Dental Chronicles

[Mrsmorton]

I have noticed a number all of the dental related questions on MN get repeated once a month or so; this may be entirely unwelcome but what I intend to do is to make a series of detailed posts answering the most common questions so that I can signpost posters to an answer. Often they disappear in chat and then resurface.

I am a dentist (that's no secret on here) but I have no way of proving my qualifications and neither do I feel the need to. I hope that this will be of some assistance to someone at some point!!

This is really interesting to read.

What can I do about toothache? I've got an appt on Monday afternoon. I'm hoping they'll just take it out as I've had a filling which has stopped the pain for a year. But I really don't want anything else done.

I've been taking paracetamol and ibuprofen. I can't take anything stronger but wondered if you know of anything I could get tomorrow?

Thanks

The evidence on painkillers is that paracetamol and ibuprofen, alternated are the best to relieve dental pain. So... I note someone on your thread said hold a hot water bottle against your face. Don't do that, it's bad advice as it can increase swelling and if there is an abscess there, it can make it point to the skin on your face which can leave a scar. We want it to point inside the mouth where healing is quick and scarring doesn't matter.

The only thing you can do is get an OOH appointment tomorrow to get the tooth drilled or removed (I don't generally remove teeth on my OOH sessions but not everyone is of the same thinking as me).

Thank you. I'll give them a ring in the morning but when I called earlier they only had an appointment 40 miles away tomorrow.

Hi Mrs morton , I have had two teeth removed bottom back, with a premolar and molar, leaving a lone tooth at back. Been removed for 16 years now (had removed when I was 10) and my dentist has referred me to have implants. I know this is going to cost me a lot as I need a bone graft as well. I'm willing to pay if I know that it's essential and I'm not just being fobbed off with back tooth migrating and top teeth having no support. Also, with the bone graft, there was no mention of the cheaper Bio SS (think it was called that), but I know they offer it, why would I have been offered the more expensive surgical bone graft?

Basically, would you get it done if it didn't affect you aesthetically (top teeth have shifted in bit though) ?

Hmm, I don't know much about implants but it sounds like the occlusion (bite of your teeth) is starting to change.

Essentially the teeth like to have other teeth, both next to them and to bite on. If there's no tooth next to them (in front, towards the middle) they often tend to tip/move forwards to touch the next tooth. If there's no tooth to bite on then the top teeth will keep growing to find one to bite on and this can reduce their long term prognosis.

A good reason to have implants at the back is to prevent the over eruption of the top teeth.

I have no idea about bio oss. Have you asked them? I don't have any friends who do implants to ask, my circle are all either general dentists in mainly NHS practice or they've given up on it all.

I have the second consultation next Sat so will ask then, just thought I'd ask second opinions. As I said I'm more than happy to pay out for it if I know it'll help my teeth. The dentist did say my teeth at top had erupted? What does that mean? I don't get pain there or anything...

I just explained it in that post? About the teeth trying to bite on something?

Ah OK, thanks for replying. The dentist is having the implants slightly higher so that over time it will shift my top teeth back to their original position. I guess what I was asking was, will the slight eruption I have now fix itself so to speak?

Nice work Mrs M. I'm doing my perio MClinDent so absolutely love the bits you hate but you've explained it beautifully

[Runs for the hills at perio MClinDent]

Holy hell armani, I feel a bit nauseous at the thought!!

confused yes they will slowly move back to their original place. It can be a bit uncomfortable but it's a very useful thing to be able to do, move them back in otherwise the space is gone and we can't get it back.

It's called the Dahl effect. Have a Google if you're inclined!

Brilliant! You've helped immensely

A hygienist appointment will definitely help. The law changed recently, you used to have to see the dentist first and we would make a diagnosis and write a prescription. Now many hygienists will do direct access (I think their insurance goes up...) so you can just make an appointment directly with them and they can sort your gums out. Generally if there's anything they are concerned about either with your gums, your teeth or the soft tissues in your mouth, they'll advise you to see a dentist sooner.

I think I use too many commas.

Oasis is what we call a "dental body corporate". The new model of healthcare supports large practices that are part of a chain, a lot of dentists who are fed up will sell their practice to a chain, work there for a year or two and piss off to retirement because the conditions and level of service aren't great. I don't have any first hand experience of Oasis (or any other corporate) but on the grapevine, they're not well thought of.

Oh I agree about corporates. Oasis aren't even the worst, there are some terrible corporates. I had the misfortune to work for one once. Sainsburys are now jumping on the dental bandwagon too.

Thank you for this. From your posting, I think I have pulpitis! I have a lower wisdom tooth that has a filling in in; part of the tooth came off a few years ago but caused no pain. Over the last year, there have been intermittent bouts of pain which is as you described - it comes and goes and when it's there it is AWFUL and is made worse by heat. I've had problems with dental phobia over the last few years - but I changed dentist to one that's supposed to be good for nervous patients. For the last few times it wasn't hurting so nothing's been done about the break, but since my last year appointment is when the pain started. I went a few weeks ago and told him all this and he x-rayed and noticed that the filling in the wisdom tooth is also now cracked, so he's referred me to the hospital for an extraction as I'm nervous so will have the option of sedation. The tooth is also very flush to the gum line, so he thinks that it may need to be cut to remove it.

Anyway - I have two questions; one, what is sedation like and would you recommend it?

Secondly, what is your opinion on electric water flossers? My husband has bought one and I've tried it (it has replaceable heads!) and whilst it feels nice, I'm not convinced it will get off all the embedded plaque between teeth and around the gum line. Your opinions would be appreciated!

I am very nervous about dentists - but tooth ache is so horrible that I honestly really want the damn thing out! I just don't know how long the waiting list is and am hoping I hear something from the hospital soon...

I haven't been sedated for dental treatment but it gets very good reviews and has an amnesic effect so people tend to remember nothing about the treatment.

Water flossers, as I said earlier I have no idea or interest but i will ask my hygienist tomorrow. Any adjuncts to cleaning are only any use if you've seen a dentist/hygienist recently. if the plaque has solidified into tartar then they will do nothing.

Why do you think you have plaque embedded around the gum line?

FWIW, pulpitis is the most common toothache I see, almost all of my patients today had it in one form or another.

I'd say water flossers are ok as well as tepes or floss but not instead of. But if the plaque has calcified you need a hygienist to remove it

I do see a dentist and hygienist regularly and my hygienist showed me how to floss properly and I have healthy gums. I guess I don't mean embedded around the gum line; I was thinking about it because I've used the water flosser for a couple of days and also tried flossing straight after, and whilst not much stuff came off, a little bit did, which made me think that water flossers on their own probably aren't as good as using regular dental floss. I think I'll probably use it as well as flossing, but not instead of. So I guess I meant that I don't see how they can get everything off.

The dentist wouldn't take my tooth out as I had my DD there.

Going to try for another emergency appt tomorrow when my mum can have the children. This pain is the worst I've ever felt. I'd rather give birth.

ooh Mrs Morton....just the person!!
I am terrified of the dentist, have had so much go wrong in the past but over the last few days my toothache has been so bad that today I nearly jumped into the dentist's chair!
It's an upper molar (one right in front of the wisdom tooth), it's filled and when I had my bottom wisdom tooth out last year, it was a really difficult extraction of an impacted tooth, and they smashed into this tooth while pulling! It has been niggly for a while but terrible last couple days, on and off.
So, I went today and had x-rays and I have an infection, way up at the top of the roots, near the sinus. He said he could treat me with Clindomycin and then try and take it out himself but didn't really want to as the roots were so close to the sinus and if they snapped he would have to leave them there. I also have another lower impacted wisdom tooth which has caused severe decay in the tooth in front, these don't hurt at all as yet.
So, I have opted to have these three teeth out at the hospital under anaesthetic, the waiting list 14 weeks or so.

Do you think this is what I should do?
I can't bring myself to have them out with the dentist as he really looked very unsure about it, and the previous impacted wisdom tooth I had out took 2 dentists and 70 minutes so I'm thinking I really want to have them out under anaesthetic.
On the plus side, everything else is great. When I was last seen last May I was told my gums were a 2 but since then I have used an emmi-dent toothbrush and was today today they were a 0!!
Any advice greatly appreciated.
Ohhh, and I have already made my 6 month appointment to go back. Going to conquer this fear!!

Hey good work. 0 is ace bloody well done. I had a bit of pink in the sink this morning so TePes for me!!!

Yes, it sounds perfectly reasonable to have the three out under GA. no point making your fear worse. Three teeth don't take three times as long to heal as one so all in one go definitely good.

The sinuses can be a PITA sometimes, in my limited experience of doing GA extractions, it's all a bit more favourable. We don't have to keep apologising for leaning over or shining lights up your nose, the theatre is well set up for difficulties and even simple things like suturing are easier in theatre because the nurses are more experienced at handling that specific equipment.

Good work for fighting your fear though. So sensible to get things done early on.

Thank you for your kind reply.

Really looking forward to getting these 3 teeth out the way and going religiously every 6 months!!

While DH was waiting for me he even made an appointment for himself - he hasn't been for 3 years!

High fives all round. I had a good day at work today. Did a really hard surgical extraction and it went smooooothly. Booked 45min, done in 20 so all round. Then I used our new root canal machine majig and the results were fab.

All is well in the dental world!