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Dental advice needed.

TrueEnglishGent

TrueEnglishGent

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Dudley, United Kingdom
Hello,

First let me quickly introduce myself, I'm Joseph and I'm 22 years old. I've suffered with rheumatoid arthritis since I can remember (though called juvenile rheumatoid arthritis as a child) and there is a reason I mention this. My health history is long, so I apologise in advance if this post goes on a bit or I ramble, I'm looking for help and advice from those who might have suffered the same issues.

So next Tuesday I have an appointment to see a new dentist, I'm scared and worried though for different reasons. I've had dental problems for many years, which mixed with all the problems that occur when growing up with arthritis causes even more problems. A few years back I was having dental treatment, which saw me fitted with a brace (which I had on for two years), a few fillings and an operation to remove a tooth that was stuck inside the gum. Unfortunately I was never happy with the dentist, who spent as much time chatting up the assistant then explaining things to me or calming my worries. I should note that I've had spells of depression growing up, due to chronic pain and a total lack of self-confidence. My arthritis as always come before anything else in my life, I've struggled to just survive with it so any dental issues have always been put towards the back.

That said I don't smile, I have two cavities on the right set of my teeth (one towards the back and one further at the entrance) and my teeth are discoloured due to a love of fizzy pop as a kid and teenager, and medical treatment I've received and medication I still take. Now comes to an important part, despite cutting heavily back on soda consumption and looking after my teeth considerably better (I use a hard toothbrush as advised by the previously mentioned dentist, though I'm not sure that's for the best) I still suffer from enamel problems and recently it got bad. Now I had all sorts of problems when the braces were fitted, I was never happy with them and my dentist made a point of criticising me whenever possible concerning them. I found cleaning my teeth difficult with the braces but I always did my best. Trouble was, the braces starting scratching off the enamel of my teeth and these past few days some of that enamel as literally chipped off.

After my previous experience with a dentist, I'm worried. I'd love to be able to smile again, I find living with arthritis hard enough and worrying about my smile doesn't at all help. Having done some research it appears I might have tooth demineralisation and I'm concerned that these teeth are far past being saved. I can only hope that this dentist I see is kind and understanding, as my previous one appeared more interested in what the assistant was doing that night then my own teeth. I should note that I eventually put a full stop to that treatment, I'm always worried about embarrassment when seeing a dentist. So I haven't been brave enough to see one since.

If my teeth can be saved, I hope that my teeth can receive some whitening treatment or treatment to help restore the enamel. Been a long time since I've been able to smile properly.

So can teeth be saved at this point, and any advice on what I should ask the dentist?

Sorry for the post being so long.
 
Dr. Daniel

Dr. Daniel

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Hey
It is difficult to answer without seeing and examine you.
I can point out two things: To begin with, it is very helpful for the dentist to address a specific complaint/s like sensitivity to cold, trouble with eating, esthetic features. So try to articulate your needs, not only dental but also those who concern your psychological needs (like gaining trust because of your history).
Second, with what you describe, after finishing the treatment and achieving the treatments goals the maintenance is extremely crucial. point it out also to the dentist, because he (or she) will see that you are a serious patient, who wants good results.:D
 
Dr. Daniel

Dr. Daniel

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I apologise in advance if this post goes on a bit or I ramble, I'm looking for help and advice from those who might have suffered the same issues.
By the way, your post was not long at all. You wrote what you found important. That's what matters.:thumbsup:
 
TrueEnglishGent

TrueEnglishGent

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Dudley, United Kingdom
Thanks for the reply Dr Daniel, hoping the appointment goes well. I have decided to start using a medium brush again, worried that using the hard brush is just doing more damage to my enamel.

Will update on the situation when I can.

Thanks :)
 
brit

brit

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Thanks for the reply Dr Daniel, hoping the appointment goes well. I have decided to start using a medium brush again, worried that using the hard brush is just doing more damage to my enamel.

Will update on the situation when I can.

Thanks :)
We usually advise soft brushes only. You can even get soft 'sensitive' brushheads for the rotary electric toothbrushes. High fluoride toothpaste and/or sensitive toothpaste can help with enamel problems.
Your last dentist sounds distracted to say the least. Hopefully your next experience will be focussed on how they can help you. Write a list of what your concerns are so they can be addressed one by one as Drdaniel says.
 
TrueEnglishGent

TrueEnglishGent

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The new toothbrush I'm using is an Oral B medium brush, I'll use that for a while and see how it does. I've used Arm & Hammer Enamel Care toothpaste for a good while now, and it's the best I've used. I did change my mouth wash a few weeks back to Corsodyl Daily Defence, which seems to be okay.
 
TrueEnglishGent

TrueEnglishGent

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Been doing some more research and came across this picture (some of the pictures you see when doing this research scared me a great deal) which is exactly one of the issues I'm having with my front right tooth. While nowhere near as bad as those in the picture (it's just the one tooth) I'm scared witless about it. It's basically part of the surface that's chipped off as seen in the front left tooth of that picture. Is there any hope for it?

Probably doing all this research isn't helping my anxiety, I'm not worried about going. :( Though having concentrated on my arthritis for so many many years now my teeth need attention. I guess I'm just scared that all is doomed! Expecting to be told to leave by the dentist with no hope.
 
Dr. Daniel

Dr. Daniel

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If your front tooth is like the one of the photo, there is a good chance it can be treated without anesthesia (I do so on many occasions). Of course, I do not know what is best in your case, but the thing is that the only certain answer can come from the dentist who will be treating you. Other sources of information cause more uncertainty.

A very good dental device is the dental rubber dam
This device provides isolation between the treated tooth/teeth and the rest of the mouth. It's not only helps to get a better quality for the white fillings (keeps the tooth dry) but it also has a psychological effect because it provides a sense of isolation, between yourself and the treated teeth. I really recommend it.
 
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TrueEnglishGent

TrueEnglishGent

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Location
Dudley, United Kingdom
Thanks again Dr Daniel, firstly for calming my nerves and secondly for providing some helpful tips.

So the tooth can be treated, that's good to hear. Will hopefully speak with the dentist in detail about it.
 
TrueEnglishGent

TrueEnglishGent

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Dudley, United Kingdom
Off to the dentist in a short while, nervous about it all. More worried about finding a dentist who will listen and understand then anything. If I'm not happy with the dentist I might look elsewhere to find one more helpful but I'll wait and see how things go.
 
TrueEnglishGent

TrueEnglishGent

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Back from the appointment, an odd experience to say the least.

Dental practice was certainly efficient, once called had x-rays done by an assistant and waited for a dentist. Then suddenly had four dentists come at once, some of those must have been trainees but it was so odd being examined with four dentists in a room. He spouted off a bunch of numbers and answered one question then left! He was in there for about seven minutes at most.

So one of the back teeth needs to be removed, while the other one can be saved. Asked him about the front tooth and he said they will simply fill that in (though how I'm not sure, he was in a rush). Next Monday I'm to have the treatment, with a couple of fillings as well. It was so odd. He actually seemed pretty nice, certainly didn't criticise and offered some quick advice (he got the assistant to offer extra advice) and in that respect he was pleasant. So I don't really know what to make of it.

One real concern I have is a personal one, when filling in the form my hands couldn't stop shaking! This as happened recently at another appointment and it's disturbing. So I guess I'm to have treatment on Monday. Was hoping to ask him a few more questions but guess having the trainees he was in a rush. Still, mixed feelings!
 
TrueEnglishGent

TrueEnglishGent

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Dudley, United Kingdom
The other concern I forgot to mention was that it sounds like the dentist wanted to treat the teeth very quickly, asking if I could come in the next day. Unfortunately I can't make that and the assistant could only get me in for the Monday evening. Should I consider bringing the appointment forward or leave it as it is?
 
brit

brit

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It all sounds very odd indeed - what kind of set up is it? It doesn't sound like your typical NHS practice but that could be a good thing. It's also a lot to do in one appointment. Do you know who you saw? I would look them up on the GDC Register.
 
C

comfortdentist

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your dentist needs to understand the implications of your immunocompromised state as a result of the R.A. treatmennt. Are you on a TNF Inhibitor?
I would also rinse with a mouth wash with flouride in it.
 
TrueEnglishGent

TrueEnglishGent

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Dudley, United Kingdom
Hello again,

So in about two hours I go for my treatment, and as you might expect I'm nervous. In a weird frame of mind, glad to be having it done and worried about something or other, what that is I'm not sure. I guess the first appointment caught me off guard with how sudden and quick it all went by, I just wasn't expecting that. I'm not totally sure what I'm having done today, so will make a point of asking if I get the chance (unless they go speeding through it all again). Worried that my anxiety and other mental issues are getting worse though, finding ways to try and battle them.

brit: The dentist practice is one of many in my area owned by the same family I believe, they have a number of practises throughout my area. It was an odd experience, they weren't for chitchat but I got the feeling that they were well organised in what they were doing. It's possible that I'm only having part of my treatment today, I'm pretty sure the one tooth will be taken out and the rest might be done at a later date. I can't remember the dentist name I saw, it went so quick I didn't even catch his name. Not even sure if he's the same one I'll see today.

comfortdentist: At the moment I'm on Celebrex Celecoxib as an alternative to Naproxen which caused me nasty side-effects. That's NSAID and if my knowledge is correct I should be alright. I've already shown them my medication including my painkillers (co-codamol effervescent) and the assistant said it was fine. I'm using Corsodyl Daily Defence mouthwash as the moment, which seems fine to use for me unlike many other mouthwash brands I've tried.

So I guess I'll update once I return. Not sure why so many aspects of my life is affecting my anxiety and the shaking as only recently got especially bad. Might have to eventually see my doctor about it or something. Already seen a psychologist a few months back after a breakdown of sorts last year due mostly to chronic pain. The mind is unpredictable!

Wish me luck! :redface:
 
TrueEnglishGent

TrueEnglishGent

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Update!

Well it's officially the morning after my treatment, I had hoped to write up my experiences when I got back from the dentist but blood and constant pain would not allow me. As I write this my head is on absolute fire and feels like it's about to explode while thankfully the blood as calmed down and been replaced by saliva which gives me the appearance of a dribbling mess. This will probably be a long post so please keep that in mind as I ramble. My experiences might be able to help other people.

So got to the dentist and was eventually sent for my treatment with a different dentist to the one I first saw on my check-up appointment. First of all I wish to actually say how nice the dentist was, the first appointment confused me and worried me by how quickly it went by. I actually asked him about this and it sounds like it's the useful procedure for the practice. They treat a lot of patients so I guess they're just efficient. He explained what was being done in detail (which was all the required treatment) and told me I can simply put my left hand up if I wanted to take a second or was having problems. I point this out as this was something my past dentist never did and never rarely explained matters to me well.

So then I had what felt like seven or eight injections in my mouth, I've gotten use to injections over the years with treating my arthritis so they didn't bother me at all. Cleaned the teeth up a bit and first did the fillings which went okay. Then he worked on the two caries that were bad, including the one just at the side of my mouth. I wondered off at this point as I had been in the chair for a long while already and eventually in informed me that he was doing molds for the top and bottom teeth. Being dentist yourself I guess you know the process well enough and that was fine. Now came the trickiest bit of all, a bad tooth that needed extraction.

Now a good three or four years ago I had a full six wisdom teeth out at once by my previous dentist, yet this was rather pleasant compared to this one. Took forever to even get going, I'll have nightmares about the way he at to pull at it. Finally the mother of teeth came out, I was just thankful for having the area numbed. Then some other smaller molds were made and that was it. Was in the chair for just under two hours I believe and was told that I needed to return to have a crown (or crowns) fitted next week.

Got back home to rest but did take a look at how my front teeth had faired and it caused a pleasant smile. :D The chipped gap in the enamel had been done wonderfully and the bad tooth to the side of it which had suffered caries look fantastic to. That alone as made all this pain worth it. Don't know how the other side as faired, can't really look as I need to let the extraction point heal. I'm concerned though that after removing the gauze a considerable amount of blood... well I guess I'd call them pools of blood came out at the same time and I'm worried I may have disturbed the blood clot. It bled all last night quite badly, but as stopped this morning. Concerned due a friend who had dry socket which was nasty and concerned about that.

That's all I can think worth mentioning, which is a lot I know. Still will ask him about potentially whitening the front two teeth at my next or later appointment when everything as settled and the mouth as time to heal. But I have to say it was a pleasant dentist considering the treatment I had.

Guess that's it really.
 
Dr. Daniel

Dr. Daniel

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Hey
It sounds like the dntal practice you went to is ver concerned with "time chair" concpet (that means makeing most treatments possible while the paitnet is on the chair). That is why you had extensive anesthesia adn long sitting on the chair. I don't find it a proper way to treat a dental phobic patient, but at least you are pleased from the end result, and that what matters :D.
Regarding the dry socket, if over the next day or two the pain from the extracted tooth is less and less hearting (after all there is a wound that needs to be healed so it should be a bit unpleasesnt) you are on the right track.:)
You did great.:jump: I hope that the next appointments will go well for you.:thumbsup:
 
brit

brit

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Hey
It sounds like the dntal practice you went to is ver concerned with "time chair" concpet (that means makeing most treatments possible while the paitnet is on the chair). That is why you had extensive anesthesia adn long sitting on the chair.
Yes, it's deeply worrying if this approach is starting to reach the UK from USA. I usually call it 'production line dentistry' although this seems like a variation even on that. I still don't see how ethically one dentist can diagnose and another who you have never met can then treat you. What if they did not agree with the first dentist's diagnosis and to check that they did, they would have to repeat the check-up stage...to be sure....which they probably don't do and so are 'taking a flyer' as it were and trusting 100% to their colleague's judgement.

Glad to hear the treating dentist was pleasant though...that certainly helps. Congrats for getting through it.:jump:
 
Pianimo

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I still don't see how ethically one dentist can diagnose and another who you have never met can then treat you.
Sorry to butt in - just this statement made me think, as this basically happened to me too. (In my case I did meet the dentist treating me once before, but only so she could talk to me about sedation; she didn't look in my mouth at all.) It did make me feel uncomfortable - especially since she (D3 for Brit) seemed to contradict the first dentist's (D2) diagnosis, before she'd actually looked in my mouth! But I just figured it must be normal practice...but apparently not??

TrueEnglishGent (love the name btw! :)) - congrats on getting through your looong ordeal, and emerging with the smile you wanted! :yay: Sounds like you did really well. Hope the healing is going ok for you - how's the pain been today?
 
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