Clustered teeth in one spot and two opinions

T

Thropp

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Me again! So I wondered if a dentist here can help me. As mentioned in other posts I have an overcrowded highly grim mouth! Ive started getting it all sorted but there's a cluster of three teeth (see attached) where a baby tooth (I think) is under one adult tooth that's on its side and touching yet another tooth across from it (If that makes sense). My dentist said something needs to happen as theres decay so she sent me to the dental hospital In London, where I was told it was too likely there's be nerve damage and a huge gap that would need something doing to it, so the best bet was leaving and my regular dentist fills it. My regular dentist is irritated at the response as she said it's not possible to access the area to fill. I'm anxious at medical stuff at the best of times and have no idea how to proceed but nerve damage alarms me greatly! I'm only 30 and don't want to lose bone either. Any thoughts or advice would be amazing. Screenshot_20201125-173407_Gallery.jpg
 
T

Thropp

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As a follow up, I'm now consumed by worrying about it. I don't know what the risks of keeping them in are but my dentist thinks something has to be happen. Would nerve damage effect my speech? Please help!
 
Gordon

Gordon

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Oh that's a mess, there isn't going to be an easy or quick way out of this one sorry.
1) Removing all the teeth will be highly likely to cause nerve damage. Your lip/mouth will be numb from the middle to the right edge at the corner of your jaw.
2) Your dentist is right, filling that cavity will be very difficult.
3) There's no reason to panic just now, nothing bad is going to happen for ages, possibly years and possibly never.

However, I think there might be a way forward without risking nerve damage. BUT it's likely to be a long and fiddly process. How keen are you to co-operate with a long treatment plan?

You'd need to get a mixture of a surgeon and an orthodontist involved in this one. I think there's a way to get a reasonable outcome with a joint approach. You're lucky in that you've got a "spare" wisdom tooth back there that can be brought into play.

I would suggest that you ask your dentist if he can refer you to an orthodontist and if they can work together on your case. I'm not sure how much the NHS will fund this, but it's possible you'll get help. If you think you can manage to go through some extensive treatment, mostly orthodontics but with a bit of surgery thrown in for luck!
 
T

Thropp

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Gordon you're fast becoming my hero! All I've done since realising how bad it might be is panic and be in tears at points! Thankyou for explaining this so well. I would be totally up for a long process with a positive outcome rather than risk nerve damage! And while it wouldn't be easy I think I could muster up money if necessary (NHS help would be great!) Are you able to tell me what this long term approach would entail? God how I wish it could just be filled and left alone! Or that I'd fixed it when I was younger. Sadly the choice of dealing with all this was left to me and I was about 9 perhaps 11 when I last saw an orthadontist about it who said my jaw would need breaking etc. I was silly to not know better but had no idea at the time what it would all mean long-term. Sorry to bombard you, do you think there's any way leaving it might be the best option? I will also mention to my dentist about an orthodontist like you say (though I don't know how to bring it up really! ) Once again BIG thanks for replying!
 
M

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Not a dentist, but as a fellow overcrowded tooth person, I sympathize. I had mine fixed as a teen, but orthodontists and oral surgeons can do amazing things! I had my upper canines impacted into the roof of my mouth and they were able to work together to expose them and bring them down.
My daughter had her bottom teeth all messed up. Her canine tooth was impacted and the lateral incisor was on top of it, under the gums still, at a diagonal, kind of like yours, except her incisor was in the place of the canine. It is hard to explain, but her adult teeth hadn’t come in yet, and the incisor was under the gums, on top of the premolar and the canine, laying almost sideways. It was beginning to emerge but in the place of the canine, so the canine and incisor had switched places. The orthodontist was able to move them into the right place, having them pass each other without damaging the roots. It was amazing but took a good year and a half to accomplish!
 
T

Thropp

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Not a dentist, but as a fellow overcrowded tooth person, I sympathize. I had mine fixed as a teen, but orthodontists and oral surgeons can do amazing things! I had my upper canines impacted into the roof of my mouth and they were able to work together to expose them and bring them down.
My daughter had her bottom teeth all messed up. Her canine tooth was impacted and the lateral incisor was on top of it, under the gums still, at a diagonal, kind of like yours, except her incisor was in the place of the canine. It is hard to explain, but her adult teeth hadn’t come in yet, and the incisor was under the gums, on top of the premolar and the canine, laying almost sideways. It was beginning to emerge but in the place of the canine, so the canine and incisor had switched places. The orthodontist was able to move them into the right place, having them pass each other without damaging the roots. It was amazing but took a good year and a half to accomplish!
Thanks for your reply and I'm glad to hear all went well for your daughter and yourself! That is very impressive on the swapping the teeth around! They do do amazing things, I'm just hoping it's still as possible with adult teeth! It's certainly worth a shot in any case. Yes overcrowding has caused me a few issues unfortunaly, I wish I'd been pushed to follow through on work as a child but that's hindsight for you. Anyway, thanks for your reply, I'll be sure to update here on what happens next in case it's of interest or use!
 
Gordon

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I don't want to be too specific, I've not examined you so just working off an x-ray.
I think that the way to go would be to:

1) Extract the tooth with the cavity
2) Extract the baby tooth (should be doable without risking any nerve damage but you'd need more investigations to be certain. If that was a risk then there's a 2 stage process to get it sorted.
2a) Ortho to bring the baby tooth up and away from the nerve area (bit like MM and her daughter had done). It might be necessary to sacrifice your first molar at this stage too, hence why it's great you've got the wisdom tooth as a "spare".
2b) Now extract the baby tooth!
3) Ortho to bring that buried premolar up into place and align the molars with it. Simples (!)

The crucial part is not to try to sort everything at once, but to do it in stages to avoid the risk of nerve damage. There are probably alternatives to this but I think this would work.
 
T

Thropp

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Hi Gordon. Again, I truly appreciate the reply and it's settled my mind mind a little that there's another way possible! I will try and get this moved forward with my dentist and hospital and update you all. Big big thankyou!
 
Gordon

Gordon

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You know what they say about skinning cats :) I hope you can find some way forward.
 
T

Thropp

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Me too! I certainly feel more hopeful about it all and hope my dentist is as open minded! Have a great weekend!
 
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Hello gang, just thought I'd update. So off the back of the great advice here and after talks with people close to me I visited a second dentist who has more experience in tricky situations like mine. Unlike my regular dentist, she feels that she can remove the baby tooth (potentially leaving the root) and that would mean the decayed tooth was accessible for restoration. She's reccommended an Orthadontist too who seems like a dental god from all the reviews I've read! But I'm going to take it slow and get this first step out of the way first. I'm quietly hopeful that maybe this is going to be the answer to it all and while I'm nervous about the extraction itself as it will again be under local and is a pain to reach, if it means this issue gets resolved without lasting damage and yet more worrying well, all the better! The dentist who perform this, as I said, is not my regular dentist and I'm feeling truly guilty about seeing her! My regular dentist is wonderful but she did not want to go near this area, whereas the lady I was reccommended is older and seems confident in doing something, which in turn makes me confident. Would any dentists on here be miffed at me in this situation? For seeing someone else for this particular work? I think my regular dentist is lovely and don't at all want her to feel as though in not grateful to her! Added to all this I'm still waiting on another hospital consultation to see what their verdict is, which I suppose I should do before confirming the removal with this reccommended dentist. All this to say things seem to be moving in a positive direction and I will continue to update on the offchance there's someone else our there with equally unusual teeth!
 
Gordon

Gordon

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Chances of success without nerve damage depends totally on where the baby tooth is lying in respect of the nerve, which you can't tell from that x-ray. Leaving a bit of root is always an option, to prevent damaging the nerve.
A few more x-rays of the area to give more information would be a good idea...
 
T

Thropp

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Chances of success without nerve damage depends totally on where the baby tooth is lying in respect of the nerve, which you can't tell from that x-ray. Leaving a bit of root is always an option, to prevent damaging the nerve.
A few more x-rays of the area to give more information would be a good idea...
Thanks for your advice as always Gordon. I'll try and push ahead with getting my hospital referral before committing to the tooth removal, maybe I can get one of those 3D scans which seem to be fairly common to use on these types of situations.
 
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Thropp

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Hello all. I've posted before and this is an ongoing situation but today I got news and I was hoping for a bit of comfort/advice.

Essentially I've visited lots of dentists recently because my overall teeth and gum health is bad, I have an overbite and I have buried teeth as well as an impacted baby tooth.

Today I visited a highly reccommended Orthadontist in London who I was told might have another perspective on how to fix the aforementioned problem area. The woman who saw me, Claire, asked me how I'd "fallen through the cracks" and that dentistry had "failed me" (I'm much more to blame than any dentist when it comes to my oral health to my mind but anyway...) because, from her perspective, the overriding issue is I need jaw surgery. What's more, I could have it done on the NHS as she doesn't consider this a cosmetic problem as much as medical one. She has said that I have some bone issues that in part she believes is due to my jaw misalignment (I think she called it overjetting?)

All this to say that I didn't know my overbite in and of itself was a medical concern and I'd previously been told by my dentist that I couldn't have orthadontal work done via the NHS. Now that it's a possibility I'm at a loss. The risks are scary from what I've read, nerve damage being the greatest hit of them...and it takes something like a year to heal? And I'm 31 so not the ideal age.

I suppose my question is one that's hard to answer but, do most people feel glad post surgery? And if I'm not experiencing outright issues now (she pointed out how my bottom teeth touch the roof of my mouth for example, though that doesn't hurt mw) is it silly to poke the bear so to speak?

Also, I'm totally up for listening to the professional opinion, it's just that every professional seems to have a different vantage point and if I'm honest, the neverending anxiety is starting to take a toll on me day to day. I'm spending money and treating myself and looking at my partner and cherishing him because I feel like what ever happens, what ever I choose, it will all come crashing down and I'll lose it all due to some awful outcome.
I know that sounds like a crazy reaction and yet, it's where I've been for the past 8 months.

Any advice, stories, etc etc as ever would be super helpful. Big thanks to anyone who reads.
 
Gordon

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The trouble with doing osseous surgery at the moment is the infected area around the premolar, the max-fac guys will be nervous because of the risk of infection going into the surgical area. There are some significant risks with the surgery, mainly permanent loss of sensation in the lower jaw.
The NHS will pay for the treatment but it depends on the severity of the jaw discrepancy, normally there is a joint approach between hospital orthodontists and max-fac surgeons.
 
T

Thropp

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Hi Gordon. Thanks for your input as always. Does this mean (and as always you've not seen me so I appreciate you can't give me anything ironclad) that I should try and continue with my original plan of removing baby tooth and just restoring the tooth that's damaged? I know a lot of people get jaw surgery due to discomfort etc, none of which I have. I just look fairly dorky but I can live with that! As before, I'm more concerned with sorting out this problem area. The orthadontist seemed to think that was a secondary issue to the overjet however and that it's contributed to some small bone loss etc.Thanks for whoever merged this thread by the way!
 
Gordon

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It's probably best to get the immediate issue sorted out first, i.e. the baby tooth/decayed tooth issue, since the surgery is a more long term thing.
Obviously I don't know what you look like but the results of orthognathic surgery can be literally life changing in a good way... I'll dig up some photos... nothing gory.
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T

Thropp

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Yes this is similar to how I look. Sort of fine from the front but the profile is ugly. The Ortho said rather than remove the baby tooth and risk the damage, she advises doing it all in one go,.so baby tooth, take a back tooth out too and then surgery as, as she put it, to do otherwise is to take the same risks with less reward.

I can live with looking weird. It's defined me for this long and by some miracle my boyfriend doesn't seem to care. So, with that in mind, is surgery worth it? Can I have a healthy mouth of I remove this baby tooth and keep on top of my hygiene? Or would it lead to bone loss as my Ortho implied? Also, really sorry to keep messaging, I appreciate there's a lot of people to respond to and help!
 
Gordon

Gordon

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Sorry but you'd need to speak to the surgeons about that one, it's not really my sphere. The ones I worked with previously would have been nervous about doing the gnathic work if there was still an acute infection present... but things change and different surgeons have different POVs.
 
Gordon

Gordon

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Oh sorry, I missed the actual question. Yes, if you got rid of the baby tooth and did something about the decayed canine then your mouth would be reasonably healthy.
 
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