Dental Concerns

Miscellaneous and Personal Stuff I Must Share
1

Well, confession - I am seriously overdue with the dental visits due to simple lack of funds. I haven’t had any dental coverage for years now, and these past two years have simply not had the money to pay out of pocket.

I now have some sort of inflammation going in the upper right rear quandrant. I don’t think it’s a cavity because the tooth itself doesn’t hurt, it’s the gums that are painful. I don’t know if I got a piece of something wedged up there or something else is going on, but it’s sore. Not enough to interfere with eating or sleeping but it’s damned annoying.

Well, because the letter from Medicaid was six weeks late I signed up for dental coverage at work. This means I now have not one but TWO forms of dental coverage. I called my old dentist’s office and discovered that neither insurance was welcome. Either I paid the full cost out of pocket or nothing. Damn.

I’ll spare you the tears involved in finding a dentist that was willing to deal with BOTH forms of coverage. I will say that whoever decided the most important item in searching for a dentist was his proximity to your home should be slathered in honey and buried in an ant hill. Of fire ants. Hungry, pissed-off fire ants. Of all the things I’d like to know about a dentist “how far do I have to drive?” is someone around item 4,263 on the list.

Anyhow - I now have an appointment for next Wednesday and I’m not looking forward to it.

For one thing, I was honest about my previous brush with periodontal disease. I sort of have to be, because I did lose some gum tissue and any competent dentist is going to notice that the moment he looks in my mouth. That, however, happened thirty years ago. I beat that bad boy gingivitis down and kept him there for a long, long time.

But, of course, the lady brings up the whole root scaling thing. Here’s the problem: Medicaid does not cover this. Period. My other insurance has a $50 copay (OK… I can probably pull that out of my ass) and only pays a percentage of the rest. Given the cost of the procedure… I can not do this. Period. Sorry. If that’s demanded of me I simply can’t do it. Forget setting up a payment plan - I can’t afford it. I have NO extra money. None. Other family resources are going to dad, who is dying of cancer. It will not happen.

Yes, I know technically it’s malpractice to just do a cleaning or something else, but the fact is I do not have the money. Even for a payment plan. WTF is the point of setting up a payment plan if you can’t make payments? If it comes down to either I get the deep cleaning/scaling or no further treatment I am going to have to walk out that door untreated. There is no money for this.

The other worry is the wisdom teeth. I do NOT want to have the argument again about taking them out. I am sick of the scare stories. First, I was told I had to have them out because they wouldn’t come in fully. Well, they did fully erupt. Then it was horror stories about throwing my other teeth out of alignment. Again, didn’t happen. In fact, a lot of people assume I had braces because my teeth are that nicely arranged. Last time I got that argument I pointed out it had been twenty years since my third molars came in and my teeth had not started moving yet, so I didn’t anticipate it happening. Then it was the dire THEY’RE GOING TO ROT OUT OF YOUR MOUTH!!! Um… hasn’t happened. Now, gum disease might happen, but I have all of four cavities, and those occurred BEFORE the wisdom teeth showed up. Again, nothing has rotted in the past 30 or 40 years and sure, it could happen, but I don’t think it will because I didn’t have unnecessary surgery when I was 20.

In other words, they’re fully erupted, in line, functional teeth. WTF would I have them pulled? My dad is 85 and still has his, never been a problem for him. What can I say? We have big mouths in my family.

So yeah, those are my two big bugaboos for dental visits. I hate finding a new dentist. I don’t give a f*** about how close he is to where I live, what music plays during cleanings, how many whitening procedures he offers, and all that other froo-froo. I want basic dentistry without up-selling, unnecessary procedures, and some understanding of my financial situation beyond “we’ll sign you up for a loan at usurious interest rate”.

What I really want is my old dentist. :frowning:

2

I feel your pain. But remember, the quote about teeth? If you ignore them long enough, they’ll go away. Bite the bullet (well maybe not) and get as much palliative care as you can handle, if you’re adventurous, perhaps try a dental school…maybe your oral situation is interesting enough to be used as teaching material.

3

Check out the nearest teaching hospital. They sometimes have dental surgical clinics, offering needed procedures to those without means. It sounds like you might qualify. Large savings can be realized but the downside is often more paperwork, more appointments and slower proceeding visits. (Every move the student makes is double checked, by a Dr, before moving forward. It does slow things down!)

It’s worth looking into. But it’s not a dental school clinic, to be clear. It’s a teaching hospital dental surgery clinic.

Wishing you good luck! Don’t give up!

4

It’s not malpractice to do a regular cleaning and not a deep cleaning if the patient refuses it. It’s only malpractice if you don’t mention, educate and suggest it if it’s clearly warranted.

You need a few deep breaths and a mantra: “My body, my choice. Informed consent or no consent.” Repeat as needed.

5

So if I’m understanding this correctly, the problem is money?

:slight_smile:
Seriously, that sucks. I hope things work out for you.

6

Dentist here. Yes it is malpractice. One may choose to have a procedure or not but it is malpractice to do a prophy if scaleing androot planning is warranted. They are each based on a diagnosis. If the diagnosis is periodontal disease then doing a prophy is malpractice. Just the same as a diagnosis of gingival health and then doing scaling is malpractice. Malpractice has nothing to do with whether or not the patient was informed as a patient cannot consent to malpractice. Jurisdictions vary and I only have a Texas license.

7

Actually, I went to the local dental school while I was in grad school and for about a year afterward. Best dental care I ever had. Cheap too. The only downside is that everything takes 2-3 times the number of visits that a normal dentist might take.

In general, the students did the exams and whatever work you needed- they were saying the only real bad candidates are people who need NO work, as they don’t get practice with anything but the exams for them.

But you don’t have to have crazy dental work- fillings and crowns are fine. The students did the exams, and had the actual professors look over the treatment plans and then double-check the work at each step. So I had 2 people looking over everything.

I did have an interesting situation where I was a teaching aid; I apparently have astoundingly healthy gums; to the point where the prof stopped the work and called all the students not actively doing something over to look at my gums- to point out that THIS is what good gums look like. Which was interesting, because my teeth are a mess of fillings and crowns, but my gums are apparently textbook beautiful.

8

Yikes. Then I have a few dozen dentists to report. (Or things are different in my state.)

Seriously?! If they refuse a scaling and root planing, you can’t clean their teeth at all? That’s crazy. I’m sorry your profession ties your hands like that.

9

Yeah, seems odd. I had to do the scaling and root planing but my dentist doesn’t do them and referred me to a specialist. He did the standard cleaning before sending me out the door.

10

Depends on how things are worded, but yes a prophy is not appropriate if periodontal disease is diagnosed. In the real world that isn’t how things work, but responding to WhyNot, it is malpractice. Once it is treated then it is fine to do follow up prophys.

11

The good news is that whatever was playing merry hell with my upper right quadrant seems to be improving. I really think I did have something (fragment of popcorn?) wedged up in there and it caused an infection, but even though it’s better and less swollen I probably should still have it checked out and, what the hell, I’m overdue for a visit anyhow.

Here’s hoping things are not as bad as my fears keep whispering. The appointments is Wednesday, did I mention that? I’ll let ya’ll know what the verdict is.

12

Well, I went to the dentist today.

It actually turned out pretty good, even though I got some bad news (read on).

The office staff were pleasant and knowledgeable about my insurance. in fact, they knew more about it than I did.

I got a full set of x-rays, which I haven’t had in almost 10 years. They show the bone as very healthy, which is good news in regards to keeping the gum disease in check, and all prior fillings are intact and good.

The hygienist said that I’d done an excellent job of keeping things clean. I did have some build up and staining but it was pretty minor, especially given it had been about two years since I’d had any sort of cleaning at all.

Yes, it was a piece of food wedged into the gums causing infection, swelling, pain, and problems. She got that out, which was the only time I whimpered but hey, do what you gotta, that has to be cleaned up.

They evaluated the gum pockets. About half my mouth rated a “1”, the rest being 2’s with a couple of 3’s and 4’s spotted here and there, mostly around the wisdom teeth (no big surprise there, really) The deep cleaning/scaling/etc. was deemed unneeded so a regular cleaning it was.

There was a small cavity on the left upper first molar (14). No pain, but I’ll get it taken care of when I have the bigger problem dealt with.

Remember I said those gum pockets were 1’s and 2’s? Well… except the upper right wisdom tooth, which rated a 5 and 6. There is definite decay on the outer side of the tooth. The gum tissue has receded further and as a result there is just no way I’m ever going to be able to keep it sufficiently clean anymore, that’s why there was wedged-up food debris and all the other problems. The tooth next to it rated a couple 2’s on the gumline, this one just sucked. For whatever reason. Rather than wait for an explosion, and after discussing it with the dentist, I agreed it was better to pull it sooner than later. He’s rather gung-ho about getting rid of the rest of them, although as I pointed out, having gotten to my 50’s with all four I am clearly not eager to have them yanked. Since none of the others are an emergency that’s been tabled although I’m sure I’ll be discussing this again in the future. I’m getting the bad boy pulled on May 21st. Sooner if things go south but I went in before anything became catastrophic, I should be OK until then although the area will probably remain a little sore and irritated. I currently have some bleeding from around there but any actual infection seems to be resolved. The dentist said based on x-rays it should be a straight-forward extraction with no anticipated complications. I’ve never had a tooth extraction before, and he did answer my questions and concerns to my satisfaction.

Well, can’t say I’m happy about that, but I knew something was wrong and I just want to deal with it and get the problem solved. Otherwise, good to hear my mouth is otherwise quite healthy and I’m doing a proper job of keeping things clean (aside from that one problem tooth). Scheduled the next cleaning for six months from now, and insurance will pay for it so I can get back on my regular maintenance schedule.

Turns out having two insurance policies will be a good thing. I may not have any out of pocket expenses at all. Even if I do, they will be manageable (even if any expense at all on my budget is painful). The office staff were very good at explaining how the billing would happen and how these things work, I did appreciate it.

Have to get the spouse in to see them next.

>sigh<

I’ll still miss my tooth. Think I’ll ask him if I can have it after he pulls it. Maybe I’ll put it in a little tiny tooth urn or something.

Also miss the social interaction with my old dentist, but I think he’d rather me be seeing someone than being unable to afford anything at all.

13

I’m glad the visit was better than you were anticipating. Still sucks about the tooth, but it seems more manageable.

14

Well, that infection/irritation problem I was having around that one wisdom tooth seems to have cleared up. Which is probably one reason the dentist didn’t go for immediate extraction, right?

But now that it’s not hurting I don’t want to get the tooth yanked. Easy to consent to a pull when you’re hurting, but when you’re not, not so much. Irrational, I know, but there it is - I’m tempted to not go in for the pull even through I’m still having a lot of trouble keeping that area clean. It’s just hard to go in knowing that what happens means significant pain for awhile when I’m not hurting right now.

Got that cavity, too - no pain there. Apparently, dental decay progresses slowly with me, but that’s another thing where I rationally know what I should do but emotionally it’s “whaaaa! mommy I don’t want to go to the mean man with the needles and the drill and the pliers!”

15

If you don’t get it pulled you risk it being worse the next time. Been there.

16

Yes. I need to hear things like that, hence my post. :wink:

17

I would most definitely get it pulled now. I don’t really know what things like “root canal” and “dry socket” are, but I’ve heard of them and they don’t sound fun. Get the tooth pulled now to avoid unthought-of nasties.

18

Also, for reasons I can’t quite recall (maybe something to do with acidity from bacterial goo?) dental numbing agents don’t work as well when you actually have an infection active. So if you let it go until it’s infected again, it’s likely to hurt more to have it pulled than if you have it pulled now, without an active infection.

19

Well, tomorrow I get my tooth yanked. The dental office called to remind me and confirm. >sigh< Encouragement welcomed, the spouse has promised to help me deal with the pain (anyone who tries to minimize it as “discomfort” is going to get punched), and I’m probably going to avoid the really crunchy and chewy food for a couple days. Maybe use it as an excuse for some ice cream.

I’m hoping for an uneventful procedure and recovery, I’m off work until Saturday, and I’m also hoping most of the worst of it over by then. Probably my biggest concern over the first couple days is being comfortable enough to get some good sleep.

20

If they’re pulling the tooth, a root canal isn’t ever needed. And if you get a molar pulled, dry socket is highly probable (stats say anything from a 25% to 50% chance; dentists have told me it is actually higher for molars). It’s also quickly treatable, and the pain is gone really fast.