Can dental infections cause other problems/unwellness? Help please...

[K.M]

Have posted here before re teeth and extreme dental medical fear due to traumas. Current deteriation. Three teeth further constant pus, pain, two loose. Unable to eat, talking minimal due to looseness. Last two days only soya milk. Today lower back ache pain, constant urge to urinate, but nothing, general very unwell-are these related to dental? How to do medical dental care? when very traumatised, constant flashbacks and dissociation. Have no support to call on if further unwell.

 

[Gordon]

Not directly related to your dental issues but probably a sign that your generally debilitated you're not eating properly and the constant pain will be dragging you down.

 

[K.M]

Not directly related to your dental issues but probably a sign that your generally debilitated you're not eating properly and the constant pain will be dragging you down.

Thankyou for replying. Hear you, nodding. Will be buying some soup and easy to eat/ swallow food tomorrow. Have also upped the vitamin C further along with existing co enzyme Q10, B complex, magnesium, multivitamin.

 

[Gordon]

That's a good idea You might want to bump your Vitamin D a bit, given you're not going out in the sun much.

 

[K.M]

That's a good idea You might want to bump your Vitamin D a bit, given you're not going out in the sun much.

True, you must have known, have been sitting in the sun with herbal teas. Thankyou for replying and your care. If you are able to expand on this question, it would be very much appreciated: have you or colleagues worked with someone with Dissociative Identity Disorder and PTSD; many vast significant traumas, some involving the mouth/head, if so what are some tools, advice you use and share to support someone requiring extensive dental work under general anaesethetic, as in approach to extreme dental fear triggering traumas and related dissociation and minimising current pain (as above post) before surgery. It feels like a catch 22, status quo and any surgery; both situations retraumatising, not good. Any thoughts, experience please?

 

[Gordon]

Only one or two to my direct knowledge. I was basically working under the guidance of their mental health team, so my involvement was basically to do what I was told by their psychiatrist.

We arranged day surgery, the patient made several visits in advance accompanied by a couple of trusted people to familiarise themselves with the unit and staff, before that, my dental nurse and I met with the patients a few times in a non-clinical environment again with their support staff in accompaniment. We made sure they didn't have to hang about waiting to be seen, they were first on the list and we basically took them straight from reception into treatment area.

Following the surgery we did any necessary denture work in the patient's home, again with trusted people present although by that point I think Lesley and I were also trusted.

Pain after surgery wasn't a big issue, I put in some very long acting local anaesthetic round the extraction sites which gives about 16-18 hrs numbness for one patient, the other decided that they would rather have some slight discomfort on waking than be numb for that length of time.

Generally extractions don't cause a huge amount of pain afterwards, providing they are straightforward extractions and barring unusual events like dry socket. The anaesthetist normally pops in a bit of pain relief towards the end of the procedure and by the time that's worn off, paracetamol/aspirin/ibuprofen should work fine.

 

[K.M]

Only one or two to my direct knowledge. I was basically working under the guidance of their mental health team, so my involvement was basically to do what I was told by their psychiatrist.

We arranged day surgery, the patient made several visits in advance accompanied by a couple of trusted people to familiarise themselves with the unit and staff, before that, my dental nurse and I met with the patients a few times in a non-clinical environment again with their support staff in accompaniment. We made sure they didn't have to hang about waiting to be seen, they were first on the list and we basically took them straight from reception into treatment area.

Following the surgery we did any necessary denture work in the patient's home, again with trusted people present although by that point I think Lesley and I were also trusted.

Pain after surgery wasn't a big issue, I put in some very long acting local anaesthetic round the extraction sites which gives about 16-18 hrs numbness for one patient, the other decided that they would rather have some slight discomfort on waking than be numb for that length of time.

Generally extractions don't cause a huge amount of pain afterwards, providing they are straightforward extractions and barring unusual events like dry socket. The anaesthetist normally pops in a bit of pain relief towards the end of the procedure and by the time that's worn off, paracetamol/aspirin/ibuprofen should work fine.

Thankyou so much for this informative perspective. Your approach in special needs dentistry is trauma informed care, this is to be commended. Thankyou for sharing. Here in NZ, nothing has been offered or suggested by the mh team; left alone which adds to an already distressing overall situation. You can see the self health proactive measures taken re supplements. On a more personal note. The status quo with dental health is distressing as are the extractions (two baby molars both sides and top front tooth) needed and other work needed, ie scaling, detailed xrays etc under G.A. A catch 22, given multiple traumas that relate to teeth/mouth/head. Also due to traumas unable to have replacement for the top front tooth due to inability to have artificial in mouth setting off further distress (due to nature of traumas). No easy answers with this and it is very upsetting, distressing creating deteriation in mh, while trying to maintain physical health. Thankyou for replying and your time. Thank goodness for this forum and our heart goes out to all with dental, medical fears and phobias.

 

[Gordon]

Would a Maryland bridge be an option to replace the front tooth? Nothing to touch the palate or tongue areas. It could be fitted at the same time as the extraction under the GA, if you could manage to tolerate the impression before hand?

 

[K.M]

Would a Maryland bridge be an option to replace the front tooth? Nothing to touch the palate or tongue areas. It could be fitted at the same time as the extraction under the GA, if you could manage to tolerate the impression before hand?

The dentist has said thats not an option. They said its only temporary solution, as in only cosmetic and doesnt last long and can, will not be redone/fitted/bonded (when it falls out each time) under general anaesthetic. Its a funding issue (NZ public hospital dental dept). This is also upsetting as its funds vs distress with no solution. With the impression, that would scare; trigger us and the tooth is also very loose, would likely be pulled out as the impression is being done. We do not have the funds to go private, this could have been an option and/or second opinion, discuss solutions to a very complex situation. At the mercy of the public system, which adds to the lack of control/choice equals resembling traumas. Trusting this makes sense. What are the options that havent been considered please, in your opinion? given you now know the distressing nature of this issue overall and deteriation physically and mentally. Thankyou, you have been and are kind; feels like we are being heard fully.

 

[Gordon]

I would challenge that point of view, assuming you have a normal(ish) bite, and don't have too many parafunctional habits like biting nails, opening hair clasps etc, then I would not expect a Maryland to fail if it's done well.
I've had one patient who had cerebral palsy who had one in exactly your circumstances, he fell over unfortunately and knocked out the supporting tooth, with the Maryland still attached to it!
We finished up making him 2 Marylands to replace the 2 missing teeth, as far as I know he's still doing fine with them. He actually turned down free implants because he was happy with the Marylands.

No, you wouldn't get the tooth pulled out by the impression, it's really not that easy to remove even very loose teeth. If you were worried about it though, a small smear of vaseline over the loose tooth can help.

There aren't many other options, a conventional bridge would be difficult to do since you'd probably need 2 GAs fairly close together, one to prepare the bridge and one to cement it on, which is a bit more risky and couldn't really be justified for a purely cosmetic procedure (the 2nd one).

If you had enough support, could you tolerate the dentist removing the temp crown from your front tooth and cementing in the bridge? That would remove the 2nd GA, although I don't know if your PDS will pay for it?

The only other option would be to get a denture made during the GA, then see if you could work with your mental health folks to learn to tolerate it? At least for short periods when you were wanting to be sociable?

 

[K.M]

I would challenge that point of view, assuming you have a normal(ish) bite, and don't have too many parafunctional habits like biting nails, opening hair clasps etc, then I would not expect a Maryland to fail if it's done well.
I've had one patient who had cerebral palsy who had one in exactly your circumstances, he fell over unfortunately and knocked out the supporting tooth, with the Maryland still attached to it!
We finished up making him 2 Marylands to replace the 2 missing teeth, as far as I know he's still doing fine with them. He actually turned down free implants because he was happy with the Marylands.

No, you wouldn't get the tooth pulled out by the impression, it's really not that easy to remove even very loose teeth. If you were worried about it though, a small smear of vaseline over the loose tooth can help.

There aren't many other options, a conventional bridge would be difficult to do since you'd probably need 2 GAs fairly close together, one to prepare the bridge and one to cement it on, which is a bit more risky and couldn't really be justified for a purely cosmetic procedure (the 2nd one).

If you had enough support, could you tolerate the dentist removing the temp crown from your front tooth and cementing in the bridge? That would remove the 2nd GA, although I don't know if your PDS will pay for it?

The only other option would be to get a denture made during the GA, then see if you could work with your mental health folks to learn to tolerate it? At least for short periods when you were wanting to be sociable?

Thankyou kindly for your reply. Very interesting; would it be ok please to share your trusted opinion re challenge. This is extremely acutely valid given the circumstances. Hear you with the two very close G.A's, this would not be an option within the NZ public health system. The top right front tooth of concern is a natural adult one (no artificial crown) that is extremely loose, (receded; hangs lower) so presuming this is what you mean? With the denture, this would not be possible, due to vast previous mouth/head traumas and would be extremely triggering; an ongoing PTSD trigger as well as the upsetting confusion within (DID). We much prefer (if anything, but needs to be done) the bonding of artificial tooth to the left natural healthy stable tooth. Very much less invasive, do your patients find this so? And do you feel like its artificial, can it change speech, produce gagging or Any issues that your patients have at any stage experienced please? No we dont bite nails etc. We are being very very cautious in eating; soft foods, no biting. And only able to eat left side due to the lower right baby molar extremely loose (listed to be extracted) and now the left baby by molar is starting to play up with pus, likely as have been eating only this side. We are also very very cautious with brushing as anything too keen wobbles the loose teeth; its tiring being in a state of hypervigilence. When the top front one grates against the other one, a nasty sensation; PTSD panic sets in and inner turmoil exacerbating DID challenges. If teeth are this loose (we understand you cant see them, but maybe with the above description) are they easily "knocked out", "messy if that happens"? Worst worst nightmare. Some clarity of the status quo until treatment would be helpfully supportive if you are able, from afar. Thankyou and very much appreciate your time in replies; feel heard. Apologies if this is a longer post, challenging to communicate as unwell.

 

[Gordon]

The question I would like to have answered would be why your dentist is so convinced that an adhesive bridge is bound to fail. I assume they know something about your case that I don't, because otherwise it doesn't make much sense?

I understand about the previous issues, which was why I was suggesting a denture may work given lots of support and time. It really would be the only other solution available if an adhesive bridge wasn't an option.
Maryland bridges are pretty well tolerated in my experience, they increase the thickness of the supporting tooth by about .5mm and will feel a bit "different" for a few days but they become natural very quickly. Speech is rarely affected, had one patient who was a professional saxophone player, who was incredibly worried that the bridge would affect his playing, since he couldn't play with a denture in (lost his front tooth in a basketball incident!), but he was fine with it.

Is there a reason why you're so worried about losing the loose baby tooth? If it comes out when you're eating or brushing then it's not a problem, in fact it's saving you an extraction.
Loose adult teeth are not easily knocked out, even if they are apparently very loose indeed. Baby teeth are a bit different, they become loose because the roots are eaten away as part of the eruption process.

 

[K.M]

The question I would like to have answered would be why your dentist is so convinced that an adhesive bridge is bound to fail. I assume they know something about your case that I don't, because otherwise it doesn't make much sense?

I understand about the previous issues, which was why I was suggesting a denture may work given lots of support and time. It really would be the only other solution available if an adhesive bridge wasn't an option.
Maryland bridges are pretty well tolerated in my experience, they increase the thickness of the supporting tooth by about .5mm and will feel a bit "different" for a few days but they become natural very quickly. Speech is rarely affected, had one patient who was a professional saxophone player, who was incredibly worried that the bridge would affect his playing, since he couldn't play with a denture in (lost his front tooth in a basketball incident!), but he was fine with it.

Is there a reason why you're so worried about losing the loose baby tooth? If it comes out when you're eating or brushing then it's not a problem, in fact it's saving you an extraction.
Loose adult teeth are not easily knocked out, even if they are apparently very loose indeed. Baby teeth are a bit different, they become loose because the roots are eaten away as part of the eruption process.

The only reason that was given re no bonding/maryland bridge was that it couldnt be redone each time it fell out needing a G.A each time. No other reasons given. This appears to be a very unreasonable reason and stressful. As it looks to be a needed urgent solution with what you are saying. Thankyou for alleviating the concerns re its least invasive, easiest to deal with and an example. We are feeling powerless in being able to change the public health dentists decision (they ultimately hold the power) and this is not good, adding stress to an already distressing situation. To be honest, we dont know what to do, to change their saying no to bonding/maryland bridge To a yes will do it, given the whole situation. Likely we now have trust issues with them too. Re the adult loose tooth not that easy to knock out when this loose, this is reassuring, thankyou for this, needed to hear this. We will still continue to be very very careful but maybe relax a wee bit. In regards to the baby molar, it has root resporption-what is this please (was not told the meaning of this) the roots show, brown and leans in and up, quite the associated very looseness. This is hard to share, with one of the many mouth/head traumas, an offender threatened to pull teeth while holding pliars if we ever spoke up or told anyone (of what they were doing). Just sharing this part with yourself and a few other people verbally feels threatening. But needs to be shared; we have legitimate reasons with mental health deteriation. This is why any removal of teeth; including baby teeth are a significant distress. An ongoing physical PTSD trigger that is not remedied. Esp when they move, panic physically (as any person likely would) yet in our case, nasty flashbacks etc too. It feels like a no win catch 22 situation: surgically sorted or status quo-both situations distress us greatly. Thankyou for caring and your reassurances.

 

[K.M]

Top right adult very very loose tooth including pus....was unable to take decent photo of retained baby molars, the right one of more concern and the left is starting to pus now too due to only eating right side for months.

 

[Gordon]

Root resorption is basically the baby tooth "self destructing", the roots get eaten away by the body's "tidying up cells". It seems to happen to baby teeth which don't have a permanent replacement. Nobody knows why, it just seems to happen out of the blue.

They will naturally be shed on their own, same as other baby teeth which do have permanent replacements. Most people get annoyed with the looseness and pull them out themselves though.

That front tooth will take a fair bit of effort to take out, despite what it looks like, there's about another 1.5-2cm of root still in there.

 

[K.M]

Root resorption is basically the baby tooth "self destructing", the roots get eaten away by the body's "tidying up cells". It seems to happen to baby teeth which don't have a permanent replacement. Nobody knows why, it just seems to happen out of the blue.

They will naturally be shed on their own, same as other baby teeth which do have permanent replacements. Most people get annoyed with the looseness and pull them out themselves though.

That front tooth will take a fair bit of effort to take out, despite what it looks like, there's about another 1.5-2cm of root still in there.

Thankyou for this, you are kind and having this chat with you has given a broader overview opinion and importantly, feeling heard. Health is status quo (touch wood teeth do not deteriate further in a hurry, doing our best) and continuing to gather more support during this time, not an easy task, given the situation, shared with you. Thankyou kindly for your time in replying.