Hi, My husband is having surgery in 1.5 days to have all the teeth (26) left removed and dentures. He works in an underground mine and is constantly getting sinus infections. Within 48 hours of getting a sinus infection, he ends up with 1 or more absessed teeth. The dentist is calling the removal of all of his teeth "medically necessary" and we need to do this ASAP. He also commented that my husband has very large teeth. Dentist suspects the work environment (dust, dirty water) and the changing of pressures from going from surface to underground/vice versa is contributing to his condition, on top of the sinus infections.

His blood pressure is through the roof (148/114). He's battling a sinus infection that turned into bronchitis last week on top of 2 absessed teeth, so the family doctor gave him an antibiotic and told him to resume the lisinopril (BP med) for a few weeks after dental surgery. We suspect that is due to the infections and pain. He took lisinopril 20mg 3 years ago for his hypertension that occured to the stress of my mother's passing and his BP improved enough to go off of the meds (1 yr later) once things settled down and a nutritionist emproved his diet. We are trying to get our health insurance involved to help pay for this because we only have a $1000 allowence on our dental insurance and the dentist calling it "medically necessary". The bill is going to be over $10,000. We are working to establish this as a chronic issue and show that this will greatly improve his health (reduced infections and BP, etc) in hopes that our medical insurance will help cover this huge bill.

Can you please provide your opinion and possibably direct me towards any study findings that I can additionally use to further my case in getting the health insurance to help cover this? He's had other teeth extracted (molar teeth/wisdom teeth) already and they all have extremely long roots and some are curved like fishing hooks. He had one root canal 2 months ago and it failed within a week, so we had the tooth pulled last month. He works 28 days straight before he gets 14 days off. I know his work schedule is definitely no help to these infections because he waits until he's off of work to seek help. All research I've seen says absessed teeth can cause death. He's in bad shape and scared.

Thanks, Amy

Hi Amy,

My first thought after reading your post is there may be more to his dental problems than what is thought to be related to his job. Does he have periodontal disease and/or major tooth decay throughout his mouth? Both of these things will cause an elevation in BP and in inflammation throughout the body.

There is a correlation between sinus infections and tooth infections. But it is more likely that an infected tooth could cause/contribute to the sinus problem and not the other way around. Although it's not impossible to occur differently, just not usual. So I'm wondering what the health of his gums and teeth really are. If he has uncontrolled severe periodontal disease and/or rampant unrestoreable decay then extracting all of his teeth may be warranted.

Working tremendous hours in a damp underground mine can be a problem for the respiratory tract and alter the bacteria in the nasal cavity making him susceptible to sinus problems. So he may still have that problem even after his teeth are removed.

With regard to the insurance situation.... the documentation has to come from his physician, his general dentist and his oral surgeon. They have to show just cause as to why they deemed this "medically necessary". Any blood work that he has had done that indicates elevation or abnormal results with any inflammatory/infection markers like C-reactive protein; Fibrinogen, Homocysteine, White Cell Count WITH Differential, Erythrocite Sed Rate, etc. All of these would be evidence pointing to the diagnosis. All medical records pertaining to treatment of sinus infections... all prescription receipts as well as OTC meds he has used for sinus problems.

I don't think the insurance will connect his dental problems to being work related. They may link the sinus problems, but the only way to connect the teeth would be in written evidence from the dentists. Also anything associated with the surgical removal of necrotic bone due to infections and/or cysts that are removed at the time of surgery need to be noted in the surgical report as the insurance may deem the removal of all of that medically necessary.

I don't know of any particular site on the internet that could guide you any differently. The proof has to come from the medical and dental teams treating him. You can gather all of the other information about the blood work, rx receipts, written history of the numerous sinus infection, elevation in BP (would not mention stress as a cause)... etc on your own and present that with the surgical report and the dental bill to the insurance company.

I hope this information has been helpful. I also hope your husband plans on taking some time off of work to recuperate??!

Please keep in touch here...ok
Bryanna

Bryanna,

The dentist did not say anything about periodontal disease, but his mother had major periodontal disease and had to have all of her molars extracted at the age of 28 and the rest pulled & dentures before the age of 40. Also his dad was born with brittle teeth due to his mom not drinking milk when she was pregnant. He too has had all of his teeth removed before age 40. My husband has had several molar teeth or wisdom teeth crack & break and no problems with his gums. His family has never had access to dental care during his childhood and finally got benefits in the last 9 years. I am also wondering if any of this could be hereditary? His older sister had almost the same molar problems at about the same age (35), and his younger sister (23) is starting to exhibit the same problems too. I am assuming the lack of care he received as a child/young adult has contributed to this, along with the work environment. He's been mining for about 10 years now. A lot of the miners here have dentures.

I am going to ask the dentist tomorrow if he saw or suspects a perforated sinus and if he needs to see a ear, nose, & throat dr. and at what time frame after surgery should he be seen. Also the last two dentist's he's seen have told him that his teeth are able to be saved (root canals, etc). We tried a temporary root canal on one molar two months ago, but it failed and became infected within a week. Husband is not a fan of root canals, just like you. He'd rather have them pulled and deal with dentures to stop the viscous cycle.

The physician he saw on Friday is very "old school". He's seen him a few times. I don't care for the guy because he doesn't respect women patients. He thinks the sinus infections are secondary to the teeth infections and he's skeptical of the BP going down after having surgery tomorrow. Yet the dentist, which is also the surgeon, and the anesthesiologist who's working on him tomorrow, both agree that having the teeth removed will greatly improve his health, reduce his BP, and stop the infection cycles. These guys are fresh out of school, within the last 7 years. I trust their opinions and assessments much more than the old physician. They appear to be up to date on the latest medical information and have seen cases like this before.

The last full blood panel was done in 4/2010. Everything came back within normal range. The physician, nor the dentist, have suggested a new panel be done. Husband & I did discuss getting a new full panel done the other day, would you suggest a new one to document changes? His dental/sinus problems have become frequent/chronic after the last panel.

The insurance agent who sold our policies to his company is helping me prepare a case to the health insurance company. Her first reaction to this was that it could be considered a workman's comp. situation, but the company owner is the type of man who hates workman's claims. He will treat you differently and get you to quit if you make a claim. We can't afford to lose this job. This man is known for making you "unhirable" in the mining community if you make him mad. We convinced the agent to not go that route due to the owner's personality. She is having me gather all medical records, dr's notes, and any letters on our behalf so she can present it to the health insurance company.

I will ask about the necrotic bone situation. I assume he won't know about that until during surgery. He starts his 14 days off in the morning, so he'll have time to heal before returning to work. I am going to do my best to have him healed as much as possible before he has to return to that environment to avoid complications as much as possible.

Thanks for quickly answering my post and all the help. I will post an update over the weekend.

Amy

Thanks a bunch for the info! The surgery ended up taking two days. He woke up after 3 hours. He metabolizes medicine fast! Got 20 out of 27 pulled the first day. Had to return on Friday for the last 7, which took about 40 minutes to do. The dentists', who did the surgery said that some of the roots were pushing on his optic nerves. I didn't tell hubby when he woke up. The next day, he noticed changes in his vision (for the better). He can read street signs farther away without glasses, but has to continue to wear them for a few days because he has astigmatism. I told him what the dentists said about the optic nerve thing after he proved to me his vision was different. I did ask the dentists prior to surgery to be on the lookout for sinus perforations, and they said they would close them, if they found any. It took 3 hours to do the top teeth and he's got quite a few stitiches in the top, but none in the bottom. Swelling was fairly minimal, his blood pressure is getting MUCH better (136/88). It was running 163/114 prior to surgery. His color and energy has come back quite a bit already. His sleeping is SO much better! No more snoring, tossing & turning, and choking anymore. He's had follow up care yesterday and has soft liners in both dentures and is doing so much better eating, only has a slight lisp when he says certain things. It's amazing how I'm seeing vast improvement almost instantly. His next follow up isn't until 8 days from now unless he has a severe rub spot, infection, etc.

He wants to wait for a month before going to the eye doctor for a new exam & glasses. He says he wants to make sure the swelling in his cheekbone/eye area is completely gone. Do you think that is reasonable, or should he go in next week?

Again, thanks so much, your advice has given me confirmation to what our dentist was telling me. You made me feel like I was getting a 2nd opinion without him having to go through all the poking & prodding again and confirmed my method of presenting this to our health insurance for some help with the bill.

Amy

Hi Amy,

YAY!!!! So glad the surgery is over and he did so well!!!! That was A LOT to go through.... whew. And you are very welcome....~'.'~

I am not surprised that he feels better already. His eyesight may still change... I would give it several more weeks before getting a new permanent pair of glasses. The other option is to see the eye dr, explain that his sight may still change and can he have the lenses changed as inexpensively as possible as this may be needed a couple of time before he feels the sight has stabilized.

He should see the dentist if he gets a sore spot and not wait. He should be eating a soft nutritious diet and drink only water throughout the day. No sugary drinks or foods. Make sure he rinses with warm salt water 3-4 times a day and washes the dentures thoroughly when he takes them out.

He is on his way!!!!!

My best regards to your husband.... I'm glad he did well.
Keep in touch here, okay.
Bryanna

Things are continuing to improve. His blood pressure is now running in the 122/79 to 129/84 range, and the dentist told him to just come in for relines as needed, no appointment necessary. They expect it to take around the two to three month mark to be completely healed versus the typical six months. He's been back to work for a week now and not one single sinus infection, sniffle, sneeze, cough, etc!

Eating is coming along. He's not into pushing the envelope on food choices. We are eating extra lean (92/8) hamburgers, and lots of shredded or small bite chicken breasts. He says things like green pepper slices, cheese sticks, and smoked ham sandwiches are too tough still, and milk based dinners like stroganof cause a "slime" with the dentures. He thinks he can do a steak, but has yet requested I cook one. That's the goal he's aiming for. The dentures fit extremely well, he has progressed to a medium-like liner last week.

The only major hurdle left is convincing our health insurance to help pay for this. The company our policy is with is known for being hard headed and not paying anything. They have a bad reputation among other clients who have had them in the past, but here in Montana, there is a law that allows us to have an external review for denial, which they have to hire 3 independent consulting firms for the review. I just hope they see the medical necessity in this just like the many people I've talked with about this subject.

As a side note....one of his co-workers went in this week to have the same thing done for the same reasons, and another one, who is almost 10 years younger, is needing the same thing done for the same reasons.

I'll keep you posted.
Amy

Hi Amy,

I am so glad to hear your husband is doing so well! He has had one hell of a journey and hopefully his health will continue to improve

He should definitely continue with a predominantly soft food diet for a few more weeks. Nothing that requires a lot of chewing because he is susceptible to choking because he is not able to chew his food up in small enough pieces yet. The best way to get the most nutrition out of a soft food diet is to eat home made soups which can contain all sorts of vegetables, chicken or beef which is all soft and easily edible for him .... fruit smoothies with protein powder .... vegetable juicing is rich in antioxidants.... things like that.

May I ask ....what type of mining does he do? Why do so many of the miners have such dental problems?

The insurance is more apt to pay on the claims if the dentists elaborate on his dental issues as they related to his medical problems. Also, their surgical report has to be in detail and state what their findings were during the surgery. Without that information the insurance may just look at the claims as nothing other than routine. Hopefully they provided that information to your insurance company.

Bryanna

Bryanna,

He's a underground hard rock miner. The mine recycles their water, which goes through minimal filtration and the breathing air is fan driven from the surface. The drills the guys use require water, pressurized air, and rock drill oil. The ingredients in the drill oil is a trade secret, so who knows what's in it beyond a form of petroleum. I suspect the reason for the high rate of dental problems stems from the water being recycled, which is NOT potable. MSHA has in the last year required the mine to provide bottled water for drinking, but the water on surface for showers is recycled too. They just filter out the solids out of the water and send it back through the underground and surface systems. I also suspect the air. Colds spread through the employees faster than kids in a school. Again the air is supplied via ventilation shafts and driven by large fans. Each mining area has what they call vent bag, which is similar to the heating ducts in a house. There are only certain functions they do that requires a ventilation mask, but the filters on those don't capture fine particles. They are mainly to catch dust and smoke.

But on an excellent note....I can report, he hasn't gotten sick yet. He's been back to work for 2 weeks now and not even a sniffle or sneeze! Having the procedure done has definately done wonders.

He goes in Wednesday for another reline. They're getting loose again. This reline lasted almost 2 weeks. I will ask the dentist to draw up a letter for us elaborating on the medical necessity and improvements he is seeing. Got in touch with the eye doctor today and he will call me back with his opinion on when husband should have a new eye exam. I am going to add those pre-op and post-op findings to further support the necessity.

Amy

Hi Amy,

Wow...he not only has a dangerous job but a toxic one as well!!! You would think that it would be a law to supply these miners with clean water to drink (long before last year!) and bathe in! The vent bags and vent shafts have to be coated with debris ... are they ever cleaned? Geez... he has a lousy job

I am very glad to hear that he has been healthier. I wish there was a way to keep him that way!!

Thanks for updating us and sharing so much information about his profession. It's very interesting .... although mind boggling to say the least.

Bryanna