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Anxious about having to tell to dentist to reconsider his diagnosis



Jan 24, 2017
Hi all,

hope you're well and pain free. Appologies for this being so long.

I've recently moved house and signed up with a new dentist, and as you can imagine I have severy anxiety over the appointment next Monday. I seriously thought I was alright but I woke up 3 times last night shivering so I know things are not good but the thing is I don't know why. Well, I sort of do but I know this is a routine treatment so I shouldn't panic but my body says otherwise. Most of you definitely have it so much harder than me and you are a true inspiration but any advice you can share about how to approach and not end up sounding like i'm nuts would be very welcome.

In short, I have a chronic abscess that drains through fistula on my gum, and it's been going on for some 9 months to a year now. When it originally appeared it was hurting a lot, I went to my dentist at the time who got it drained and the looking at x-ray he said he can't see anything around roots so it's either gingival abscess or my periodontal pocket got blocked (I had/have a deep one at that tooth, i treated it and had 3 deep cleanings to maintain since). He said it's draining so it shouldn't be a problem to wait for a bit. Since it was pain free and I didn't have a dentist at my new place (different country), and I was plenty busy with the move, the time just flew by. Usually I'm dilligent with going to the dentist but this time a year passed. In general my teeth are not the best due to having a really bad dentist from when I was a kid to when I was 27 (now I'm 38) when I was diagnoised with advanced gingivitis/early paradontitis, and genetics (my parents and grandparents all had dentures by 55). My dentist at the time never told me that cleaning of calculus was needed or that I should use floss, or that I should fix my bite so it just went on until the things went really bad and I changed her for someone who actually knew what he was doing. Her solution to everything was to put a filling so I have some 15-16 fillings, fair few of them amalgam, but I turned the tide since, and have good hygiene. I only have one crown and no extractions. Horrible bite through.

Anyway, since few other bits and bobs are now giving me grief (one filling chipped and tooth tender and I think that that one crown is a bit high and hitting the tooth above) I decided to go for a check up based on a recommendation and it was quite good if I'm honest. They've done x-rays, had a look around but when we came to abscess was where the trouble started. It's like the dentist is not really listening to me. He's patient and explains stuff, and he sounded very knowledgable and described the abscess and options perfectly fine but he insists that it is a periapical abscess and not periodontal one. I've told him about my medical history and all he said is that he doesn't think that's the case as the tooth has deep filling which he thinks is the culprit. He thinks the tooth is dead and he wants to do a route canal and crown, and expects 80% success rate, it being first molar, and I said fine, everything is better than extraction. So I booked appointment for this Monday to do RTC but when I left the surgery I started thinking - he hasn't actually tested the vitality of the tooth or looked whether I actually have a blockage in the periodontal pocket. He hasn't checked the the depth of the pocket. And the tooth feels vital to me anyway.

This was really worrying me so I've asked on the dentists support forum and DRM has been kind enough to reply that vitality should be checked before any treatment is attempted and that it can't be abscess from a root if the tooth is vital. So to improvise the test I've picked a bit of frozen vegetable and placed it against the tooth in question and lo and behold, tooth responds in exactly the same way as the other teeth next to it.

There is a response that quickly disappears. The thing here is that from what I'm reading periapical and periodontal abscesses have completely different treatments and one won't resolve the other so if indeed I have a periodontal abscess, he will do RCT and crown for nothing leaving my tooth fragile and with a unresolved periodontal pocket. It will inevitably end up in extraction but if it is periodontal, in best case it might be just a matter of cleaning the pocket and job done.

In short I'm planning to stop him and ask him to reconsider and do the vitality and pocket tests first. Since we already booked RCT I wanted to be polite and called the receptionist telling them that there is chance we won't need to do RCT but she was dismissive straight away, explaining again what periapical abscess is and discounting the periodontal one. I gave her the diferrences between the two and my medical history but I don't think she liked me being the knowsitall. She said I'll need to discuss this with the dentist then but I got the impression she thought I was a troublemaker.

This is causing me massive amount of anxiety now. How do I approach this without ruining the relationship with a dentist and sounding like a nutcase? I realise the doctors and dentists absolutely hate patients diagnosing themselves. Am I wrong to insists and just follow what he says even though it feels he hasn't done his job properly? I just don't know. Perhaps I should trust him. I don't mind having RCT or a crown, I just don't want to do something that might not be necessary and cause me harm in the long run. This tooth will probably have to be RCTd sometime in the future when amalgam eventually fails but I was hoping to buy it a few more years, if at all possible. I know the easiest solution might be to find another dentist but multiple people tell me this is the best one in the area so I don't know what to do.

Anyway, I was just hoping to ask him to do vitality tests and check the pocket on the tooth. If the pocket is there, to then periodontally treat the pocket and there's no complications, the abscess should disappear within weeks. If it doesn't, then they can proceed with RCT and crown, but then we would treat both and there would be greater chance of success for RCT and crown. Does that make any sense?

Sorry about going on for so long. I just need to tell all this somewhere and it's keeps buzzing around my head. Thanks everyone.
Hmm, dentists (and other healthcare providers) sure can be stubborn. :p Perhaps you could simply say you don't want the RTC unless the dentist does a vitality test on the tooth first. You can tell him you're basing your opinion on the advice of another dentist. If he doesn't like that then, "best dentist in the area" or not, he's not worth the time. A dentist who doesn't listen to their patient is *not* actually a great dentist. It's not like you're being super unreasonable here: you've been dealing with this problem for a long time. It's not like you developed symptoms yesterday and Googled them for a diagnosis, y'know? You're the customer, so if he doesn't meet your needs, go elsewhere. And don't let him convince you to do any procedure you're not sure of.