Filling, crown, CEREC or extraction...?

[Karenw]

I'm still reeling from yesterday's diagnosis but will be proceeding with his recommended treatment course starting with the bite analysis on the 29th. In the meantime, I hope no more teeth with break.

I had told my NHS dentist I couldn't chew on one side but in the rushed appointment, maybe it didn't register. I felt I was being fobbed off - particularly when asking for his advice re the other broken teeth. He never queried my bite and indeed no dentist ever has.

Advice seems to have unanimously been to make a complaint to the NHS practice including advice from a lawyer friend (also a benefits adviser) who attends the same NHS practice, needs a root canal and has been advised similarly that the practice won't do this because it's uneconomic, and I will probably pursue this once I have the bite analysis results. When I registered with them last October, the worst LL6 tooth wasn't grey (but had the crack) and I specifically sought advice for it - I was advised to wait for the front cusp to break off and then the dentist would make a simple repair but there would be a small gap where the missing cusp had been. It didn't sound right to be because I felt the remaining filling would be unsupported but trusted his advice as the dental professional. Possibly the tooth might have been saveable then.

I feel I've had a lifetime of poor dental treatment and this episode certainly hasn't helped me build any confidence although I do feel the private £6k dentist seen yesterday has given me the benefit of a proper assessment which I have never had previously.

My husband has very kindly and generously offered to fund half the cost of my treatment so that's a big step forward. I've still had a sleepless night coming to terms with the shock of the appointment and worrying how I'm going to get through the extensive drilling.

Thanks to everyone for your advice and support. It is helping...

 

[carole]

Don't stress too much about the drilling, I am and have always shaken badly as soon as the drill was anywhere near me. I hate the drill.

I have had some very long appointments over the last few months and it has involved a lot of drilling, more than I thought I could cope with. The first couple of appointments I shook a lot, I was shaking the week leading up to the appointments, but the dentist has been really good and understanding. I don't like the drill still but I no longer shake going to the appointments with him, I have got to a point where I trust him. He makes sure I am numb and I haven't felt anything at any time.

I don't think I am cured because with a different dentist the fear is still there but with a dentist that you can build a trusting relationship with and one that will take it slowly and work at a pace you can cope with the treatment isn't as bad as we think it is going to be.

You sound like you have found someone that you can place your faith in and who will put your feelings and comfort first, I think you are going to be okay now and get the treatment you need.

I think as nervous patients we always expect the worse, but in reality nothing is as bad as our own imagination and we do more to ourselves stressing out than any dentist could inflict. I do think your nhs dentist did not treat you properly and you were right to find another that would both listen to you and come up with a treatment plan to get you out of pain, and get you orally healthy.

Good luck

 

[brit]

Advice seems to have unanimously been to make a complaint to the NHS practice including advice from a lawyer friend (also a benefits adviser) who attends the same NHS practice, needs a root canal and has been advised similarly that the practice won't do this because it's uneconomic,

Your lawyer friend would do well to steer clear also. The trouble with NHS root canals if done in a rush and without magnification is that they often fail and then doom you to an extraction. If he can afford it he would be well-advised to go to a specialist endodontist for the root canal or at least to a private general dentist experienced in and interested in rcts and not interested in implants lol.

Root Canal Treatment FAQs

Get detailed answers to FAQs: Is root canal treatment painful? Why am I sore afterwards? Why do I need a crown? And many more!

www.dentalfearcentral.org

My husband has very kindly and generously offered to fund half the cost of my treatment so that's a big step forward. I've still had a sleepless night coming to terms with the shock of the appointment and worrying how I'm going to get through the extensive drilling.

Great news. Don't feel guilty. He's your husband, you're a team, he should help you out here. After all he will benefit from the pain-free you as well. You didn't get back on the benefits. I agree with Vicki to check with CAB if Job Centre have tried to pull a fast one.

Re the actual treatment - did the dentist actually inspire confidence, did you feel comfortable with his chairside manner. Was he friendly and sympathetic? Remember with the fees you are paying, you can up your expectations with regards to TLC levels. For instance mid-treatment, it would not be unusual in the private sector to get their mobile phone number for out of hours issues.

It is great that he has planned multiple appointments, the last thing you want technically (and as a phobic although you will disagree) is long but slapdash appointments. Taking it at a reasonably slow pace allows you to get used to things and learn to relax and most importantly build up trust.

If he has good injection technique (gel, slow delivery) everything should be pain-free from start to finish. Do not expect any pain and if there is any, alert him immediately and expect him to take it away.
A slight pinch (if their injection technique is not so good) is the worst you should expect. Only pay for each treatment as you complete it. Do not pay the full amount upfront and then if it goes awry you are not locked in and can go elsewhere.

I am hoping the experience will seem like chalk and cheese compared to NHS but usually, there would have been some positive vibes forthcoming at the consult.
Think about what he could do to help you in case he is well-meaning but not used to nervous patients. Do you want him to explain each step in advance, give you a running commentary or would you prefer to put the DVD goggles on and tune out. Agree a raised hand stop signal so you can have a break or draw his attention to anything that is bothering you. It should not cause you pain....so do not put up with pain...you are paying....you have control...I sound like a dentist's nightmare but I am really not, I am just careful where I go

Feeling Powerless (Loss of Control)

Feelings of helplessness and lack of control are very common when visiting the dentist. Find out how you and your dentist can put you in control.

www.dentalfearcentral.org

 

[Karenw]

Thanks for all the reassurances. I'm trying to take heed of them but still dreading it all.

Today I've been brave and confirmed and paid a deposit for the first appointment. This is for the Lucia Jig (which I've been googling) and is set for next Tuesday, after which there will be a follow-up review appointment. Next, the dreaded drilling appointments will follow starting with examining the cracked/split tooth to see if it can be saved then adding a temporary filling so I'm not left without a 'chewing side'.

For me, these will be the worst. I don't think I've ever been fully numb and instead feel a deep nerve pain, particularly in my lower jaw. This doesn't help my anxiety in the least and I have terrible palpitations, pounding heart, then feel exhausted, weak and wobbly after appointments. Dentists have always said that my excess adrenaline is flushing the local anaesthetic away - which is possibly true. On a few occasions, I've been given the jab early in the afternoon with very little effect other then tingling and slight numbness, then more numb around 8pm in the evening. Just to add to the complications, I'm also a redhead which, from what I've read, makes it harder for me to be anaesthetised. Great - not!

I'm taking your advice - although I've been offered a whopping 5% discount if I pay for the full treatment ahead, I'll be paying for each treatment as it happens, with a deposit in advance when booking long appointments. I wouldn't want to pay the full amount ahead, just incase anything goes wrong.

Re the benefits issue mentioned earlier, no I'm not eligible for a penny. I've looked into it many times but - nothing. I'm one of those people who doesn't fit neatly into a box and slips through the system just like many others and conveniently don't appear on any Gov't statistics.

Re the NHS dentist I registered with last October, I thought I'd been lucky in finding affordable treatment but it looks as though I was wrong and I won't be going back.

 

[brit]

Good luck. You must tell him that you have issues getting numb. We have a bit on the redhead genetic thing (which people with other hair colours can also have btw) - again it means you need much more LA than normal and it is best to do this upfront, not try with a standard amount first and then top up to keep you comfortable. You do need to relax....it really helps.
Different LA brands may also help.
If you really cannot get numb then you need to get sedation....pain is not the way to get over dental phobia (entirely logical if you have never got numb).

If you want to look her up, there was another poster who had to go to great lengths to get comfortable treatment. her name was bluestringpudding.

I have also experienced it (on lowers) myself in the past but for last 6 years have always had no issues getting numb although it does take me a bit longer than some people (apparently).

 

[Karenw]

I mentioned the fact I don't think I've ever been numb - I get tingling in my cheek and an upper/lower lip can feel 'swollen' but I've always felt a deep pain which makes me want to scream.

Next week when I have the Lucia Jig, I will stress this to the dentist because I really couldn't tolerate 50 minutes of this drilling which is what I'm told it will take.

I tried IV sedation 4 years ago - for the replacement fillings LL5, 6 & 7 including the LL6 which I'm now having problems with. It got me through the fillings but I didn't have the easiest time - it took me 4 days to fully wake up and the 2.5 days following it I was quite drowsy. I think I had far too much (8mg?) followed by a full vial of the reversal agent (which I'm told is rarely used?), had to be carried out of the surgery, down the road and then up to my bed at home. I had a pounding heart, palpitations and felt quite anxious in the days following.

This time, I don't have the option of sedation because I need to be able to drive +1 hour to/from appointments so really need to get to grips with this with some effective anaesthetic and somehow manage to keep myself calm/distracted on the chair. If I could get to this stage and get through the drilling, I'd be so pleased with myself.

 

[Karenw]

I've now had the first appointment - the Lucia Jig. First it was fitted to my upper jaw then I was sent outside to wear it for 30 minutes before returning to the surgery. It was a new experience for me as waxed sheets were inserted into my mouth for me to bite on to create tooth imprints. My jaw was maneuvered into different positions and afterwards it felt as though my mouth closed differently.

Then, after 20 minutes or so, came the next bit - impressions. I didn't realise these were part of the procedure and went through a mild freaking session because I really didn't want this. The dentist seemed to understand and used some rapid-setting powder but I was a complete wimp and the paste set in the trays on the first 3 attempts before I would allow it anywhere near my mouth. He then changed tack and suggested doing the lower jaw first instead of the upper and it wasn't too bad. He told me to breath through my nose - which I did loudly, shaking, sweating any close to hyperventilating for the 34 seconds it took to set. It wasn't pleasant but it was OK and I didn't gag - a major fear following some horrible impression experiences in my early teens.


Afterwards I was still quite shaky but had to get back onto the chair for measurements to be taken and for my facial and jaw muscles to be checked and measured. My head was below my feet which I found uncomfortable so asked for this to be raised, but I was still quite edgy following the impressions. After a few minutes I became quite panicky, woozy and had just had enough of it all so the appointment was brought to an end.


I stayed longer on the chair than I ever have before and found some of the unfamiliar procedure interesting but was quite anxious and drained by it all. I was a complete wuss with the impressions and embarrassed.


I get the bite analysis results on 13/6 after which it's time to get started on the real treatment with the dreaded drill for an investigation of the split LL6 tooth (which is getting worse), a temporary filling in it or an extraction, 2 crowns on the LR6 &LR7 then to be followed by a crown on LL7 and possibly a bridge between LL5-LL7. The drill remains a dread because I've never endured so much drilling previously and panic after just 5-10 minutes drilling and I still can't face the extraction. Anaesthetics are to be discussed at the bite analysis appointment and I've been assured there are several types available.


I'm still having sleepless nights over it, find the whole thing very daunting but am trying to break it down into smaller targets and looking forward to (hopefully) having a mouthful of stronger teeth at the end of it all.

 

[Karenw]

Equilibration??? (Was filling, CEREC or extraction)

Yesterday I had the follow-up appointment following my bite analysis. It seems my jaw muscles are exerting too much pressure on my back teeth which is causing them to break hence the cracked lower 6 & 7 molars to both sides. Also my front teeth are poorly aligned too which is causing wear on them and having an effect on my back teeth and the dentist has recommended I have an 'equilibration' to file down and reshape my teeth to give me an improved bite. (Teeth pics included with first post on this thread.)

I was presented with two quotes (as below): The first quote is for a huge amount of work and amounts to a whopping £17,639 (yes, nearly £18k!) to give me a 'perfect mouth'. This isn't even a consideration because I could never raise this sort of money. The second quote is for just the equilibration and crowns on 4-5 of the mostly badly cracked teeth. He doesn't want to just crown the teeth because there would be a high risk of
the crowns breaking.

I'd never heard of equilibration before and need to decide whether to proceed with it. The dentist talks sense and I think he is genuinely looking for a long-term solution to what has been a long-term problem for me with my teeth cracking and cusps breaking off. The cost is £1200 for the equilibration and will involve 2 hours in his chair. It is a small fortune for me because I'm not working and in the current economic climate, I don't foresee this changing for some time but my husband has kindly offered to fund half the cost to help me out.

Does equilibration sound like the correct way to go and is £1200 a reasonable price? This would then be followed by 4-5 crowns at about £820 each.

 

[Karenw]

I'm very pleased to report that this thread has now resulted in a Success Story.

Thanks to everyone who provided advice or support. It was much appreciated and I hope my Success Story thread may help others in a similar position.