Disagreeing with my dentist! Please help

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#1 Post by **Gennel** » Mon Jun 12, 2006 3:00 pm

Ok this is my situation. I have come a long way from not visiting a dentist in 20 yrs. I got 4 extractions as suggested by the ortho plus two other molars in the back that were decayed badly and needed to be extracted as well. I had the 6 extractions done in one day. I was sent to get a cleaning. I was really nervous but was calmer this time. I went in and met the dentist. She was very nice and gentle. I had a full set of digital xrays done and then they took this sharp thing which measures the inside of the gums to see the severity of gum disease I had. They have it numbered from 1-9 I guess or 1-10 not sure. Well most healthy ok gums have a 3. Each tooth was measured and the back molars were like 4-5 which showed moderate periodontal disease. My front were not so bad around 3-4. So I needed the "Deep Cleaning" Lots of chunks were removed today and I feel my upper teeth fresh now! Ok sorry for all the long details.
She checked over my Xrays and she found 2 cavities total. I have one on my lower molar next to my wisdom tooth which I knew about. Not terrible but it needs a filling. The other one is a small one on/in myfront tooth.
I asked her since my front tooth is overlapping the other front tooth ,would it be easier to fix the cavity if my front tooth was in the correct position or at least seperated enough from the other front tooth and she said yes, it would be easier to fix. But then in the same time she tells me that People should not get braces if they have a cavitiy. The cavity in question does NOT have a hole and you can't see any spot on the tooth itself. It's in the tight space where my front tooth is overlapping the other front tooth next to it. She also wanted to do a dental something mold and write on each tooth the depth of my gumline or something like that. I called my ortho and explained to him that even though I liked her and I loved the dental hygenist. I felt that she is the type of dentist who wants everything perfect and sometimes does so many things on a patient without thinking of their finances. I asked the dentist if they needed to do any work and I had braces on how would they do it. She said that the ortho would need to remove the wire for that day and then put the wire back on . My ortho said he had no problem in removing the wire so she can work on a tooth etc... I want what is absolutely needed to have decent dental health. I made it clear to her that I understood that she probably wanted to do many things but I had to decide what was absolutely neccesary to keep the teeth I have.
My daughter has a small cavity on one of her upper molar and she has had braces on for about a month now. I am taking her in soon to get that problem fixed.

I am going back for my lower deep cleaning which they call Debrisment .
I already have an appt to get my braces on the upper teeth only on this Wednesday. My main problem is that I don't agree with all the stuff the dentist said. She has extensive training in this and I understand that. Why does she say I NEED this mold done in her office etc..... I don't agree that I should pay an additional $250 for the mold that insurance does NOT cover. She also said that all my wisdom teeth should be pulled. None of them are under the gumline,they are not twisted,they do not have cavities in any of them.I have seen several types of wisdom teeth that needed to be extracted ,usually impacted wisdom tooth,or it grew in laying down or it's way below the gumline. I told her that I would cross that bridge when I get to it. If I have a problem later on that they are giving me pain,cavity and so on I will have it extracted. But it's rare that a dentist ever says "leave it alone for now"
I feel bad sort of because when I go back in two weeks to do the deep cleaning on bottom I will have my braces on top and I know the dentist will frown when she sees this. My other issue is the fact that I cannot chew anything bigger than a lima bean because of 4 molars extracted on the bottom.

AAHHHHHHHHHHHHH!!!!! any suggestions? Great dentist are not that easy to find in my area. There is another highly recommended dentist but she is always booked about 5 months in advance!

Gennel

#2 Post by **ShinySmile** » Mon Jun 12, 2006 3:31 pm

I have a cavity in the tooth next to my front one, and it cannot be fixed until my teeth move into position. This is an exception to the perfect dental health rule for braces, but he was very adamant in making sure everything that can be filled/fixed was before I start orthodontics...you have to, in order to ensure a good end result.

#3 Post by **ingyandbert** » Mon Jun 12, 2006 6:03 pm

You need to get the problems with your teeth fixed before you get into braces. I'd do what the dentist is suggesting in order to be sure your teeth are in the best shape possible before your braces go on. After neglecting your teeth for so long, this is the price you pay. It shouldn't surprise you to need remedial care after all that time. Just do it and get it over with; your oral health is worth the investment.

#4 Post by **Gennel** » Mon Jun 12, 2006 7:00 pm

I do agree with the deep cleanings and I'm going ahead with that.They did the top today and the bottom deep cleaning will be done in 2 weeks. I don't agree that I HAVE to have the special dental mold so she can tell the ortho exactly what he has to do. I have to pay out of pocket $250 for the mold. WIth my ortho it's already included. Why should I pay for two molds? The treatment that she suggested I will do ,which was basically the deep cleaning and then schedule a simple cleaning.Anything to do withn gums can be done with brackets on as she also agreed.But the small cavity in my front tooth will have to wait at least 6 months because my dental insurance has exceeded my limit for the year. I only have the money for the braces and not a penny more.Everything I had done today would be covered almost 100% but since my limit has exceeded I charged it on a card $405 just for today. The only reason why I won't take money out of my money for braces is because I'm getting a discount for paying the braces in full. Right now if she drills in my front tooth ,the hole will be bigger because that tooth overlaps the other front tooth. I prefer a smaller hole/filling in 6 months.
I know I am to blame for not going for so long but bombarding a patient in the first consult of all these things that have to be done right away or else... I was honestly expecting like 10 cavities! But there are 2 small ones that I never knew were there because they only showed up in the xray. I am super committed to reversing any issues with my gums and I will promise my dentist that in 2 wks when I see her again .

Gennel

#5 Post by **SamanthaClavier** » Mon Jun 12, 2006 7:06 pm

How bad is the cavitiy?i thought for sure that i had one (my two front teeth kinda over lapped just a little(like at the middle of each tooth)it was staid a bit and i got it all off with one of those hook things the dentist uses.did your othro not do molds on you?xrays....all that good stuff?

#6 Post by **Gennel** » Mon Jun 12, 2006 7:08 pm

I am doing as much as possible with the $ I have now. Until my insurance is renewed again in January. My case was not a severe one, I had no spots ,discoloring, or easy to see buildup on my teeth. That was cleaned ..umm drilled off today lol. I had what felt like sand in my mouth and it was all the buildup of tartar in my back molars that were cleaned.
My oral surgeon,my ortho and myself all felt that it was best to leave my problem with 1 tooth on bottom that has a receding gumline. They want to see my teeth there moved and aligned before they give me the go ahead to have a little piece of gum tissue transplanted there. My ortho and surgeon said that when the teeth start moving around my gum will be stretched ,pulled or recede more and it was better to just fix the problem once and no more.
Sorry for all the long posts but I've had a million thoughts in my mind today and I keep feeling 50/50 that I am doing the right or wrong thing.

Gennel

#7 Post by **tictac** » Mon Jun 12, 2006 8:24 pm

I may have missed something, but I don't understand why she needs a mold of your teeth. I understand you are having periodontal therapy, but perio charting depths and whatnot have nothing to do with models of your teeth. And $250? That's nuts! Especially since your ortho already has a model of your teeth. I wouldn't agree to that part.

#8 Post by **Gennel** » Mon Jun 12, 2006 9:02 pm

My front teeth overlap and you cannot see anything wrong with the tooth. Onthe Xray she saw a small speck and told me it was a cavity ,but getting to that cavity would not be easy because it's right in between the overlapping part. I want that cavity taken cared of as soon as there is movement in the front teeth when I get braces. I have chosen NOT to pay and I cant really afford a mold $250 by the dentist.
The periodentitis is mild according to what I just reviewed. Anything from 3-5 is considered mild , moderate for 5 rating. I got 3-5 . My back molar on each side have a 4-5 so deep cleaning again will be done.So deep cleaning will remove the plaque. I will go back every 4 months or so with braces to get cleanings done also. Severe cases are ranging from 8-12 which is the worst case possible

Gennel

#9 Post by **rsprouse** » Tue Jun 13, 2006 8:56 pm

Hi Gennel,

First off, probing depths greater than 3 mm do not mean that you have periodontal disease. Now if the office is performing a debridement and quadrant scaling and root planing then it is likely that you may have some form of periodontal disease. It is good that you are getting it under control before it gets out of hand and causes all sorts of problems. But Periodontal Disease can only be diagnosed via radiographs and a clinical exam. Probings alone do not indicate the presence of periodontal disease.

Regarding your wisdom teeth. There are many schools of thought on whether to keep them or remove them. I am of the mentality that they should usually be removed. If you have enough space where they come in to the oral cavity just fine and you can properly clean them then leave them alone. But most people have space issues (especially if you are having ortho treatment) and cleaning issues. I have patients with impeccable home care, and they have perio issues in the area of their 3rd molars. It is virtually impossible for some people to properly clean the area. So why leave them in and risk damage to other teeth and bone when they are doing no good? Ask your dentist why she wants them removed, most likely she feels that you cannot properly keep them clean or they will cause some sort of other problem as (root resorption, impaction, etc). But it is better to get them out now before they become a problem if your dentist foresees a problem.

I am not really following the mold comment. What is the purpose of the impressions? Does she want to make you an oral appliance? Study models? A splint?

And regarding the cavity. Fill them before they become a bigger problem. Decay does not go away, it can only get larger (unless it is an incipient lesion ONLY in enamel). Now if the clinician feels that less tooth structure will be removed if you wait a couple months then by all means wait it out. But it is in your best interest to do this sooner rather than later.

Good luck.

Best,
Rory

#10 Post by **Gennel** » Wed Jun 14, 2006 7:02 pm

I'm deffinately planning to get a filling for my back molar next to my wisdom tooth (before they get banded) Now my other cavity is in my front tooth that is not visible at all by looking at it in the front or back with a mirror. It showed up as a small speck on the digital Xray, that is somewhere near where my front tooth overlap so it would be easier to work on if the front tooth is more aligned at least so I am going to wait. I think that before Christmas that front tooth should have moved enough to get that filling done.They did the debrisment/scaling and she said I needed another cleaning .The cast mold that she wants is basically I guess like a study mold so she can see what and where she be positioned. I just felt that my ortho will be able to know wher my bite should be . So I chose not to pay the $250 for the dentist to do this cast mold. They told me my situation was totally reversible . I felt like I was at the point of no return.

Gennel

#11 Post by **josephine** » Thu Jun 15, 2006 11:31 am

Usually the ortho will do the taking of impressions / making a mold before they proceed. Maybe the dentist can look at that instead of making a separate one? I'd ask the ortho to talk directly to your dentist to clear up any confusions and answer any questions. Now that you've been brave enough to go back and take care of your teeth, you need to get all the info and encouragement you can find. You might also want to get a second dental opinion even if you have no intention of changing dentists. If the extra input will make you feel more comfortable it may be worth it.

#12 Post by **Gennel** » Thu Jun 15, 2006 1:28 pm

Most likely I will end up going to another dentist because this one is not in my insurance network. I was referred to one dentist that is booked solid until late September. The first dentist referred this dentist that I went to.My ortho knows the current dentist I'm seeing but I get the feeling that dentists or anyone in the dental field does NOT say negative things about another dental profesional.I guess like the old saying " If you don't have anything nice to say,don't say anything at all" Maybe I'm just imagining this . I will have my ortho look through the dentist list for my insurance and see which ones he knows well and who he recommends from my list.
I just wish my insurance would kick in sooner! For now I have to pay out of pocket for everything until January. The filling I need will cost anywhere from $160-$240

#13 Post by **rsprouse** » Thu Jun 15, 2006 2:00 pm

Gennel,

If you are uncomfortable with a clinician then seek treatment elsewhere. There are plenty of good ones out there, just ask your friends and co-workers. Professionals will offer good referrals, but your friends are a better option IMHO.

$250 for study models? I assume it is for something else, having to do with treatment. But if it is the cost for study models then you are better off going elsewhere

That is an average cost for a filling. Some areas are higher and some are lower, expect to pay 20% with dental insurance for fillings up to a maximum benefit of $1000-1500 per person per year. Of course it varies from plan to plan but that is a general rule. Good luck.

Best,
Rory