Your teeth and people who drill them

[01101010]

I use the regular old minty listerine. I got the no-alcohol version once by mistake because I didn't realize that was even a thing, I just grabbed the bottle of the correct flavor. I tried to stick with it for a week and tossed it out for the good old alcohol version. The burn is good, but I also use 90% rubbing alcohol for aftershave.

So what's this about the purple kind? Is it better than the regular green or blue or whatever it is I use?

My mother has pretty bad perio, mine was up to 6's in the back but over two years I brought it down to 3's in the worst spots. I'm bummed because we have a new hygienist and she's nowhere near as good with the perio treatments. I'm considering going to the practice she went to, even if it means a 45 min drive each way. What's that compared to your teeth? But I love my dentist, so it's a tough call. Anyway, note that I was a dumbass and didn't go to the dentist for 18 years after high school, and got away with only one crown and a filling for that. In my defense, having no insurance in the 'greatest country in the world' is fucking balls.

I think the purple stuff has a Fluoride supplement to it. It is, however, the worst tasting shit in the entire listerine line, including the good old GOLD. I got a smaller bottle of the purple once since it was on sale. Horrible horrible horrible. I'm with you on the good old green mint - and if it isn't burning your mouth, it isn't working.    Been using it for years and I don't really notice the burn anymore and feel funny when it doesn't.

[ghost]

Dental insurance is pretty much a miss.  If your employer isn't paying for a substantial amount of the insurance it isn't generally going to be worth your money, for several reasons that I won't get into here as it will head us into politics for certain.  You might consider getting your hygiene done at the other place that the hygienist went to and then get your checkups and treatment with your other dentist.  If you're paying cash there's really no reason you couldn't do that. 

Yeah, the purple Listerine has fluoride and it doesn't taste quite as obnoxious. 

[Stewie]

Question for you Ghost,
I had an extraction about 8 or 9 months ago and they keep telling me that i should get an implant. Of course that costs a fair bit (they were quoting around 3k) They told me that he jaw bone where the tooth was will recede a bit with no tooth there any more and of course the teeth on either site will start to crowd in.
Every time I talked to my dentist & hygienist about it, it felt like a sales pitch. if it stays as it is right now I would have no issues. So how important is an implant? (or a bridge for that matter)

[ghost]

It depends upon where the tooth is.  If it is in the front, you obviously have more motivation to get something done because you don't want to look like a hilllbilly.  If it is in the back, it becomes more problematic because of situations where people don't see the need for pumping a ton of dough into something that isn't cosmetic.  

If you don't get it restored with an implant, two things will happen:

1.  The bone will go away.  This is absolutely true.  How fast will it go away?  Who knows?  It varies from person to person.  If you wait longer than 9 months to a year to get the implant placed in the bone your chances of needing a graft go up significantly.  A graft in that area is problematic because it can increase the cost of the entire procedure significantly ($2-3000).  It also increases the chances of the implant failing.  Implants in the back of the mouth are generally highly successful, however (>95% over 10 years) and this should be considered a minor factor.  So my answer to whether or not it's a sales pitch is yes, it is, but it's still good information that she's giving you.  If you were related to me I would recommend that you at least get the bone portion of the implant done ASAP.  If you get that done and can't afford the rest for a bit they can "sleep" the implant, meaning do the surgery and leave it buried beneath the gumline so that you don't get an infection or have other trouble with it.  This is a nice option as it will keep the bone in place and possibly help prevent the need for the graft.

2.  The opposing tooth will overerupt and cause trouble.  This is a major issue that should not be ignored.  Teeth will erupt until they touch something, even if you are 50 years old.  So if you lose a lower tooth and the upper tooth isn't touching anything it will start to erupt again.  This is why if you get a wisdom tooth out you need to get both the top and bottom in most instances.  If you have a space and a tooth erupts into it to a significant amount you will be talking about getting a root canal and crown on that tooth just to make room to restore the implant, thus adding additional cost to the situation and additional risk as root canal treated teeth have a 7 year success rate of only about 70% when treated by a general dentist.  If you choose to do the "sleep" option that I mentioned above, I would recommend getting an Essix retainer (clear plastic and looks like Invisalign) made for your upper teeth or lower teeth (whichever does not have the missing tooth) so that you don't run into this problem.  

You may find a cheaper solution at the dental school if you have one nearby.  The treatment is generally going to be as good, if not better, than you'd find out in the community.  However, what you are gaining in cost you are paying for doubly with your time.  It takes  much, much longer to get anything done in the dental schools.  A nice middle ground is to go to the specialty residents, preferrably the Periodontist residents for an implant.  I highly recommend an implant over a bridge.  The success rate is going to be as good and you'll feel much better having a "tooth" in the spot.  Also, with an implant you are preserving the bone in the area, which is extremely important.  

Also, if you ever considered getting any form of orthodontic treatment you'd want to do it prior to getting an implant placed anywhere.  Teeth move, implants don't.  

Hope this helps.

[Reg]

This is great information ghost.  Just reading your replies to everyone's questions has convinced me to go back to my dentist after Christmas and let him put the cap on the tooth he just root canaled.
I'd told him to just slap a giant filling on it but after reading your stuff I understand why that's a generally bad idea.  If he'd just explained properly why I needed a cap I'd have scraped up the thousand bucks somehow and had the procedure done right away.

[ghost]

Most dentists (and clinicians in general) are remiss in educating patients.  This is unfortunate.

[Selby]

So in the interest of teeth, what does one do when they believe they have a cavity that is starting to affect their ability to eat food, but have no dental insurance coverage until January?  My girlfriend is pretty miserable most nights at dinner but her insurance doesn't kick in until January (but hey, for the first time in her life she has a job that actually provides insurance so that's a win).  Most dentists I can see it being a 4 figure bill without insurance (I know my doctor visits have been).

[ghost]

Go in and see if they can do a temporary filling.  It sounds a bit like a tooth that may need a root canal.  One tip that may let you know that it is heading that way is if the tooth is very sensitive to cold and/or hot for an extended period of time after exposure, i.e. you drink something cold and the tooth throbs for 45 seconds or more.  Also, if you have throbbing that tends to keep you up at night, that can be a sign of needing a root canal. 

[Selby]

Excellent.  Follow up to that question... how does one get in to see a dentist on such notice?  Most dentists won't see you for 3-4 months.

[01101010]

Excellent.  Follow up to that question... how does one get in to see a dentist on such notice?  Most dentists won't see you for 3-4 months.

Walk in clinics usually work pretty fast, but the work is hit or miss. At least in my experience. Dental schools are another way around the wait and IIRC, cost. But if it is an emergency, they'll usually open up a spot - I got bumped from an appointment due to some guy coming in with 4 broken teeth from a kicked back chainsaw.

And I only throw my two cents in the ring as I have a sorted history with the evil dentists and being in that god awful chair. These days however, septocaine has changed my thinking.

[Reg]

3 or 4 months to see a dentist? That's crazy! Where are you guys from?

[01101010]

3 or 4 months to see a dentist? That's crazy! Where are you guys from?

Land of the free and home of the brave. Now get in line and wait your turn like everyone else.

[ghost]

Yeah, most dental schools with have a walk in clinic that can get her out of pain.  Otherwise you'll just have to call around and keep telling people you are in pain and looking for a solution.  Somebody will help you out.

[Sky]

Most dentists (and clinicians in general) are remiss in educating patients.  This is unfortunate.

I always ask tons of questions, including 'what other questions should I be asking you?'

If a doctor won't answer them gladly (and satisfactorily), time for a new doctor. I  my specialists...GP different story.

[Lantyssa]

It might be worth figuring out what dentists will be on her plan if she doesn't have one in mind.  That way if she can get in and does like them, she can be ready to pick them in January.

[Cadaverine]

If you don't get it restored with an implant, two things will happen:

1.  The bone will go away.  

Since we're on the topic.  I had one of my back teeth break on me around 4 years ago.  There wasn't enough of it to salvage, so the dentist I went to just pulled the remainder of the tooth.  He never mentioned getting an implant, or anything like that.  I visited a different dentist in the not too distant past to get a small filling in the tooth behind the one that was removed.  He also did not mention anything about implants, or what have you.

Poking around in the spot where the tooth was, there's no indention, or anything that I can feel.  Should this be something I should be worried about?  My skull won't evaporate, or something equally distressing, will it?

[Reg]

It's already happened. People are just not mentioning it out of politeness.

[ghost]

If you don't get it restored with an implant, two things will happen:

1.  The bone will go away.  

Since we're on the topic.  I had one of my back teeth break on me around 4 years ago.  There wasn't enough of it to salvage, so the dentist I went to just pulled the remainder of the tooth.  He never mentioned getting an implant, or anything like that.  I visited a different dentist in the not too distant past to get a small filling in the tooth behind the one that was removed.  He also did not mention anything about implants, or what have you.

Poking around in the spot where the tooth was, there's no indention, or anything that I can feel.  Should this be something I should be worried about?  My skull won't evaporate, or something equally distressing, will it?

It takes longer for the vertical bone loss.  Loss in width starts first and can make placing an implant very difficult.  It's hard to graft sometimes, too.  If it was one of your 12 year molars they may not have seen a need for it, and I wouldn't stay up at night worrying about it necessarily. 

[Jimbo]

Do you ever replace the 2nd or 3rd molars?  I know some endo's who said it was crazy doing root canals on 2nd and 3rds.  I'll clarify as the charting I'm used to, goes upper right 3rd molar (wisdom tooth) is counted as 1 and goes to 16, then drops down and goes 17 to 32.  I know there is like a million ways to chart teeth (or there used to be).  So if you had your wisdom teeth extracted (1, 16, 17, & 32), then lost #2--your 2nd molar, how bad would it before #31 since it doesn't occlude against anything now?

Not that I'm in that boat, instead I have the excessive build of tartar (calculi) which is causing some mild gum problems.  I love the hygenist at my office because she just blast the hell out of the teeth with the ultra-sonic cleaner, it feel so much better after that.  The other hygenist uses hand scaling which doesn't feel as clean.  It still doesn't hurt, she keeps asking if I'm doing okay, and I'm like hell ya, keep on blasting and get my mouth feeling better.  So far so good, haven't had to go to a periodontist yet.  Oh and I don't do the risk factors...don't smoke, drink moderately (like 1 a week at the most), don't chew or dip, don't drink sugary drinks.

[ghost]

3rd molars are rarely replaced.  Second molars are regularly, but in some instances they are not.  There's no loss of function without them.  It really is a bitch to do endodontics on a second molar.  You might not need to replace a second molar if the opposing tooth is occluding with another tooth, even just a little bit.

My personal thought is that 99% of all wisdom teeth need to be removed.  The partially erupted ones are the worst offenders-  you've probably seen bad dental infections in the ER.  Usually they are from lower wisdom teeth that have gotten out of control (but not always).  Fully erupted third molars are the next worst offenders.  People don't brush very well that far back (and sure as hell don't floss) and people inevitably have issues with them.  Often the issues will drag the second molars in as well, particularly if the problem is periodontal disease.  The fully impacted third molars cause trouble the least, however when they do cause trouble it's often the kind that causes  you to have to lose half of your jaw.  I just say fuck it and recommend to people to get them out.  It will save a lot of headaches (literally) in the long run for them. 

[Fordel]

Why the hell do we even have all these Extra teeth mucking things up!

Dammit Evolution! 

[RhyssaFireheart]

So here's a question - what about cleaning/brushing the tongue?  I've been doing it for years now when I'm finished with my teeth, I take the brush and go over my tongue as well.  I think it helps with keeping bad breath away and gets rid of the whim scum layer.  Neither my dentist or hygienist have ever mentioned anything for or against tongue cleaning though. 

[ghost]

So here's a question - what about cleaning/brushing the tongue?  I've been doing it for years now when I'm finished with my teeth, I take the brush and go over my tongue as well.  I think it helps with keeping bad breath away and gets rid of the whim scum layer.  Neither my dentist or hygienist have ever mentioned anything for or against tongue cleaning though. 

Do it.  You're spot on.

[01101010]

So here's a question - what about cleaning/brushing the tongue?  I've been doing it for years now when I'm finished with my teeth, I take the brush and go over my tongue as well.  I think it helps with keeping bad breath away and gets rid of the whim scum layer.  Neither my dentist or hygienist have ever mentioned anything for or against tongue cleaning though. 

Do it.  You're spot on.

I am not a complete psycotic when it comes to hygiene, I mean I take my shower every morning - but I am almost OCD when it comes to bad breath. I been scrubbing my tongue after I brush and before the listerine for years and years now. Your tongue harbors a lot of bacteria and is the main cause of halitosis. That was enough for me to start scrubbing every time I brush.

[Sky]

I was told to only scrub the tongue in one direction. Is that true or doesn't it matter?

I also scrub out the roof and I dunno what you call-ems, the crevices at the top/bottom of gums where they meet the cheeks. A full wordhole cleaning.

[ghost]

Doesn't really matter which way you brush your tongue.

[RhyssaFireheart]

I was told to only scrub the tongue in one direction. Is that true or doesn't it matter?

I also scrub out the roof and I dunno what you call-ems, the crevices at the top/bottom of gums where they meet the cheeks. A full wordhole cleaning.

Never thought about scrubbing the roof of my mouth or the cheek pockets (? or whatever they're called) but maybe I'll try it.  I definitely agree with Numbers though about cleaning the tongue.  I can't stand it when I don't brush before going to bed and then in the morning my mouth feels so disgusting, especially the tongue.  It's just.. ugh.   

[ghost]

The area sky is talking about is called the "vestibule".  You really don't need to brush those other areas as much as there is natural cellular turnover with time.  The tongue is special because of the little rough areas  (called papillae) which will trap noxious substances and bacteria thus leading to bad breath.  Also, if you don't brush these areas the papillae can overgrow with time and get gross.

[apocrypha]

Any advice on an electric toothbrush?

My GF has just been told by her dentist that she should use one because she tends to brush too hard and is doing damage to her tooth enamel. Are there any that are generally held to be good brands by dentists?

Cheers.

[Merusk]

My hygienist told me the same thing, though it's my gums suffering.  There's evidently brands/ models out there that shut-off if you brush too hard, but I didn't think to ask her what they were.  Google got me here:
http://www.amazon.com/dp/B000U08ZN4/?tag=centralbeekee-20

[ghost]

I would use a Sonicare.  I don't really like the rotating heads on the other ones.

[Hammond]

I have a sonicare and it works pretty well.  Its not cheap though.   

So got my teeth cleaned today from my dentist of 15+ years.  His dental hygienist did something I have never had done before.  She pulled my tongue aside with a piece of gauze and checked my cheeks, gums, and tongue for oral cancer.  I wonder how prevalent this is? I don't smoke, chew etc so I am guessing I am fairly low risk but still it was interesting.

Oh and it helps she is hot and is super chatty :).

[ghost]

That has been standard practice for dentists for about 15 years.  If your dentist isn't doing it you should ask them to do an oral cancer screening when you go in, particularly if you are a smoker/drinker.  The combination of smoking and drinking is a significant combination for developing oral cancers.  Interestingly, using smokeless tobacco is not.  Most research that has been done shows that people that use smokeless tobacco are at barely any increased risk of oral cancers as compared to the general population.

[Lantyssa]

Hot gases are more permeable would be my guess.  Plus whatever compounds are created by burning which aren't present in the raw form.

[ghost]

Well, people assume that it's the nicotine which is causing the cancer, which would be false.  It's the noxious chemicals, as you stated.  But part of the theory about smokeless tobacco was the irritation caused by the tobacco, thus leading to a high cell turnover rate in those areas and eventually the introduction of dysplastic cells.  It's just not the reality of the situation.