Cracked my main eating molar; haven't been to dentist since I was a kid.

[FrightenedJerk]

I'm freaking out, but am hoping to find some solace and info from you folks. My backstory: I'm 47. I went to the dentist like a regular kid, got fillings and all that. When I was around 13, they recommended that I get some sort of device either to enlarge my palate or push my bottom jaw forward (don't recall), and I never went back. I also don't go to the regular doctor for routine check-ups/physicals, but do for things that are a problem. The dentist, though, is a different situation because the years have just kind of piled one on top of the other. Each year I tell myself I need to go and get checked out, but I never go. I'm afraid of the idea of having one or more teeth extracted, and what that will mean. As you can tell from my profile, I joined this board over 10 years ago and posted for a short while. I was having concerns and fears about what my outlook would be then, but haven't gone since.

My teeth aren't in great shape. They're sort of yellowed and worn down with acid wear through the decades. My molars, aside from being not all in alignment, are worn as well, and could use fillings of course. I actually posted a few photos back when I originally posted, and they're still on my profile. They haven't changed a ton except for one lower molar that had a patch on the side come off that doesn't affect its overall integrity. In 2008, one of my lower molars on the other side, which had a filling in it, cracked off. That was the side I chewed on, so I switched to chewing on the other side. Today, I was eating a tortilla chip that was crunchier than usual, and I felt something up between my main chewing molars (I guess it's the first large molar on the top). I was hoping it was a part of the chip, but unfortunately, after I flicked it out, it was the cheek side of the tooth, basically the corner of it from top to bottom. So I have a sharp side to the molar, and it probably would chip off even more if I ate something hard. Currently it is not painful, but it will definitely affect my ability to eat because I am used to eating on that side. On the opposite side, while I might be able to get by with some stuff, I don't want to eat hard stuff on that lower molar that is cracked.

So I 100% need to get to the dentist soon. This also irritates me because I don't like to be forced into this; I'd rather go on my own time. But it's all my fault. I just don't know what will happen. If you can envision a regular molar having a corner cracked top to bottom, what could be done? I cannot tell how far up the crack reaches. What kind of say does a patient have in what will happen to their teeth?

How can I choose a dentist that will be understanding of my long absence, and how do I tell them about it? Thanks for reading, and hope to hear from you.

 

[NervousUSA]

Hi there. I can relate, I didn't go to a dentist for 19 years, so not as long as you, but pretty long. When it comes to what kind of say a patient has with their teeth, the patient has 100% say. You can refuse any procedure. You can also ask a dentist to tell you what all the different treatment options are, and you can see more than one dentist, and see if they offer different treatment options, which they often do. After my long absence, I found a dentist who specifically said on their website they welcomed people who hadn't been to a dentist for a long time. I told them matter of factly about my long abscence and they weren't bothered. I think if you go to dentist who mentions anything about nervous or anxious patients on their website, they will also be understanding about a long abscense. I think this is really common that people come in after a long break and it doesn't offend dentists.

 

[FrightenedJerk]

Hi there. I can relate, I didn't go to a dentist for 19 years, so not as long as you, but pretty long. When it comes to what kind of say a patient has with their teeth, the patient has 100% say. You can refuse any procedure. You can also ask a dentist to tell you what all the different treatment options are, and you can see more than one dentist, and see if they offer different treatment options, which they often do. After my long absence, I found a dentist who specifically said on their website they welcomed people who hadn't been to a dentist for a long time. I told them matter of factly about my long abscence and they weren't bothered. I think if you go to dentist who mentions anything about nervous or anxious patients on their website, they will also be understanding about a long abscense. I think this is really common that people come in after a long break and it doesn't offend dentists.

Thanks for your feedback!

 

[FrightenedJerk]

An additional question: Since I haven't been in so long, they would likely need me to come in for a routine visit for exams and a cleaning before they'd be able to address the cracked molar, right? I'd likely need to go in on a separate day to start addressing it, is my impression. It's an emergency in that it's affecting my ability to chew the way I'd like, but given my long absence and other issues, it's likely that a quick resolution isn't likely. If someone were a regular patient who kept up on their dental maintenance, it would be easier for them to go into any place on an emergency. Am I correct in this?

Mentally I'm not doing well with this, am feeling very depressed (more so than usual) and regretful. This butts up against a lot of things for me personally and psychologically outside of the purely dental. It's time to pay the piper, essentially. My worry is that the many issues I have are too many to be able to keep quite a few teeth. I could have turned this around at any time in the past decades. What sucks is that I did have a vague plan to go to both the regular doctor for a checkup, and then the dentist, at some point in the next few months. I'm wanting to leave my job of over 20 years, and wanted to utilize the insurance. This forces the issue before I was ready.

 

[letsconnect]

Since I haven't been in so long, they would likely need me to come in for a routine visit for exams and a cleaning before they'd be able to address the cracked molar, right?

Hi @FrightenedJerk, unless the U.S. is radically different from the rest of the world, there's no issue with booking an emergency appointment to address the issue at hand. However, the advantage of having a regular (non-emergency) appointment is that it can act as a get-to-know-you meeting, where you can talk to your potential dentist and find out if you like and trust them. If you're extremely nervous about the dentist, it's also a great idea to ask for an appointment just for a chat, without any exam.

There is lots more information in the Help section of this website:

What Can Help

What can you do to overcome dental phobia? Get information about psychological strategies, new technologies, and sedation.

www.dentalfearcentral.org

 

[FrightenedJerk]

Thanks, letsconnect!

I'm looking at reaching out to dentists for the first time today and am having some definite anxiety. My co-worker actually seems to be going through something similar - had a filling come out and a crack was found, and was asked to go in today for a root canal. If it's the same one, he might be going to the same dentist I have as one to contact. However, while he is open about his dental issues with the office, I do not choose to disclose my health or dental issues to others, so will not be asking him how it went such that I'd reveal my issues.

While physical pain is bad, my issue is more the mental regret and knowledge that this all could have been prevented. My parents of course asked me for years when I was younger to go to the dentist, but I never did, and they still periodically ask. I don't like to talk about this stuff, but am going to let them know what happened and that I'm going, because when I go over I won't be able to eat normally anyway if I have this chipped tooth. So it's unavoidable to mention it. My whole family seems to like to discuss dental stuff, but I don't. My sister's former fiancee, age 50 (whom she parted with earlier this year) had to have all his remaining teeth removed and implants put in just this year. I'm not totally sure why, but I heard something about a family issue of a degenerative thing. So dental stuff is in conversation.

 

[FrightenedJerk]

Well, I wasn't able to force myself to make the call to a dentist today. I told my mom about what happened, and she of course said I need to go, and referenced cousins who have lost all or most of their teeth. Most of the day I was looking at reviews and trying to find the sweet spot of location and good reviews. I had one pretty much decided on, but read a review that said their procedure rooms have neither doors nor walls that go to the ceiling, such that other hygienists and patients can hear what you are saying (they complained about hygienists giggling). I had emailed a local place shortly after it happened on Tuesday, to inquire about timetables for visits, but they did not reply.

 

[FrightenedJerk]

I made an appointment for Tuesday. I was close to calling another place, but I found that one of the two brother dentists went to my high school and graduated a year before me. Wasn't comfortable with that.

I probably should have tried to get an appointment this weekend just in case anything is critical that's happening with this cracked molar that I can't discern. Not in any pain currently, though; it's mainly affecting my ability to chew some stuff. From what the receptionist said, I won't get a cleaning; this is just to look at the cracked molar. I'm not quite sure how you can work on a tooth that hasn't had a cleaning in over 30 years, but whatever. She said that this appointment time, as opposed to one on Monday, will allow the doctor time to do anything needed. If he recommends an extraction, I don't know that I can consent to that right on the spot. I would need time to think about it. Is it possible just to say "No thanks, I need to think about it" and literally just leave?

My impression has been that dentists work on an "exam . . . and then come back another time for the actual procedure" basis. That is, unless it's an emergency.

 

[NervousUSA]

@FrightenedJerk Good for you, making an appointment is a great step! After so long, too! The dentist may be able to fix it at the appointment, even if you haven't been in for years. I went in because a filling fell out after 19 years without seeing a dentist and got it fixed on the spot. They didn't clean my teeth or anything. You can definitely refuse a treatment and leave if you want to. A dentist doesn't have any type of authority over you more than anyone else does, you can always say no to their recommendations. You can, and I would say should, also, ask if there are different options. Like if a dentist says "I want to do this" you can say something like "are there other options" or "is there a less invasive option" or something like that.

 

[FrightenedJerk]

I have my appointment tomorrow, and I'm feeling increasingly depressed, negative, apprehensive, regretful, and shameful. I won't bore you with how the potential of the work to be done and what it could mean for me (depending on a few circumstances) interacts with my OCD tics, but that is an additional consideration.

I don't go to the regular doctor for check-ups, but earlier this year I developed a pimple-like lesion on my lip. I had it for so long, several months, that I felt I needed to have it looked at, so I went to a dermatologist. I went into the appointment with almost no apprehension because I thought that it would just be called folliculitis or something like that. Due to how it looked and the length of time I'd had it, they feared it might be cancerous, and asked me on the spot (with the doctor, her resident, and another person looking on) to have a biopsy. I agreed, and they sat me back and dug out a sample of my lip, stitching it up. (They also used surgical pen to mark the area which interacted with my OCD involving writing; I asked them if they could forego the marking, but they couldn't.) So I went home to wait. In the three days I waited, based on things I read, I felt pretty certain that it was cancerous and that I'd need Mohs surgery (carving away portions of my lip and face tissue until it was arrested). It turned out to be an infection, but in those three days, I felt more sanguine and "okay" with the prospect of the surgery and facial scarring than I do about what could take place tomorrow and what it might mean for me long-term. I was philosophical about the former circumstance, but not this.

 

[NervousUSA]

At this moment, the time right before the appointment, something that works for me is to tell myself that the fact the appointment is soon, means it will soon be over. I feel a lot of relief when appointments are over, even if there are more in the future, maybe you will too. A lot of people find the dentist more stressful than the doctor, it just seems to go that way. One thing I can tell you is nothing ever happened to me involving being marked with a pen or written on at a dentist. Best of luck for tomorrow, if you would like to, update on how it goes.

 

[FrightenedJerk]

Thanks for the support @NervousUSA ! That's a good way to look at it. My anxiety is that this is just the start of bad things that will be trying both mentally and physically. I'm a wreck.

 

[FrightenedJerk]

Well, I went to my appointment. I didn't actually have any work done today as I was expecting. It turned out to be more of a consultation with both average and bad news. Even though I'd put in my online form that I'd not been to the dentist in over 30 years, I was still asked when the last time was by each person who came in. The first person who brought me back kind of did a stop in her step when I said it. She didn't browbeat me, but was probably close to saying more. She did 18 x-rays at different angles. Then a hygienist came back and did measurements, calling out numbers (I had a lot of 4s and several 5s - what's the worst/highest number?). I had decided not to get the cleaning in addition today even though an appointment had opened up, but the hygienist said that they'd need to do a deep cleaning which would involve numbing, one appointment per side.

Then the dentist came back to the area (which, strangely, was just an open partition, no doors or walls, which was one reason I decided not to go to another dentist I was considering, because I read that in a review). I went in primarily for the cracked top right molar, but I also have a cracked lower left molar that has been that way since 2008. He said that both are not salvageable even with a crown because the decay runs too deep. I asked a couple times if a crown could be a possibility, and he turned it down. He told me it's my decision what to do with any of them, but that that's what realistically needs done. For the extractions, I would need to go to an oral surgeon, and options would be nothing in its place, a bridge (which he said involves shaving down and basically ruining the teeth on either side, something I'd never heard of), or a single-tooth implant. I have no idea what I want to do, and am quite crestfallen about this. He also recommends at least two of the wisdom teeth to come out, one of which came in crooked years ago and cracked off. He did say that my teeth look good for someone who hasn't been to the dentist in 30 years, so that was one of the only bright spots of the day.

So currently I'm scheduled for two separate cleaning appointments later this month and early next. I don't currently have mobile teeth (one in the front bottom I'm unsure about), but I asked whether the cleaning would cause some problems with that, and the hygienist said the goal is to strengthen them. I could have gotten fillings at the same time, and it looks like they want to fill seven teeth. I probably should have decided to do it at the same time, but I think the cleanings are going to be crazy enough. Surprisingly, they didn't mention root canals, and I forgot to ask, so flustered was I with all the info being thrown my way.

I'm definitely not feeling well mentally, but on the balance it was the right thing to do. I have OCD preoccupations that all of this stuff related to the potential of implants and such butt up against, and I need to find out some details about some things like the materials used (i.e., paints and pigments). You never know how "good" a particular dentist is at diagnosis, and I wouldn't be surprised if I go to an oral surgeon for a consultation, as this dentist said I could, if they don't give as sanguine a view. Even though the dentist's and others' reactions seemed to be sanguine as opposed to all bad news, I wouldn't be surprised if things don't turn out great. For the moment, I suppose I'll just maintain and try to eat on this busted molar, and do research.

 

[NervousUSA]

Hey its great you went in and took that step. This is what those gum charting numbers mean https://www.waterpik.com/edu/gum-disease/dentist-gum-check-numbers-what-they-mean/
I think the cleaning will help you get better numbers, when you do that. The open partition thing is awkward and sounds stressful. My dentist doesn't have doors and I wish he did. When it comes to that work he said needed to be done, if you feel like you want to, you can always see a different dentist, and see if they make a different suggestion. Also, if you don't want to see an oral surgeon, if you shop around, you can usually find a dentist who does extractions. I didn't want to see an oral surgeon so I did this, and had a general dentist extract my wisdom teeth and do an implant for me. It was cheaper and I didn't want sedation which is pushed harder by oral surgeons, or to go to a different office. It is great you got the cleanings scheduled! I think that will be good for you, for sure, and make your mouth healthier. Just in case it is any use to you, there is an app/website called Denteractive where you can message with a dentist for $10. You can ask the dentist you saw to email you your x-rays and then you can chat about them with a dentist on this app if you want (you can upload the x-rays). I found this really helpful when I was having a lot of work done because I had lots of questions, and wanted to research and get information, also it seems like no dentist is answering the "ask a dentist" questions on here right now. I also like "The Teledentists" which is a video call, not text messaging, and a bit more expensive, but useful too. It's good you are making some progress to getting better oral health, and you have some information to work with now.

 

[FrightenedJerk]

Thanks so much for reading and for your encouragement and resources, @NervousUSA ! I will check those out. Did you get the extractions and implants on the same visit?

Replaying the visit in my mind, I feel like this dentist might have been rushing things a bit. To my recollection (a bit scattered and nervous as I was, though), neither the dentist nor the hygienist pulled the big overhead light down while looking at my teeth. The room was well lit from outside, though. It might be worth chatting with a dentist online to get an idea of whether a second opinion is worthwhile.
I'd need to do a lot of research before deciding on anesthetic, if I decide to go for it. I've read horror stories about anesthetics, including regular shots for fillings and such. They suggested the idea of combining the cleanings and fillings because I'd only have to get numbed up once, perhaps because of the risks(?). The online form I signed before the session mentioned risks with anesthesia.

Perhaps the only good thing was that I got an idea of the situation, assuming that the doctor was thorough and got his diagnosis correct. I'm still surprised that he didn't mention root canals, but don't know how they are diagnosed as being needed - solely through x-rays? The hygienist, after doing her measurements, said that I have some type of infection at some areas and that they'd work with that when cleaning.

 

[NervousUSA]

My first dentist wanted me to have extraction and implant in the same visit done by an oral surgeon, but I moved on from her to another dentist who did these things in different visits that were some months apart. Over several months we did an extraction, implant planning appointment (cone beam x-ray) and then the implant surgery. The dentist who wanted me to do everything at once was generally aggressive in other ways and also was talking to me about things like veneers and sedation too much, so I didn't want to continue. I don't know what to think about the light, I guess I haven't noticed if my dentist pulls it down or not. Was the dentist wearing loupes? That is a good sign. With anesthetics, if it is any use, my experiences is I have never had any issue from local anesthetic, it always has worked well for me and never had side effects, and I have had a lot of it due to 5 teeth extracted in three different sessions, and the implant which required 3 rounds of local anesthetic for three different sessions. Getting more information and getting a better idea of the situation is definitely a good thing. It looks like Dr. Gordon is answering questions again in the ask a dentist forum, maybe he was on vacation and is back, so I bet he could help you out, I am sure he knows about how need for root canals is diagnosed.

 

[FrightenedJerk]

Thanks @NervousUSA . I don't know if they had loupes on while looking. As far as advice boards, I've also used the Reddit board "askdentists" a couple times.

Between yesterday and today, I was feeling a smidge better that I at least went to the dentist and a plan is in place even though it's likely that two main molars need taken out. But the more I read, the more anxious I'm becoming, questioning whether their work and diagnoses were thorough.

I wouldn't be surprised if the next stuff isn't as easy as just getting the deep cleaning and fillings; I'm sure more bad stuff will be found or caused, perhaps during the deep cleaning. I'm concerned with the deep cleaning discovering worse bone loss (which I don't know much about the causes or progression yet) which could cause them to say that one or more additional teeth are likely to need to come out or are in danger. I told my parents how it went, and they were nervous about it being worse obviously, and my mom has mentioned a few of my cousins who have few or no teeth, in their 60s, and my sister dealt with her ex-fiancee needing to get his remaining teeth out at 50 and implants (though his condition might be inherited; didn't probe for info because I dislike talking with family about any dental matters that anybody experiences). My parents seemed encouraged, so if things are even worse than was let on, that would suck for me and them. Both my parents are in their 80s and have their teeth. My dad has had ten crowns, he said, but I don't know what work my mom has had done; never asked.

So at this point, ideally, I want to get this deep cleaning and fillings, and during this time try to get my mental "house" in order to try to prepare for the extractions and potential for implants.

As far as the "open room" thing, you're sitting talking about personal stuff with a doctor, and someone in the next "area" could hear, so that's definitely a consideration. I don't know if anybody was next door. I was trying to maximize my time with the doctor and ask questions, but the dental assistant kept coming and going behind me and would occasionally chime in. I prefer to be talking to one person in front of me, not wonder whether someone is coming in behind. So it's kind of a poor set-up, and I wonder why places have that.

@NervousUSA - How many total implants did you get, if you don't mind me asking? How does having the implant feel as far as being natural, or having any pressure in the jaw itself?

 

[NervousUSA]

@FrightenedJerk I haven't had good luck with the reddit ask dentists, usually I don't get a response there. I have had OK results with Quora and some good answers on "Dentistry Forums" which is on this list: https://www.dentalfearcentral.org/dental-forums/ It is true more stuff might be found but it might not, I didn't have bone loss after my 19 year break, and two big cleanings didn't uncover anything wrong with me that wasn't detected at first glance. I did have an infection that wasn't detected but I was purposely hiding it from the dentist due to phobia. I don't think you necessarily have to have the same dental outcome as your family, I have a lot better teeth than my parents when it comes to decay. Going ahead with the deep cleanings and fillings and thinking things over and getting information is what I would do too, I think that sounds like a good idea. I think dental offices are set up with the open rooms due to convenience of the staff, like it is easier for them to hear each other talking, easier for them not to have to open doors, and also liability, to make it harder for people to say a dentist sexually harrassed them, or something like that. I have one implant. The implant itself was no big deal. I had some complications with the crown. It is considered good for the crowns to be a tight fit with tight interproximal contact. My crown was oversized, got stuck during installation, and ended up shifting my other teeth. I had some crooked teeth next to it that already fit together in an uncomfortable way. My teeth shifted enough so I can feel the change, and it is negative. After the crown was installed for a while, I felt pressure on neighboring teeth and had a bad effect on my bite for a long time, though I no longer have that. The pressure on neighboring teeth was gone in a month, the bad bite maybe in three months. My situation now is the crown and implant feels natural, and my bite is as good as it was before the implant and crown, but the teeth it shifted feel worse than before. I went to a prosthodontist for a second opinion on my crown and he said it is "not ideal" that a crown would be oversized, get stuck, and shift your teeth but "it happens" and he said it was still considered normal and ok, to the point he would be ok with having my crown in his mouth. He also said even if your tooth is shifted the distance of the width of a hair, that might feel very noticiable.

 

[FrightenedJerk]

Thanks again, @NervousUSA . By "crown", you mean the tooth that is screwed onto the post, right? Is it made of porcelain? As far as biting on it, does it just feel like a regular tooth? You said in another thread that yours is lower, and if I were to get both, I'd have an upper and a lower on opposite sides. I'm sure that things would feel and work differently depending on it being top or bottom. I also have a misaligned jaw as far as I can tell, so that is a factor in all this.

Definitely feeling more depressed and worried as the days go on, and the fact that I can't eat properly is adding to that and increasing my anxiety. Food that I eat on the newly cracked molar gets stuck up inside a cleft that I guess goes up to under the gumline, so I have to eat gingerly. I can flick it out, but it isn't pleasant. The lower cracked molar I haven't eaten on since 2008, and it has a bit of a twinge when I eat on it with any force. I'm in agreement with the dentist that both should come out, and I probably shouldn't focus on any second opinion for those teeth specifically. I guess a focus of research would be deciding on whether to get an implant at the same time or waiting, but that's possibly something the surgeon would need to decide.

Even if I had gone to the dentist five years ago, some of these issues could have been arrested. I knew that this reckoning was coming, and it is probably better that this crack forced the issue rather than me allowing myself to continue to slide. They say "forget regret", but that's not easy when something is totally your fault.

 

[NervousUSA]

@FrightenedJerk Yes the crown is an artificial porcelain tooth screwed into the implant. Some people have a part called an abutment but I don't have that. It feels just like a regular tooth while biting, chewing, eating, etc, though it took some time to get that way. If I feel it with my tongue or finger it is not just like a regular tooth, as it has no sensation, and a different texture from a tooth, and will feel a bit "stiffer" than a real tooth if touched with these. It is much better than the tooth it replaced, which was in sad shape. I didn't mind having no tooth either, though, there were just a few types of food, like hard toast, or crutons where that bothered me. Sorry you are having trouble eating and feeling bad, I understand that depression and anxiety, it is hard going through this. If you look at my old posts I did lots of strategies trying to deal with that while having dental problems like box breathing, excercise, counseling, anti anxiety amino acid supplements, and more. I do feel a lot better now that I am done being actively treated by the dentist, so maybe that is a stage you could look forward to reaching? When it comes to getting an implant at the same time or waiting, my experience was that is about preference, and I had the option to go either way from two different people. I didn't research the difference that much because I was not willing to have sedation, which would have been involved with having the implant and extraction in the same sesssion with the oral surgeon that one dentist would have referred me to. Sounds like a good idea for you to research all your options. The better informed you are the better, I believe. If you mean waiting after extraction to get an implant, just be aware bone loss can progress, so if you are going to wait a long time, I think you might need to get a bone graft in some cases, either with the extraction, or when the time comes to do the implant. When it comes to regret, it is hard. I take the view that fear and avoidance of the dentist are caused in part by natural instincts that it is hard not to follow, it is only natural that we avoid situations that feel dangerous or where we have been hurt, this is a natural instinct that all creatures have, and is deeply ingrained. Also, trauma is a powerful thing. For me, a lot of my avoidance involved actions of other people than me, dentists and doctors who gave me treatments that harmed me, mistreated me, weren't honest, didn't give opportunities for informed consent, etc. Also corruption of the medical and dental systems in some ways by money have ended up harming me. For most folks, the situation isn't simple and black and white, and is more than just choosing not to go to the dentist for no reason. I have also been trying to focus on the present not the past, don't always succeed, and telling myself too, that looking back, I did my best at the time with where I was at the time, and the information and resources I has at that moment.