Dental Concerns

[Lsura]

@Broomstick

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.

I had all four wisdom teeth out at once,and I’ve had two extractions since (both of those came with added bone grafts for later implants).

None of them have been that bad, I swear. For me, I would honestly say that “discomfort” was the right word for the most part, but everyone is different in how they handle pain. With the wisdom teeth, I was given fairly strong painkillers for after the fact. With the others, I declined. Instead, I was given the advice to take both tylenol (they didn’t use the brand name, but I can’t spell it close enough to get spell check to correct it) and ibuprofen in combination. My last root canal was far more painful after the fact, and that was from the anesthetic injections more than the procedure.

Soft foods are a good idea. Avoid straws and smoking (if you do) to help avoid dry socket (I was a smoker with my wisdom teeth, didn’t avoid it and didn’t have a problem. Do as I say, not as I did. )

I hope tomorrow and your recovery go as smoothly as the ones I’ve had in the past have.

[Sattua]

My experience from having all four wisdom teeth out at once is that the day of the procedure, you’ll be on top of the world. You’ll be Superwoman. Strong. Energetic. Giggly. You will call people you haven’t spoken to since high school.

While this is happening, don’t neglect the damn ice packs, or you’ll regret it the day after.

[Poysyn]

Best advice I have received about pain - you know that pain scale they always talk about?

Take the pain killer when the pain is at 5 - don’t let it get any higher. It’s easier to keep it down than knock it down once it gets going.

I had dry socket - yeah, it sucked. They stuffed it with clove oil and gauze, that sucked for a different reason but the pain was instantly gone.

[Leoj]

@Broomstick

[A]nyone who tries to minimize it as “discomfort” is going to get punched…

…right in the femur

[Broomstick]

@Lsura

Soft foods are a good idea. Avoid straws and smoking (if you do) to help avoid dry socket

I don’t think there’s been a straw in this household in several years and I don’t smoke.

I’ve also heard you should avoid hot foods the first day or two, until the scab firms up. I’ll probably be living on tuna salad, bananas, and ice cream. Which, for a couple days, isn’t too bad.

I hope tomorrow and your recovery go as smoothly as the ones I’ve had in the past have.

Me, too!

I usually heal up well, but don’t handle dental pain as well as some other types. During the day I can distract myself and have a bunch of strategies for dealing with pain, it’s when I try to go to sleep I have the most trouble. Hence, my concern and my hope it won’t be too terribly bad.

[kaylasdad99]

@rsat3acr

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.

What is your general recommendation to patients whose finances ONLY permit them to obtain a prophylactic, no wiggle room allowed?

F’rinstance, is it permitted for a patient to obtain the prophy, and schedule the more expensive procedure(s) for a later date?

[rsat3acr]

@kaylasdad99

What is your general recommendation to patients whose finances ONLY permit them to obtain a prophylactic, no wiggle room allowed?

F’rinstance, is it permitted for a patient to obtain the prophy, and schedule the more expensive procedure(s) for a later date?

No perio treatment comes first and then one can follow up with a prophy.

That being said, in the real world folks are diagnosed with perio all the time and get what they consider to be a regular cleaning. The problem here is that while its seems to be good it is only a surface treatment. The underlying periodontal problems are not being affected.

[rsat3acr]

@GrumpyBunny

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.

Nowhere near 25%, something like 1 to 5 percent, higher in boney impacted third molars. Dry socket does occur more in molars than non molars. Also dry socket is more likely in lowers v. uppers and smokers v. nonsmokers and older patients v. younger.

As you said very treatable. We always tell patients always to call if they think it is a problem. Don’t wait and live with it.

[Broomstick]

@kaylasdad99

What is your general recommendation to patients whose finances ONLY permit them to obtain a prophylactic, no wiggle room allowed?

F’rinstance, is it permitted for a patient to obtain the prophy, and schedule the more expensive procedure(s) for a later date?

@rsat3acr

No perio treatment comes first and then one can follow up with a prophy.

That being said, in the real world folks are diagnosed with perio all the time and get what they consider to be a regular cleaning. The problem here is that while its seems to be good it is only a surface treatment. The underlying periodontal problems are not being affected.

Yeah, it really sucks when you need deep scaling and don’t have the money to get it done. Period. I don’t know any dentists that work for free. I’ve got a half dozen coworkers right now whose teeth are literally falling out because they don’t have the money for a dentist. They keep getting told they need this or that procedure they simply can not afford. Hell, one of them pulled his own teeth because he couldn’t afford even that.

Sorry to sound hostile, rsat3acr, but this is a real problem for quite a few people on the bottom of the economic ladder. Why do poor people have gap-toothed smiles? Because they don’t have money for a dentist. Coworkers half my age are missing teeth, or have decay obvious to a layperson, grey or blackened teeth, bright red and swollen gums… It’s terrible and sad, but if you don’t have the money in this society you don’t have access.

This year, for the first time, adults in my state on state-subsidized insurance are able to get dental coverage. The dentist I am going to see tomorrow is one of the minority who decided to accept those patients at the rate the state set for reimbursement. He told me he’s seen a LOT of disasters walking in the door, people who haven’t had dental care in years or even decades. I’m one of the lucky ones… but then, most of my life I have had access to dental care and used it, I’m diligent about oral hygiene, and I probably have good genes when it comes to teeth.

[Robert163]

i hope everything works out for you, i hate going to the dentist at all, any added complications only make that worse

[Broomstick]

@rsat3acr

As you said very treatable. We always tell patients always to call if they think it is a problem. Don’t wait and live with it.

Oh, yeah - if something like happens the dentist is getting a phone call.

A couple years ago my spouse had an extraction that resulted in a dry socket and a perforated sinus. Painful, but treatable. Mentioned it in a thread back then, but my Google-fu is weak tonight and anyhow, probably best I don’t revisit it tonight.

[rsat3acr]

@Broomstick

Yeah, it really sucks when you need deep scaling and don’t have the money to get it done. Period. I don’t know any dentists that work for free. I’ve got a half dozen coworkers right now whose teeth are literally falling out because they don’t have the money for a dentist. They keep getting told they need this or that procedure they simply can not afford. Hell, one of them pulled his own teeth because he couldn’t afford even that.

Sorry to sound hostile, rsat3acr, but this is a real problem for quite a few people on the bottom of the economic ladder. Why do poor people have gap-toothed smiles? Because they don’t have money for a dentist. Coworkers half my age are missing teeth, or have decay obvious to a layperson, grey or blackened teeth, bright red and swollen gums… It’s terrible and sad, but if you don’t have the money in this society you don’t have access.

This year, for the first time, adults in my state on state-subsidized insurance are able to get dental coverage. The dentist I am going to see tomorrow is one of the minority who decided to accept those patients at the rate the state set for reimbursement. He told me he’s seen a LOT of disasters walking in the door, people who haven’t had dental care in years or even decades. I’m one of the lucky ones… but then, most of my life I have had access to dental care and used it, I’m diligent about oral hygiene, and I probably have good genes when it comes to teeth.

Yes it can be tough for the truly needy, however a lot of it comes down to choices. Virtually everyone that tells me they can’t afford treatment has cable TV, a cell phone,smoke etc. Many people could afford a little treatment a year but don’t care or understand about dental care and wait until it gets bad and would cost a lot more. Not a week goes by that I don’t pull a tooth that the person can’t afford a root canal, build up and crown for $2500. Of course three years ago could have fixed it with a $125 filling. Same for periodontal care regular upkeep is the key. Of course a lot of those people also never floss and don’t brush much.

[Broomstick]

Yeah, well, I don’t have cable, don’t smoke, never eat out, haven’t bought new clothes for several years, etc. and no, I really didn’t have the money for a routine dental visit for several years. I get what you’re saying, you’re right those people exist, but when I’m scavenging cans alongside the road after a full shift at work and trying to sell off possessions hoping I can make rent only a week late this month no, I really don’t have money to pay cash out of pocket for dental care. Having people turn around and imply I give up luxuries I don’t actually have to pay for it is salt in the wound.

Things have gotten better for me this past year or so, I’m not so desperately poor and I’m able to take better care of myself, which is a relief. I’m still pissed off that in this supposedly great country the poor can’t get routine health care that is given as a matter of course to citizens in most of the rest of the civilized world. Yeah, you might have to get on a waiting list in the UK for that, but at least there is a list to get onto no matter how poor you are.

[KarlGrenze]

Broomstick, how did the extraction go?

Last year I had to have a tooth extracted. I knew for years that this was the worst of all of my wisdom teeth, but I had decided to let it be until it bothered me. Well, last year, the stupid thing did.

I tried taking it out with local anesthesia, but I think in part because at the time I had an active infection, and in part because, well, I was feeling it, the dentist opted to refer me and had me put under general anesthesia.

It took longer, but in the meantime I got scripts for pain meds (I love tramadol) and antibiotics (yay, infection cleared!). The swelling disappeared with the antibiotics, and the surgery to remove it went very well.

My tooth was so decayed and bad that I think my mouth was actually happy to having it out. I was diligent with the gauze and clamping down, but I didn’t need the pain meds after the first couple of days (took them as precaution more than actual pain), and was eating semi-solid food on the other side of the mouth by the weekend. After a week, my mouth was “YAY, normal!”.

I hope it goes that way for you, too.

[Broomstick]

@KarlGrenze

Broomstick, how did the extraction go?

Hasn’t happened quite yet, I’ll be getting ready to go soon, my appointment is at 2 pm Central US time. Depending on how I feel later I’ll update tonight or maybe tomorrow.

I really do not want general anesthesia. My experiences with being awake during surgery has been positive I can deal with the sound effects.

[KarlGrenze]

@Broomstick

Hasn’t happened quite yet, I’ll be getting ready to go soon, my appointment is at 2 pm Central US time. Depending on how I feel later I’ll update tonight or maybe tomorrow.

I really do not want general anesthesia. My experiences with being awake during surgery has been positive I can deal with the sound effects.

The problem was not sound effects. The problem was that I could still feel despite having as much of the local anesthetic as they could apparently give me. My whole face was numb, save that pesky nerve connected to the decayed tooth that had to come out. THAT nerve was alive and kicking.

[Broomstick]

Well, yeah, if you can’t get satisfactory numbing from a local that makes sense…

OK, went in for the tooth pull. I did mention I was somewhat nervous and the dentist was very reassuring and explained exactly what was going to happen. Told me it was going to take longer to numb me up than to do the extraction.

Oh, and they had a picture of a puppy and kitten on the monitor in the room in eyeshot of the patient - very cute.

Anyhow, it did go as advertised. He thoroughly numbed me up, and I honestly didn’t feel the first needle. Did feel the second but it wasn’t too bad. Felt absolutely no pain whatsoever as he loosened the tooth and pulled it out, although I did feel the tugging and pulling. He was right, it did take longer to get numbed up than to have the tooth pulled.

He told me that state health regs wouldn’t let me take the tooth with me, but I did get to look it over. It was visibly decayed, with missing enamel along the one side and a stripe of grey near where the gumline had been. It wasn’t causing me any pain yet but it was pretty clear to a layperson this was not going to end well if something hadn’t been done. I actually found that reassuring in a way. Since I couldn’t see what was amiss with the tooth, and felt no pain in it, it was a bit hard to really believe it really needed to come out. Once I saw it though - oh, yeah, that had to be either fixed up (and no, I’m not spending that money on a wisdom tooth) or taken out. Best to take it out before it’s coming apart.

So, in retrospect, I’m glad I got it done now rather than waiting for pain to drive me to it. I got a script for some 800mg ibuprophen and some aceptamineophen with codeine for before I go to bed. He was quite generous with that, based on my own history with painful things I expect I won’t need them all but I’d rather have too many than not enough.

It’s three hours later and while the numbness is starting to wear off I’m not feeling any pain yet… upon advice I took an ibuprophen about an hour after I left the office so I’m hoping that heads off any pain.

Still a little bloody, but I expect that’s fairly normal. Minimal swelling, but then, there was minimal trauma - he really got that tooth out quick.

My upper left wisdom tooth is also apparently deteriorating but not as badly as the other. What with the other crap in my life (father dying, identity theft, and that’s just two) I want to heal up from this one first. Absolutely if I start having pain or some other indication of imminent problem I will call the dentist.

So… I still miss the old guy because he was a friend, but this fellow seems just as competent and I’m trusting him a lot more. Taking a couple minutes to answer questions and show me things really makes a difference.

Took my spouse along for moral support, and also to meet the dentist. He’ll be going in for a cleaning after we get back from the trip to see dad.

Think dinner is either going to be very soft and broken up noodle soup, or mashed potatoes, or a banana. I am really hungry because nothing seems to kill my appetite but I want to be cautious about things. Also, even though I’m not in pain my jaw doesn’t seem at all eager to open up much. Probably as uneventful as these things get, but there was still a bit of trauma to tissues and I need to do a little healing. The plan is to take it easy the next couple days, nothing more strenuous than doing the dishes.

[rsat3acr]

Broomstick, I hope you didn’t think my post was a personal attack or doubting your situation. If it came across that way I apologize, it isn’t how it was meant.

Wishing you the best and looking forward to tomorrows post.

Oh, I see you just posted. Glad it went well.

[Broomstick]

@rsat3acr

Broomstick, I hope you didn’t think my post was a personal attack or doubting your situation. If it came across that way I apologize, it isn’t how it was meant.

Likewise. I didn’t mean to come across as hostile. I’m sure you find the situation even more frustrating than I do at times since you have to deal with the results every day at work. It’s a flaw in our society and no one seems to have a ready answer for fixing it.

Also didn’t help I was under a bit of stress and worry, that never brings out my best.

Oh, I see you just posted. Glad it went well.

So far, yes - the numbness has completely worn off but the pain is also completely under control. Still feel a bit beat up, even though I don’t hurt, if that makes sense. It’s the sort of thing I associate with an injury or illness so I’ll treat it accordingly so it stays uneventful.

[rocking_chair]

always a good idea to take the pain meds before the numbness wears off. get ahead of it. also an ice pack or cold pack when you go to bed helps.

good healing!