overlooked issues?

[RJayne]

Hi, this is my first post here though I've been reading the forums for a few months; for some reason I couldn't bring myself to post without having had that initial appointment (I think given any reassurance things weren't as bad as the scenarios in my head and I'd have lost my bottle!).

Anyway I got there and had my first appointment in about 10 years, I was shaking like a leaf in the reception but everyone was super supportive and kind, it's just the results of the consultation confusing me now...

I've been told everything is "structurally" fine, no cavities, no mention of gingivitis (BP numbers were read out, all 2s) I had x-rays. I've been booked in for a regular cleaning which they've broken up into two sessions for me to make it more manageable and that's it, other than six-monthly check-ups.

Does that sound feasible?! 10 years and nothing? I'd convinced myself my teeth were in a terrible state but the visual issues are apparently corsodyl stains, I've developed a serious obsession with every sensation over nothing? I'm even in the habit of pushing on my lower front teeth to see if they move (and not gently and I'm trying very hard to stop it) because I've convinced myself I have perio issues there even if the gums don't bleed. Now I'm not sure if I don't need a therapist more urgently than a dentist...

I guess what I'm asking is how likely is it something serious was missed in the consultation? Could gingivitis or more be overlooked? Despite getting what sound like really positive results I can't stop my worrying, it's from morning till night and I'm getting exhausted, I want to be able to finally relax but its practically the same level of nerves I had before finally getting myself in the chair. If you got this far thanks for reading my anxiety dump lol, I really appreciate it.

 

[grumpybear]

I'm not a dentist, but based on my own experiences and research, I guess generally if you looked after your teeth and your oral hygiene at home is good, it can happen even if you haven't been to the dentist in awhile. Some people don't build up as much plaque as others and then there are also other factors such as their saliva quality, lifestyle habits and diet that does makes a difference. Everyone is different.

Also, one thing I've learned is not everyone needs to see the dentist every 6 months, that is just a general guide. Some people get advised by their dentist to only need to come in once a year, and others go once every quarter or 3 months as advised by their dentists depending on what the condition of their mouth is.

Personally, I hadn't been to the dentist in over 20 years up until March last year. I don't have any phobia or anything like that, I just didn't go because I equated seeing a dentist to seeing a doctor, that is only when you have an issue. I took care of my teeth and oral hygiene decent enough but did not floss a single day in my life. When I had my first cleaning in 20 years, there were no cavities or deep gum pockets, the plaque build up wasn't bad, and I didn't need a deep clean. The dentist gave me a regular scale and polish and was done under 30 mins. I did have abit of gum inflammation but that was it.

On a side note, do stop pushing your tongue hard against your teeth. Tongue thrusting can cause your teeth to shift and you can lose your bite.

Don't overthink things! It sounds like you got a thorough check. Good that you not only have been given a clean bill of health but you have also found a kind and understanding dental office! Hopefully that would help you overcome your anxieties. Also, congrats on making it to your first appointment in 10 years and all best wishes for your subsequent cleaning appointments!

 

[RJayne]

That is so reassuring to hear, I'd started to assume that no professional cleanings automatically meant gum disease was going to be inevitable, I'm very glad to hear that wasn't the case for you and thank you for replying. I'm starting to believe some of these issues are in my head in just the metaphorical sense but I can't convince myself it's all ok, I'm exasperated with myself right now.

 

[krlovesherkids777]

RJayne,

Welcome to DFC , we are glad you are here..

This is great that you got some good news at your appt.. also that

"Anyway I got there and had my first appointment in about 10 years, I was shaking like a leaf in the reception but everyone was super supportive and kind"

This is a great thing!!

I'm so glad you got kind good care and this is your first appt. so maybe trust isn't built to just take their word on things. but hope you can build on your first experience . Sounds like you've done a good job taking care of your teeth .

Wishing you the best!!

 

[Enarete]

Hi RJayne,

well done on getting back on track with dental visits as grumpybear suggests, dental health problems are caused by a lot of factors (the amount and kinds of bacteria in your mouth, your oral hygiene, your nutrition, your overall health etc.) and while having no issues after many years of not having seen a dentist is not the most usual case, it is still possible.
I do not think your doctor would oversee gingivitis (which by the way would be perfectly treatable by a cleaning anyway), as the measuring of your pockets would disclose any gum issues.
If you, despite all feel not too convinced, you might consider getting a second opinion, just to gain some peace of mind.

All the best wishes

 

[RJayne]

Hi guys, thank you so much for responding, it's very useful having other people tell me what I've been trying to tell myself, I do know this dentist is well reviewed so it only makes sense that they'd be competent enough not to overlook anything, I'll try to keep that in mind and calm down. It's weird, after avoiding it for so long now I just want the first cleaning over with so I can get the hygienist's opinion too, three weeks to go on that.

Thanks again, for the answers and the kind words, I don't feel like it was brave haha but its nice of you say ?

(Oh and Enarete that's also very reassuring to hear about gingivitis being perfectly treatable even if I don't have it!)

 

[RJayne]

Hi again, I've just got a couple of additional questions I'm hoping to get some thoughts on; firstly, I'm now paying for private dentistry and my consultation cost £45, would it be reasonable for me to drop them an email just asking them to check my records and confirm the relatively "All clear" they gave me at the time? I think a response in writing my help as my anxiety has been through the roof today, I've checked and prodded various teeth dozens of times which makes things sore and me paranoid :s At least with a written reply I can re-read it, do you think that might help or does it just come across as a nuisance?

Secondly and largely unrelatedly; can/how does a dentist check for tmj disorders? I know I clench my jaws during the day - I'll force myself to stop once I notice, and I often feel a radiating heat and some soreness at the angle of the mandible on the right hand side (and occasionally the mental process, is that weird?) by the time I'm going to bed.

It's strange, I've studied dental paleopathology and I've seen plenty of remains in various states, but it doesn't help me think logically about myself, maybe the opposite even once you've seen skulls holding their teeth in with archaeological calculus, sigh.

 

[Enarete]

Hi again, I've just got a couple of additional questions I'm hoping to get some thoughts on; firstly, I'm now paying for private dentistry and my consultation cost £45, would it be reasonable for me to drop them an email just asking them to check my records and confirm the relatively "All clear" they gave me at the time? I think a response in writing my help as my anxiety has been through the roof today, I've checked and prodded various teeth dozens of times which makes things sore and me paranoid :s At least with a written reply I can re-read it, do you think that might help or does it just come across as a nuisance?

Secondly and largely unrelatedly; can/how does a dentist check for tmj disorders? I know I clench my jaws during the day - I'll force myself to stop once I notice, and I often feel a radiating heat and some soreness at the angle of the mandible on the right hand side (and occasionally the mental process, is that weird?) by the time I'm going to bed.

It's strange, I've studied dental paleopathology and I've seen plenty of remains in various states, but it doesn't help me think logically about myself, maybe the opposite even once you've seen skulls holding their teeth in with archaeological calculus, sigh.

Sorry to read about your anxiety appearing again. I am not sure if a dentist can give you an ok via email, after all they need your teeth to confirm so it might be wiser to get seen again. However an email telling them about your worries can never do any harm.

I don't know much about tmj but there is a series of short tests (palpating the muscles on your face, checking if you bite evenly, checking if your jaw makes noises that it shoulnd't, seeing if you can open your mouth properly and evenly etc.) that help your dentist see the level of your issues and if they should get treated.
Did you discuss clenching with your dentist?

Wow, I had no idea that a thing like dental paleopathology exists, that's quite impressive. In my experience the more you know about teeth the more paranoid you get if you suffer from anxiety (and that even without seeing sculls with archeological calculus!!)

 

[RJayne]

You're probably right re an email, I just keep working myself up over nothing essentially, an email would have been more of a crutch than a solution anyway I guess. I'm back for a cleaning in just ten days anyway so I'll see what they say then, if nothing improves after that appointment I might try and get a diagnosis on the anxiety, I find that conversation even more difficult than talking about the dentists though and somehow more embarrassing (I'm very grateful for this forum right now!). I'm away for the next four days at least, going to try and relax, and after browsing the forum for similar issues, set myself a couple of rules; no touching any teeth unless its with food or a toothbrush (or flossing obviously haha) and to do something distracting when I start worrying

To be honest I discussed very little with my dentist, I was too nervous to ask anything beforehand and forgot all but my most urgent questions after the examination, I think I'll book another consultation for in-between cleans to get the clenching and tmj assessed.

Dental palaeopathology is a sub section of wider osteology and is really useful for adding to the information you can get about an individual from skeletal remains, it's less useful for self assessment when you're still alive and kicking lol. Though I do now wonder if dental pathology could be used to indicate stress, mental health is difficult to research in Archaeology, at least I could get something useful out of this...

 

[grumpybear]

I wonder if you could request for a medical report of some sort for your teeth. Much like the same kind of report that one could request from their doctor. Perhaps that could be something that would help? But that said, working on the anxiety is probably something that would help in the long run than just getting a written report on the status of your oral health. Hope things gets better for you.

 

[Enarete]

To be honest I discussed very little with my dentist, I was too nervous to ask anything beforehand and forgot all but my most urgent questions after the examination

A good idea is to think about all the questions you would like to ask and make a list so that you have it handy next time. I have a list every time I see my dentist and prepare / collect / edit it sometimes even weeks before the appointment. It's not unusual to have bad memory and to be tong tied during an appointment, after all anxiety makes you slip into a very different state of mind than you usually are. I can't remember even a shopping list in a relaxed state so how impossible is it to remember anything while facing a dentist..

 

[RJayne]

Thanks for the advice Enarete, having been away for a long weekend all the things I'm worrying about being symptoms (except for the jaw ache) seem to have felt better without my constant attention, so maybe I'm imagining it. I've only got about five days to go now anyway until the first cleaning.

Since this thread has been so helpful is it ok to ask another question here rather than a new post? For context it was a dental cleaning that scared me away in the first place years ago, before that I'd been fine and went regularly for checkups but at a new practice the dentist pushed severely on my front teeth during the polishing stage, the force was distressing enough, however he refused to stop until he was satisfied - all for tea stains!

Now I've opted for airflo polishing so no one is bringing a polishing cup near me but I've got to ask; how much force is applied during a scale with an ultra sonic tool and does it completely replace hand scaling? I've found mixed answers to the latter

Thank you

 

[Enarete]

Sorry to read about your past experience with a cleaning, I get your discomfort about going again after such an experience. I am not a dentist so can just serve with limited knowledge and experience, but would like to bite on some of the things you are mentioning.

the dentist pushed severely on my front teeth during the polishing stage, the force was distressing enough, however he refused to stop until he was satisfied - all for tea stains!

This sounds very unpleasant and I am so sorry this had kept you away from dentist for some time! This sounds like you asked your dentist to stop and he refused to so before we even talk about procedures as such and what is necessary and what isn't, let me put this into a different perspective for you: a dentist needs your informed consent to carry out any procedure. Next thing - the most important- is that you are allowed to take back your consent at ANY time and your dentist (or hygienist) is obliged to stop if you do so.

If you come across any step in your treatment that your dentist feels is necessary but you would like to avoid, the way to go is to talk and find a way to make you able to cope with it. Often a small break or some friendly words or small adjustments can do the job.

Now I've opted for airflo polishing so no one is bringing a polishing cup near me but I've got to ask; how much force is applied during a scale with an ultra sonic tool and does it completely replace hand scaling?

I can only share the way a cleaning in my practice works, however there might be different approaches based on country, practice etc. so hope you get a reply from a dentist too.
We use airflow to remove stains - its a soft powder that gets mixed with water and gets applied on the teeth under some pressure. The soft particles take away any staining. We still polish the teeth after that to make the surface nice and smooth so that new bacteria can't hold too well. It's not necessary to put any hard pressure on the teeth during the polishing - it's the soft particles in the paste that polish, not the pressure. Think of a small soft electric toothbrush, that's how the sensation should feel. There is also no force applied during a scale with an ultra sonic, it's not the pressure that removes the build up but the vibration. Your dentist/hygienist is supposed to kind of drive around your teeth with it. We use it as a first step in scaling and process with hand instruments to take care of the areas that require softer approach.

The best idea would be to make sure your hygienist / dentist knows what worries you and explains to you all the steps of the treatment. Ask about the pressure and how the tools will get used. You should also arrange a stop sign (and test it somewhere at the beginning of a treatment) to let them know they should stop. After all, it's not about if the procedures are unpleasant, it's always more about how willing is your dental team to accommodate your needs and put you at ease.

All the best wishes, hope you can enjoy the five days with calmness and peace of mind and if anything else worries you, make sure to let us know

 

[RJayne]

Hi, I just wanted to say thank you for that last reply, it was very informative and what you said about my previous experience gave me a little confidence. Just thought I'd share today's results since it was the first of my cleanings (next one in a fortnight!); the hygienist was really amazing and everything pretty much went as detailed above, she confirmed my gums were healthy and if I'd been worried about any extra tooth mobility before the session I couldn't be afterwards, they likely wouldn't have survived!

That's all the good news, the bad news is I absolutely hate the way my teeth look now, I expected gaps but they're so large I'm almost wishing I'd left them alone. I feel ugly at the best of times and now I can't even avoid the sight of these spaces because I can feel them. Now I'm scared of getting braces because they cause mobility and that's my main fear. I'm starting to tear up again so I'm going to leave it here for now, thanks.

 

[Gordon]

Braces don't cause mobility, if you fancy the idea, speak to your hygienist about it, since you like and trust her.

 

[Enarete]

Glad to read that all went well. I know this might be difficult for you at the moment as there are the gaps bothering you, but please give yourself a pat on the back for having made it through the cleaning. It's lovely to read that your hygienist treated your kindly and put you at ease. Really sorry to read how unhappy the gaps are making you Maybe your hygienist can give you an advice about it next time you see her?

 

[RJayne]

Hi again, I just wanted to say thanks to both of you, I'd have replied sooner but my tech has been temperamental and then these forums were down (good to have them back).

I've calmed down about the gaps, almost

I've got a couple of questions but I'm seeing the hygienist again tomorrow, so unless I get replies super quickly I'm sure I'll manage; the gum between my teeth where the gaps are is kind of soft, I can push it with my tongue, its about 2-3mm up the tooth and I can floss down beside it to where the front gum line is- does that sound normal, will it firm up?

Since having the first clean a lower lateral incisor makes a tiny 'click' feeling if I push it back with a finger and then forwards with the tongue (I know I should stop that but I was testing it due to it being sore from the back, not in the gum but near the cusp) does that click sound like extra mobility?

Please humour me on this last question as I feel like I'm flogging a dead horse but I can't get it off of my mind - with BPE readings of 2 all over and no mention of gum disease is it at all possible I've lost bone around the lower incisors, and would it be seen on bite-wing x-rays because I cant seen how they show the fronts? Sorry for obsessing, these teeth seem so fragile to me, I can eat without thinking of them.

Also I'm confused re: braces? I've read lots of accounts of teeth being loosened during treatment and sometimes of them staying slightly more mobile.

Thanks for reading (again), whish me luck, I'm there in just over 10 hours!

 

[Enarete]

I don't have the answer to any of your questions this time, but keep my fingers crossed for you to get some reassurance and information from your hygienist today. Let us know how it went.

 

[geos]

The process of repositioning your teeth with braces takes months/years. While you might be aware of your teeth moving, they certainly won’t fall out and they will get back to feeling strong and not moving once reached the desired position. If you do get braces, your dentist or orthodontist should tell you what to expect and how to take care of your teeth to get the best result. As long as you are properly monitored, you should be all fine.

 

[Gordon]

Possibly too late now but anyway:

1) Easier to ask the hygienist, I can't envisage what you mean.
2) Nope
3) BPE 2 doesn't indicate significant bone loss. Why not read it for yourself?

https://www.bsperio.org.uk/assets/downloads/BSP_BPE_Guidelines_2019.pdf

Bitewings would show some signs of bone loss around the back teeth, but you diagnose bone loss with a probe as well as x-rays, so no real need to take more films of the front teeth.

I'd hope that your BPE score is a lot lower all round now.