Reply - Dec 7, 2012 - 12:24am PT
Callie,

Oh man, what a bummer. Nobody should have to go through that kind of scenario. It really sounds like you probably have a vertical root fracture on that tooth that is still hurting. We often cannot see these on radiographs but most of the teeth that I extract with suspicion of a vertical fracture end up having a visible crack I can see once the thing is out.

AND YOU BY ALL MEANS CAN HAVE PAIN associated with a root canal'd tooth. The microscopic ligaments that hold the tooth in place, the PDL, can transmit pain as the broken root "pumps" up and down. Even a hairline crack, like a crack in a windshield can do this. Happens all the time. No dentist should give up on somebody who says "this thing still hurts!".

The problem is, we don't have a fix for a tooth with a vertical root fracture. They usually need to be extracted, grafted, and restored with an implant, which if done right should be a smooth and fairly painless process that ends up in a tooth that lasts a lifetime.
micronut

Trad climber
Topic Author's Reply - Dec 7, 2012 - 12:31am PT
JOEY F.

"Vitamin V" can really beat up the stomach. If he Vicodin is really jamming you up, can you get by with just 800 ibuprofen/motrin/advil twice daily? If so that's your best bet. And rinsing with warm salt water thrice daily. The warmer the better. And some moist hot compress a few times a day if you are past the first 24 hrs, wherein I usually like ice on the jaw.

Tylenol III could be a better alternative for you if the Vico tears you up. Or Ultram. Its not quite as strong but really cuts the breakthrough pain down.

For the next quadrant. Take 800 ibuprofen 45 minute pre op. And hit the ice packs hard for the first 12 hrs post op. I rarely, rarely have patients need the heavy stuff if they follow the post op recommendations to the T.

Also, no real talkin or yappin or working out or jogging or nothin' for the first four hours. Moving the jaw and the surgical site around tends to get it all inflammed. Sleep elevated on a few pillows to let gravity help, and stick to really soft foods. Its a drag, I know, but saving them teeth is a major lifesaver for quality of life down the road. You'll be really glad you did it if you do your daily chores and brush and floss well from now on out.

Hope you feel better soon,

Dr. J
JOEY.F

Gym climber
It's not rocket surgery
Dec 7, 2012 - 01:20am PT
Yikes, The first round of meds wore off ouch....Thanks for the ice advice...Throb throb...Good luck tarbuster and crimpie...
tooth

Trad climber
B.C.
Dec 7, 2012 - 08:39am PT
Yes I'm following Tarbuster. I spent many trips learning from Dr. Beck, what he does won't be followed by just anyone. I've continued to study more about this area, but it isn't just drilling a hole and filling it in!



Crimpergirl, I can think of many reasons why that tooth started to hurt after... perhaps a 3D x-ray would show 1. if all 5(?) of the canals were filled 2. cracks 3. IA nerves/proximity to extruded sealer from the RCT which may hurt for a couple weeks 4.....etc Your local endodontists should be able to help you out.
Crimpergirl

Sport climber
Boulder, Colorado!
Dec 7, 2012 - 09:40am PT
Thanks to both of you.

The most frustrating part is being told repeatedly by many people that the tooth can't still hurt. Pisses me off as it's my tooth, in my head, and it hurts!

The information is very helpful!
jopay

climber
so.il
Dec 7, 2012 - 09:46am PT
Alright I have a few questions and just let me say I appreciate you dental professionals doing this. I'm 66 and still have all my wisdom teeth, over the years dentists have mentioned it being a good thing to have them removed, but I'm kinda of a "if it ain't broke don't fix it " kind of guy, and they were never any trouble.That is until about a year ago thatI began biting my cheek and of course once bitten the cycle starts, so my dentist says that I'm squeezing my cheek tissue between my lower wisdom tooth and the tooth above. The lower wisdom tooth is visible and actually used for chewing. So I made an appointment with an Oral Surgeon and he concurred with my dentist but wants to take the upper wisdom tooth on that side out as well and an extraction appointment is set, however after perusing the vast data on the Inter web it seems that older folks have more concern with this procedure as the roots are fully formed and some bone might have to be removed, yikes. Is it ever a possibility that they can't be removed due to attachment to the bone or jaw? There is even mention of harming ones jaw bone or some type of sinus area, is any of this an issue or am I just being too well read.
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