Anxious about losing teeth

[AnonG]

I had an emergency appointment last week for tooth pain (several areas have dull persistent pain, but mainly top right) and nearly finished a week course of antibiotics. Dentist said likely needed wisdom tooth out as x-ray showed bone loss and that tooth next to it was okay. I said I was panicking and he said not to panic it is manageable. However. a dentist I saw in May for a check-up at the same surgery said I would likely need the tooth next to it out if severe pain as deep filling (tooth had also cracked a bit which he filled). I also had twinges in other teeth (root canal bottom right and tooth with a temporary filling from about 4 years ago top left) which the recent dentist said could be referred pain. I’m now really anxious about what to do. I don’t want to start taking teeth out one by one until issue solved. I’m even anxious about phoning the surgery as they don’t like to give emergency appointments unless in severe pain but often 2-3 month wait for regular appointment. I’m going to try and get an emergency appointment in next few days but I’m really not sure what to say to the dentist. Should they give me a more in depth x-ray of whole mount to see what is going on? Should I ask them to take both teeth out? I’m so anxious I am going to need several teeth out and what the implications of that are. I am in my early 50s, can’t cope with this loss or afford implants. I have read on threads that most people can have about 6-8 teeth out and still eat okay. I have a small mouth so shouldn’t be able to see back teeth are missing (only saving grace!).

 

[Gordon]

Paragraphs are your friends I'm struggling to see what questions you're asking here, I'll try my best to answer what I can see, please ask again for stuff I missed.

Emergency appointments are generally for pain relief only, they're very unlikely to do any more x-rays or anything more than the minimum to get you out of pain.

Most people can eat fairly well with zero teeth. I used to have a patient who would remove his dentures before tucking into a granny smith apple

You probably don't want to go through life looking like a peasant from the 12th century, but you wouldn't starve!

 

[AnonG]

Hi Gordon, appreciate the humorous tone and reply the questions have a question mark at the end of the sentence excuse the block paragraph, I tend not to think of grammar and sentence structure when anxious.

Basically, I am confused about what to do. Since two dentists at the same surgery have said two different teeth may need to be extracted.

Dentist 1 - at a check up in May I had a cracked tooth (next to wisdom tooth), which he filled and said I may need to have it out if it causes severe pain as there is an existing deep filling and it would not be possible to do a root canal. No mention of wisdom tooth was made. X-rays were taken which showed the back three teeth at the top right.

Dentist 2 - a week ago at an emergency appointment, a different dentist said my wisdom tooth should come out as an x-ray showed bone loss which is causing the infection. He said tooth next to it was okay. X- ray showed back three teeth. I also said that other teeth were twinging a bit (only way I can describe it), which is lower tooth with a root canal from 5 years ago and upper left tooth with a temporary filling from about 3-4 years ago. He said this is likely referred pain.

I am now confused as to what to do. I really don’t want to start a process of elimination and have one tooth out and see how I go. I just want it resolved (which the emergency appointment has not done) as it is affecting my daily life.

 

[Gordon]

Getting a proper treatment plan worked out would be the best way forward, emergency appointments are OK for getting you out of pain but there's no treatment planning involved beyond that.
Emergency patients are usually slotted into a tiny gap in the appointment book and there's no real time to do much beyond the bare minimum.

FWIW then I'd probably start with removing the wisdom tooth. If it's showing a lot of bone loss and causing a pocket to form between it and the 2nd molar then it's not going to get better and needs to be gone.
If the 2nd molar is cracked then you'd be getting pretty definite symptoms from it, most commonly pain on biting but on release of force rather than on generation of the force, if you see what I mean.
Re-evaluating after the wisdom tooth is gone would be sensible.

Replacing the temp filling with a permanent filling would probably be the next step, assuming that the 2nd molar settled back down again. Temp fillings wear down fairly quickly so sensitivity around that would be likely.

 

[AnonG]

@Gordon Thanks so much for your reply, that makes sense. I will see if I can get a review. Fingers crossed I don’t have to wait 3 months and removing the wisdom tooth is straightforward and does the trick it makes me anxious just thinking about it

The dentist said the temporary filling was a longer term one (if they exist ) and not to touch it unless it hurts. I guess if it is twinging now, it’s time to review that.

Likewise, with the root canal. Really hope that settles down as that will be another extraction I imagine (trying very hard not to think the worse, but such a challenge when it comes to teeth), as not sure how easy it is to get or do a a second root canal?

Out of interest I don’t know if anyone knows what the score is with NHS check ups in the UK? I was told in May to book one for 12 months (so May 2027) and that if I wanted them every 6 months I would have to pay privately for the one at 6 months, but I can’t see anything about this on the NHS website.

 

[justtryingtohelp]

@AnonG Hi there, usually the dentist would recommend when the next exam should take place. We usually see patients every 3-24 months, depending on the clinical judgement.

Hope you manage to get that wisdom tooth out as soon as possible. All the best

 

[AnonG]

Thank you earliest appointment I could get is next week for a check-up (least it is not months ).

I told the receptionist I needed a review and treatment plan, and they said an emergency appointment and check-up were both scheduled for 15 mins. They suggested phoning again tomorrow to see if can get emergency appointment (they were all gone today).

 

[Gordon]

Likewise, with the root canal. Really hope that settles down as that will be another extraction I imagine (trying very hard not to think the worse, but such a challenge when it comes to teeth), as not sure how easy it is to get or do a a second root canal?

It's not much harder than doing the first root canal. Depends what it has been root filled with but anything in the last couple of decades won't be a problem.

Back in the old USSR days I came across a couple of patients who'd had root canals done over there. They used some kind of weird material which seemed to be actual cement! You couldn't get it out of there for all the money in the world!

 

[AnonG]

Thank you that is good to know, there is hope!

Oh wow a bit of vodka and cement and on you go perhaps they were spies carrying micro Soviet technology

 

[Gordon]

Some of their dentistry was pretty "wild", stainless steel crowns on front teeth (!) if you wanted white ones you had to go on the black market and even those were just cheap acrylic things.
I had a (very good looking) young lady patient from Moscow who had 2 stainless crowns on her 2 front teeth, after I replaced them with porcelain ones I thought she was going to have a complete breakdown in the chair

 

[AnonG]

It sounds like you have had an interesting career!

What a lovely story/memory and an amazing gift for this patient. I bet she still remembers you to this date as the person who changed her life

Update on my case: I saw a senior dentist this morning and they said I don’t need any extractions and that my anxiety/stress (and maybe grinding in sleep) is making things worse and that things should settle down. Fingers crossed. They have 40 years experience so I guess in need to have some faith and trust

 

[AnonG]

Update: things haven’t settled down

I was really hopeful and relieved after seeing the senior dentist at my surgery, but I still have a dull persistent pain in more than one tooth despite taking ibuprofen for 4 days (as they recommended). I don’t think I am grinding my teeth and have really tried to relax this week and not worry. They feel a bit tender when I bite down and it is a niggling pain rather than sharp or severe. Sometimes I don’t feel the pain and I think everything is okay and then it comes back.

I really don’t know what to do next so feel at a loss and quite depressed about it all now and avoiding people as it is constantly on my mind.

I am also perimenopausal and wondering if that could making things worse?

Do I go back and ask them to re-review? I’m worried the only option could be to start taking teeth out until the pain goes, but really don’t want to do that.

Do I get a private appointment and see what they say (thinking about it as an option as there’s one near me with an offer on for a check-up and 2 x-rays)? Although not sure I could afford to pay for private treatment.

Neither dentist took an x-ray of the root canal tooth which is bottom right (maybe because both appointments were emergency ones and they were focusing on the top right back teeth) but I guess if that is hurting then the only option is to try re-retreatment (if they will) or extraction. There is a bit of an itchy sensation sometimes too which makes me think it is infected somewhere. Then there is the wisdom tooth and tooth next to it which could also be extractions. This is terrifying.

 

[Gordon]

Do I go back and ask them to re-review?

Yes. As I've said before, you need a proper complete examination, followed by a diagnosis and a treatment plan, not emergency appointments.

An x-ray of the root canal would be helpful too.

 

[AnonG]

Earliest review appointment I could get is 7 August

 

[AnonG]

I paid for a private appointment today as the anxiety was getting me down. I came out in tears and was shaking.

The dentist started off friendly, listened to my concerns, and said reassuring words whilst the X-rays were taken, but when it came to breaking the bad news I didn’t find them very empathic. They just kept pointing to the x-rays and saying numbers related to teeth and I said I was finding it hard to understand which teeth they were referring to. I understand that medical professionals have to be to the point, but some level of empathy would make a huge difference. They asked me if I had any questions and I said I was struggling to take everything in and was in shock as I had gone from one dentist telling me no treatment was needed to the other end of the spectrum. I burst in to tears when I got in the car. Surely, there should be some duty of care to make sure your patients are okay before leaving. Maybe this is just me though. I have background as a therapist/counsellor (ironic given my anxiety) and was trained to make sure patients were grounded before leaving.

Anyway, they did a thorough exam including 4 X-rays.
Positive: No infection. Front teeth okay.
Negative: treatment plan of £2245. Including all wisdoms out not sure I can cope with that. How do you cope with it? What is the recovery time? How many do people normally have out at once? Periodontal consultation for gum disease. Also some other fillings and a crown. I suspected the tooth with a temporary filling needed a proper filling, although the NHS dentist didn’t say so, which they have included (UL5). They said the filling was near the nerve or root (I can’t remember) so could be possible root canal but haven’t included this in the treatment plan. They said tooth with existing root canal was okay though and that has been hurting so it doesn’t make sense to me.

I am not sure what to do now.
Do I pay for the private treatment plan (on my credit card) and just get it done?
Do I go to the NHS appointment still on the 7th August and show them the treatment plan and see if they agree and how much the treatment would be with them?
The NHS surgery seems a better environment for me ( I do experience environmental sensitivity/sensory processing sensitivity, which is a personality trait not a disorder) and the dentists there are friendly, but I’m concerned that they have not picked up on the treatment that the private dentist has said I needed. Then there are the suspicions (as posted by others on forums) that private dentists may recommend treatment to get more money. However, I obviously need treatment and I’m sure this can be proven by the X-rays (I took photos of them).

Any advice would be appreciated. I’m so sorry I keep posting. I appreciate all the support so far.

ps. I also think I witnessed a possible GDPR breach at the private dentist. A man was at the reception booking another appointment and he asked if his wife had an appointment on that particular day. The receptionist asked for her name, and then said we don't have that name on record, but then give a different name and the man said that is her maiden name, and then the receptionist said oh okay I will change that on the system. I know this all probably very innocent but what if said wife was a domestic abuse victim?

 

[Gordon]

I'll start with the easy one. The receptionist needs a stern reminder about patient confidentiality. Write or e-mail to the Practice Manager of the practice and give them the details of what you heard.It's not acceptable.

I was once involved (somewhat peripherally) in an utter shit show a few years ago when a dental receptionist shot her mouth off in the street to a patient's husband... She thought she was being nice but oh boy, she messed up so badly. it finished up with a GDC complaint about the dentist and an awful lot of sleepless nights for him.

On to the harder stuff... you get some dentists who are superbly talented clinicians, they have what we used to call "golden hands". They put the rest of us to shame with their skills. But they have almost no "human skills" whatever, i suspect it's why they are so good technically. We've had a few threads on here where folks have met them. They generally attract a group of patients who either don't care about the interpersonal stuff or put up with it for the superb clinical results.
There are another thankfully small group who are hopeless clinically but have amazing people skills. I've seen the results of one or two of those, adored by their patients and with a mouth full of problems. I know of one guy who was struck off by the GDC for utter incompetence and yet his patients were determined they would return to his practice if they could...

I'd really rather be treated by one of the former than the latter Which is my long winded way to say, don't be too upset by this guy's demeanour, he might well be excellent at fixing your teeth if you can get past the attitude problem

As for wisdom teeth, if they are being done under GA then it's usually 4 at a time, if under local then one side then the other a month later. The overwhelming majority of 3rd molars are removed with no drama or post op. complications whatever, it's the very small number of weird ones that give them all a bad name.

Even those ones, the biggest complication afterwards is a bit of swelling and stiffness or limited mouth opening, both of which last less than a week at worst.

NHS dentists in England are paid a fixed fee whether they do one filling or several, not a great incentive to go looking for cavities.

Hope i've not missed out anything.