Ms. CAM Goes to the Dentist

With some encouragement from kind members in the Support section of this website, I recently had my first dentist appointment in 15 years. I benefited so much from reading these journals so I figured I ought to start my own.

Background:
My immediate family is full of bad teeth/denture wearers so I never had a lot of role models when it came to good habits. My parents did work hard to ensure dental visits in our early years even paying for some early orthodontia but I remember each visit as a time of fear and judgement. The minute I was old enough to make my own choices, I decided to make a poor one and stop going. This was around the age of 17. When I was 20 I was studying abroad in the UK and had an abscess form that swelled up the entire side of my face. I sought emergency care and told the dentist I'd follow up to get a real filing in that tooth when I returned to Canada. But, I didn't. I'm 35 now and in the years since that emergency trip I've had filings fall out of two teeth and one tooth break off. But, there was no pain and they were in places in my mouth that I could hide so I just buried my head in the sand. Fear, shame, and lack of funds slowly turned me into someone who never smiled and who changed her diet to accommodate her teeth. There always seemed to be some big life thing that justified ignoring it all for just a bit longer. I'll do it when I finish this PhD. I can't do it now because my Dad is dying. I can't do it now because my Mom is dying. I can't do it now because I am in debt etc.

At the start of 2016 a few things happened that made me ready to take the plunge. First, one of the teeth that lost a filling really started to feel weird. I knew it was going to break further and I started eating only soft foods. It occurred to me that I don't want a soft food diet for the next 35 years. Second, I found this board and took away the lesson that almost nobody regrets getting started on the journey to better teeth and in fact many people write about wishing they could have gotten started sooner. Third, I do still have debt but I also have a small inheritance of $10K and before something else 'life' related pops up, now is the time to put that toward my mouth. I was gearing up to get started this summer. But, when the tooth broke I mustered the courage to make an appointment.

The First Visit:
I used the tips others have shared about looking for a 'caters to cowards' or sedation dentist in my area. I poured over every website and finally settled on a dentist that hit a couple of my key buttons. My dentist (-- so strange to write that... I have a dentist!!) is committed to continuing education and as a result has certification in a couple of specialties. She is a general dentist but is also certified to do cosmetic work and orthodontia. Her staff are trained to do advanced periodontal work. This was important to me for a couple of reasons. First, it signaled to me that she wants to be the BEST at what she does and that my problematic mouth would be a puzzle she would take pride in solving. And, second, for me I knew I was only going to get in the door of one place. I feared if I needed to see additional specialists I would come up with excuses not to make the appointment. I liked that she was a woman. I liked that she does pro bono work for a local women's shelter. I liked that the office was close to my place of work. And, I liked that conscious sedation was an option. All these years I have been paying for crappy dental insurance and she is out of network but I was willing to forgo the $1,500/year in coverage to be in the hands of the right person. I filled out the online appointment request form asking for a new patient consultation.

The treatment co-ordinator gave me a call a couple of days later. She explained what would happen at that first meeting-- Xrays, a visual examination, and photos of the teeth. She said they have many dental phobics and not to worry. She also took my insurance info because sometimes they do allow out of network care. As it turns out, this same sweet woman did my xrays and teeth photos. She was so patient and kind. I only cried a little--mostly out of embarrassment. I have a small mouth so I didn't love all the tooth by tooth xray and photo shennanigans but I survived. I also said I didn't want to see the pictures and they honored that without question. She and the dentist even looked at them in the hall so I wouldn't accidentally catch a glimpse.

The plan:
I need three extractions of teeth that were broken (one is a wisdom tooth) and have some periodontal disease that requires root planing and scaling. My next visit will involve all of this being done with conscious sedation. This is the first step of what will be a long road. I will max out my insurance doing this. After this has healed we will make a further plan. The dentist noted my tooth enamel did not develop properly and recommends crowns. My bite is off which will require braces. As much as I don't want braces as an adult, I was pleasantly surprised that my teeth are worth saving. In my darkest days I envisioned total extraction. They are going to do a 3D model of my mouth to determine which bite issues can be addressed with restoration and which will require braces. If I do go with braces I'll have provisional crowns. I am hoping this will give me some time to save money.

I felt great after the first visit but the wait until the next visit (Feb. 24th) has me googling around and imagining the worst again. You will be seeing me around these parts for many months to come!

Yesterday was my first big appointment-- I had rood scaling and planning for the full mouth (aka deep clean) and four extractions. The extractions were for 3 teeth that have previously broken to the gum line and could not be saved and 1 extraction was a decayed wisdom tooth (gross). I chose to go with oral sedation.

They gave me pre-appointment Valium for the night before and 1 hour before. It did make me sleepier than normal but didn't given me an euphoric feelings and there were still some tears. Given some of the other side effects of valium in future I might just opt for a couple of margaritas.

At the office I was given two pills. At first I was afraid they weren't working-- but they must have because I allowed all this work to happen and only have in and out memories of them asking me to open wide etc. I felt no pain, saw no needles, and remember very little sound. Most of what I remember is the awkward feeling of so much stuff in my mouth.

I am not having much pain yet and have been resisting the urge to play with my tongue and feel my new mouth. My lips hurt like heck (and were huge yesterday) from having been stretched out so much.

I have a post-op appointment in 10 days and I assume there I will get a run down of what comes next. I still have fears that they will tell me that my teeth can't be saved or that it is worse than what they first thought but I am trying to take it one day at a time.

cam

Well, since I last wrote I had my post-op appointment. It lasted less than 10 minutes and the dentist just irrigated the area and looked to ensure the extraction sites were ok. She said my next appointment (about a month from now) would be periodontal maintenance and a discussion of what's next. I had been hoping to know sooner (as in right then and there) what I should be budgeting for. But, it also made sense to me that they might want to see how things healed/whether the deep cleaning "worked" before making decisions. And, I was so happy at not having cried at all (major victory) that I didn't want to tempt fate with a bunch of questions.

Today, I am having a low day. The fear and hypochondria is back big time. Some of my teeth looked so white after that deep clean and I feel like I have ruined them by sneaking a few diet cokes/sugary Starbucks coffee concoctions (a major addiction in the past and one that I totally eliminated out of fear for 2 months). Of course, I brush but I have bad enamel and know I should cut this stuff out completely. I'm also supposed to do 5 salt water rinses a day and usually only manage three. I also never adopted a good flossing habit and since I got extractions at the same time as deep clean I allowed myself not to floss for the first week for fear of damaging the extraction site. Lots of beating myself up over here. I need to start flossing but don't know where to begin-- any recommended products or tips from those of you who developed this skill/habit later in life?

More than anything I am terrified that the "deep clean" didn't work and that my periodontal disease can't be controlled and that I am heading down the dentures path. The irony is that I was prepared for that at the beginning of this process but have now become invested (literally-- $2000 and counting...) in keeping every tooth I can.

This has been a lot of rambling but I guess I am writing part as therapy to myself and part to remind myself that just going to the dentist and not canceling appointments alone means I am doing more for my teeth than I have in years and it can only get better not worse.

If anyone who has had a deep clean happens upon this... did you also have fears/experiences of it not working? Any advice? Talk some sense into me please!

Hi! I understand how it is frustrating to not know next steps and have any answers, because that was how it was for me with the orthodontics - I went something like 7 months in between my first orthodontic consult and when I was finally given a treatment plan. Part of it was that I needed to get everything healthy again, but the other part of it was that my orthodontist wanted to absolutely make sure everything would be in place before he told me anything so that there weren't any surprises later on. So, it's frustrating, it makes sense. One step at a time - better to have a solid plan and foundation, than to rush into things and have something go awry later on down the line.

I didn't need a deep cleaning, so I can't comment on that, but don't beat yourself up too much. I've been good about limiting the sugar in my diet recently (partially inspired by trying to prevent future dental issues, but also for better health too!), but I went off the rails last week (I ate an entire bag of Peachy Os the other day. I blame it on the fact that the braces are coming on in a couple weeks and I won't be able to eat any for ~3 years!). My understanding is that periodontal disease is a slow-progressing disease anyway, so if you start taking steps, even baby steps, to try to prevent future issues now, you probably will be able to keep your teeth for a lifetime. I had never been a flosser all my life, until I started getting all my dental issues sorted out recently. I made a promise to myself back then that if I were to ever get my teeth fixed, then I would make an effort to take care of them. So I started flossing every day (they didn't even really have to force me into it, I just did it. HAHA). My hygienist told me that it only takes a few weeks of regular flossing to get the tissues completely healthy again. I knew this from practice, because in between my first cleaning last summer, and a second one I got for fine-tuning a few weeks later, the hygienist had commented that my gums had firmed up quite a bit and turned pink.

I get that it is a royal pain in the ass, but I do it anyway - even if I am feeling too lazy or tired - because I know that if I skip a day, then it will turn into a week, and then it will turn into a month. Maybe bribe yourself a bit, and tell yourself that if you do it every day for a week, or a month, or whatever, then you will treat yourself somehow . This kind of thing works for me. But just try to take it one day at a time. That's what I did. But now that it's become a regular thing in my life, I don't think much of it anymore. I just do it. It gets easier the more you do it. I went in for my regular six-month cleaning last week, and the hygienist was SOOOO happy because she could tell that I was doing it. That made me happy too, because I know that I've really been working at it. Then she dropped the bomb on me that it will probably take me something like 15 minutes to floss in braces, which will be a challenge, but I know it becomes 10 times more important then and that it is worth doing it then.

My boyfriend, who has been a regular flosser all his life, swears by using floss picks instead of regular string floss.

Anyway, hope this helps somewhat. Good luck! Just take it one step at a time. You are doing so, so well

Thanks for the encouragement, littlethings! I'm going to try to remember each day is a new chance to floss more and eat less sugar.

As an update, I have had some success with my front teeth. The sensation does feel weird and even though there is no movement, I am irrationally afraid of pulling a tooth out. But, when I see gross things come out, I see why it is important!! But, I just cannot seem to reach my back teeth.

Since I last wrote I had my first hygienist visit. I survived with the help of nitrous. I was relieved to learn that the scaling and root planing had reduced my pockets. I still had a bit of puffiness and was advised to upgrade to an electric toothbrush. At that appointment I set up a follow up visit to discuss next steps in my treatment plan.

I probably should have asked more questions in advance. I had assumed I would just be poked/prodded a bit by the dentist. I was surprised when instead I had a 3D scan and impressions made. I was also surprised by the $500 price tag. My dentist will now study these digital models and develop my treatment plan. I come back next week for the consultation. On the upside, I didn't cry in the office. On the downside, I have another week to come up with worst case scenarios and worry about whether or not I am going to be able to afford what comes next (braces+ crowns/implants)

I also survived my treatment plan consultation visit without tears. My next steps include:

- Root Canal + Provisional Crown
- Removal of one wisdom tooth
- Two fillings
- Braces for open bite

I'm having the root canal this Wednesday. I'm nervous because my dentist refers these out to an endodontist. He comes highly recommended and is just one floor down from my general dentist but since I think embarrassment + fear of the unknown are my big triggers I'm worried about visiting someone new. My general dentist would also like him to test a few other teeth which makes me nervous. I am not in any pain (even from the tooth that is getting the RCT) but I've still managed to obsess about scenarios ranging from all my teeth are actually dead so that's why I don't feel pain to the more likely outcome that I'll need at least one more root canal and am not sure how I'll be able to afford it right away.

The other restorative work I'll have done under conscious sedation. I'm okay with that.

The braces are going to have to wait a couple of months until I can regroup financially after this last big hit ($1700 for the RCT, $2200 for the rest)

Blerg.

Well, I am still numb from the root canal. There were a few tears with a new face-- but both the assistant and the endodontist were amazing. And, it really was just this one tooth in spite of all my fears to the contrary. All my other teeth are "vital". Vital and expensive but vital. I'll take it.

I survived another marathon sedation session-- down one wisdom tooth, up one crown and two filings. When my general dentist heard that I had done the root canal with just Nitrous she asked if I felt like I could graduate? I do! Were it not for the wisdom tooth, I think I could have done this last appointment without oral sedation and just Nitrous. Progress!

I am basically caught up now after 15+ years of neglect. I have to stay on top of my periodontis and do all the normal people things. The elephant in the room and next challenge is braces. I've decided that I want to save up the $ so that I can do it without debt. I am hoping that taking on some contract work teaching a class over the summer will help with that.

I'll confess my hygenine is so much better but I do have nightmares about the braces coming off and leaving me with ugly decayed teeth. Unfortunately, the braces are for bite/jaw issues more than cosmetics.

In short, I can't believe how far I've come since my first journal entry. We can do this!

Now off to get acquainted with the Archwired forum

Congratulations - well done!

I'm on Archwired too - it has been an invaluable resource for me, especially since the braces thing can sometimes be really overwhelming. It's nice to know that there are other people going through the same thing as you as well.

I can definitely relate to the worrying about not keeping up the oral hygiene and having nightmares that your teeth are going to decay and crumble underneath the braces. It does take more time and effort to care for your teeth in braces, but it does get easier and faster as you become used to it. And, according to the folks on Archwired, as long as you are doing a reasonably good job of keeping things clean, you should be ok.

Well, just as I was getting a little cocky, the universe is keeping me in check. I walked into the dentist this morning for a routine follow up on my wisdom tooth extraction. I was congratulating myself for how at ease I was and feeling like I have made so many improvements in the last 5 months.

And, then, in spite of my brushing and flossing, the dentist found a piece of food stuck in my tooth. EMBARRASSING. She did suggest a water flosser but was generally nice about it. I'm trying to shrug it off like your fly being down on your pants or lipstick on your teeth. But, it is easy to get sucked into the spiral of feeling like you still aren't doing things well enough.