I have been living in complete and utter fear of losing my teeth over the past 5 months to the point where I am now waking up at night unable to catch my breath and feeling absolutely petrified.

I had a crown that kept on getting infected and each time I made an emergency appointment to see my NHS dentist he prescribed antibiotics. Eventually the crown (on a molar in the top right side of my jaw) fell off and left a small piece of black tooth sticking out from the gum. I went to the dentist and asked if it should be taken out and he said he could either drill into the bone to remove it or I could leave it to come out on its own. I also asked if not having a tooth there would affect the surrounding teeth and he said that teeth were independent and that it would not. Over the next 18 months the tooth next to it became loose and a while later the last bits off tooth from the crowned tooth came out. I had been going to the same dental practice for over 25 years and it was not unusual to see different dentists and the next time I went I asked to have my teeth cleaned as the lower front ones were becoming stained. I was told to make a separate appointment and when I went back another dentist was there. She was running very late and when I went in she had trouble putting the equipment together and had to ask the nurse. When she turned the equipment on my teeth were blasted with a jet of sand (evidently water was supposed to be coming out as well). She said that I would need to make another appointment and she would put a note on my file to say that it should be done for free. To add insult to injury I came out to find a parking ticket on my car. The next time I went I saw another dentist, told her what had happened and she said that no note had been put on the file and that to have my teeth cleaned would cost £300. She also said that I had gum disease and that I would need to see their specialist who would charge me £95 for a consultation and £85 every two week for treatment until it was gone. I felt very sceptical and decided to raise the issue with her on my next visit. By the next visit, however, I had noticed that my incisor teeth had dropped down and one had started to migrate behind my front tooth. The dentist again said that I would need to pay £300 to have them cleaned and said that she thought I had serious gum disease problems. I decided to get an appointment with a private dentist for a second opinion and he confirmed that there were deep pockets around the teeth in the top right side of my jaw, less so in the top left and that 6 of my teeth were quite mobile. I then went to see a periodontist who told me that I had lost approximately 70% of the bone in the top right side and 30-50% in the top left side.

The outlook is very bleak and I know that I will lose the remaining teeth in the top right within the next few months and probably the rest shortly after. I cannot contemplate dentures and so will have to raise the £8000 needed to go to Romania and have bone augmentation and a fixed denture put in (over 2 visits and 8-12months). I hate the thought of this not only because I had hoped to be mortgage free within the next year or so and start to be able to support my children through uni (I have one in his first year and another hopefully going in 2 years' time), fix the house up etc. I feel so guilty about spending such a large amount of money on myself but I know that I could not cope with dentures and would become extremely depressed if I had to.

I decided to instruct a solicitor to hopefully claim against my former dental practice because I feel that I have to fight for some compensation to try and salvage this situation and the financial costs involved. I feel that had I received proper care and advice, I would not have found myself in this situation at this point in my life. Yes, I was a smoker but the damage is mainly in the top right jaw not spread throughout my mouth and I would be really grateful if anyone can point me in the direction of any research or case histories which could support argument.

I would advise anyone with any dental problems to make sure you are getting the treatment you are entitled to if you are with an NHS dentist (you can find this out by googling NHS dental treatment), if you can to go privately and either way do your own research, get problems sorted out, visit the hygienist and get dental insurance (your teeth need to be dental fit before you you are eligible).

Hi Karoncurran,

As I began to read your post, I suspected that you have periodontal disease because your dentist was not being proactive in your dental care. Meaning, since your teeth are in a guarded to hopeless condition, there really isn't much he could do for you to help you retain your teeth. The fact that the broken, blackened tooth fell out on it's own also indicates advanced periodontal disease.

Also let me clarify a misconception about periodontal disease.... you never have it in just one or two or three areas of your mouth. You have it in various degrees throughout your mouth. The bacteria that causes periodontal disease comes from a chronic build up of removable plaque and it is highly infectious and contagious as it is referred to as a communicable disease. It is also not contained in your mouth.... it continually filters through your digestive, lymphatic, and immune systems as well as your heart, kidneys and liver. So if you have not been informed of all of these things, then your dentist(s) have been neglectful in informing you.

I can your resistance of removing your teeth and going into a denture. However, it is imperative to understand the systemic consequences and the health risks you are putting upon yourself by retaining these teeth for any length of time. You could be fitted for dentures, have your teeth removed and wear the dentures for awhile. You may find that they are not as awful as you imagine them to be. If you decided you wanted to pursue something more permanent, then you could look into some implants and having a fixed denture done.

Regarding dental implants.... not everyone is a good candidate for dental implants. People who have a long history of periodontal disease run a high risk of implant failure due to the deterioration of the jawbone from the disease. There is only so much that bone grafting can achieve..... and it is imperative that your jaw bone be healthy enough to receive the bone grafting without rejection.

So it may behoove you to consider taking the first approach which would be to remove the teeth, place the dentures and rid yourself of this ongoing bacterial infection. Then after several months see where you are at and if you are a candidate for future dental implants.

I recommend that approach simply from a health stand point.

I hope this information is helpful to you. I wish you all the best!

Bryanna

Thank you for your reply. Can you please tell me whether seeing a periodontist will be of any help. Could you also tell me whether if my dentist had been cleaning my teeth and had he advised me to have the crowned tooth extracted when it first became infected, this situation could have been avoided?

I appreciate what you say with regard to the dentures but I know that it would make me so depressed that I'd never be the same person and so I have to give the implants a go. I'm planning on sky bredent implants (6 angled implants).

Hi Karoncurran,

I will reply to your questions in bold print.

<<Can you please tell me whether seeing a periodontist will be of any help.>>

IT MAY HAVE BEEN HELPFUL SEVERAL YEARS AGO, IF YOU HAD FOLLOWED UP WITH 3 MONTH CLEANINGS AND YOUR ORAL HOME CARE WAS PERFECT. BUT IF YOU NOW HAVE 70-80% BONE LOSS THAT MEANS THERE IS NOTHING MUCH HOLDING THESE TEETH IN YOUR BONE. THERE IS NO PROCEDURE THAT CAN GROW THAT BONE BACK. TO HAVE DEEP SCALINGS WILL NOT HAVE ANY LONG TERM BENEFIT IF ANY BENEFIT AT ALL BECAUSE THE POCKETING IS TOO DEEP AND BONE LOSS IS TOO GREAT. TO HAVE PERIODONTAL SURGERY MEANS TO CUT THE GUMS BACK SO THE POCKET DEPTHS ARE LESS... BUT THIS RESULTS IN MORE TOOTH SURFACE EXPOSED INCLUDING THE ROOT SURFACE WHICH MAKES YOU MORE SUSCEPTIBLE TO TOOTH DECAY, VERY DIFFICULT TO KEEP CLEAN AND VERY TEMPERATURE SENSITIVE. THERE IS A LASER SURGERY CALLED LANAP WHICH IS GREAT (EVEN BETTER THAN CONVENTIONAL FLAP SURGERY) AT REMOVING THE BACTERIA IN THE PERIO POEKCTS. HOWEVER THE END RESULT OF LANAP IS SIMILAR TO THE FLAPPING AND REMOVING OF THE GUM TISSUE. IT IS IDEAL TO HAVE THAT LANAP PROCEDURE DONE WHEN THE BONE LOSS IS MINIMUM OR MODERATE. BUT NOT SEVERE.

<<Could you also tell me whether if my dentist had been cleaning my teeth and had he advised me to have the crowned tooth extracted when it first became infected, this situation could have been avoided?>>

IF YOU HAD BEEN HAVING REGULAR DENTAL CARE AND THOROUGH FREQUENT DENTAL CLEANINGS ALONG WITH EXCELLENT HOME CARE... YOUR SITUATION MAY NOT HAVE BECOME SO SEVERE. THIS ONE TOOTH DID NOT CAUSE YOUR PERIODONTAL DISEASE. IT WAS ALREADY PRESENT.

<<I appreciate what you say with regard to the dentures but I know that it would make me so depressed that I'd never be the same person and so I have to give the implants a go. I'm planning on sky bredent implants (6 angled implants>>

I UNDERSTAND COMPLETELY. I AM NOT FAMILIAR WITH SKY IMPLANTS. ARE THEY JUST DOING THE UPPER ARCH OR THE LOWER ALSO? I WILL WARN YOU THAT IS IT NOT A GOOD IDEA TO HAVE DENTAL IMPLANTS PLACED IN YOUR UPPER ARCH IF YOU HAVE TEETH IN YOUR LOWER ARE THAT HAVE PERIODONTAL DISEASE. THE BACTERIA IS NEVER LIMITED TO JUST ONE ARCH OR JUST ONE AREA SO IT MOST CERTAINLY CAN COMPROMISE THE SUCCESS OF THE IMPLANTS.

I know this is scary for you.... I do understand. This is a huge undertaking and you certainly just want to deal with this one time and never again! I get it. So please take this information seriously and do not rush into half of a treatment plan... as you may not have the outcome that you are hoping for.

Bryanna

Hi Bryanna

Thanks for all your info - whilst it isn't great news, it's nice to get some proper answers.

Karon

Hi Bryanna,

I seem to be getting nowhere with my periodontist and after visiting him today I feel extremely frustrated and upset. I last saw him 5 months ago when he gave me a hygiene regime to follow, told me to go back to my dentist to get some fillings done and then come back and see him.

I have done all of this and he told me today to carry on with the dental regime and come back in a month. He also said that it would take him up to a year to get my mouth healthy.

I wanted to have my upper teeth out and implants put in at the beginning of July because some of my teeth are so loose that I don'T feel that they will last much longer.

From what I see on the Internet, I could go through all sorts of periodontal treatment which will may help but there is quite a lot to suggest that the best thing to do,would be to have the teeth extracted.

The other thing that concerns me is that I really don't feel very well and I'm not sure whether this is simply due to worry or the gum disease. My stomach feels very uncomfortable and I am very low in myself. I have become a bit of a hermit and feel very depressed. I have been to my doctor and he has suggested talking therapy but I know that until I resolve this situation no amount of talking will be of any use.

I think my periodontist wants to see the inflammation reduce before he derides the teeth. If I can get him to agree to do this next time I see him and it can be done before the end of June, do you think I would be able to have the implants done in July?

I need to make a decision by Thursday as I'm going to get the funding sorted out.

Sorry to be such a pain.

Kind regards

Karon

Hi Karon,

What exactly is your periodontist doing for you? What treatment? What oral hygiene regimen has he recommended?

It's important for the dentist to explain to the patient what the goal of treatment will be so that you have an understanding of what he is trying to achieve. What does he say about future dental implants? Have you had that discussion with your periodontist?

In most cases, dental implants should not be put in until the bone from the extractions has healed for 3-6 months. Patients who have periodontal disease, sometimes need to wait longer.

It is imperative that the bone be healthy before implants are placed and there needs to be adequate bone to hold the implant. Bone grafting is helpful but it too needs bone to hold it in place while your own bone grows into it. The graft cannot be placed on top of or along side the bone it needs to be placed into the bone. If you have extensive bone loss, then there may not be enough bone to hold a graft or an implant. What does your periodontist say about all of this?

When teeth are very loose due to periodontal disease, this means that the bacteria has destroyed the bone causing a reduction in the level of bone making it flatter. Has your dentist informed you about this?

I know you are upset about your dental situation and you want to trust in your periodontist to treat you properly. It is so important for you to understand what he is doing, what he is recommending and why.

With regard to not feeling well.... yes anxiety can cause all sorts of ill health. Especially if you are not well to begin with. Periodontal disease affects the whole body. It is necessary to be thorough with your oral hygiene regimen but it's also necessary to take care of the rest of you as well .....through nutrition, clean drinking water, and spiritually to help keep the anxiety in check.

Do you feel that your periodontist is listening to you?

Bryanna

Hi Bryanna,

The periodontist hasn't done any treatment apart from giving me some brushes to use (I believe they are supposed to loosen the bacteria around my teeth), some inter dental brushes, told me to use an electric tooth brush, told me not to use mouth wash and told me to stop smoking. All of which I have done and which was why I was so devastated when he told me that I needed to carry on doing it and come back in a month's time and that it would be a year before I would have a healthy mouth. I did try telling him that I just wanted all the top teeth out now and that I didn't want to wait a year because the ones on the right top side are loose and I really doubt whether they will last a year and I don't want to wait for them to just fall out one day. He seems to think that if the loose teeth do fall out I could have a 'training plate' to replace them and I could just add teeth to this as they fall out. I told him that there is no way that I would contemplate a denture and that I cannot just let them fall out one at a time. I feel that he thinks that in time I will accept/relent to what he sees as inevitable but that's not an option. Also, why put myself through the treatment to end up wearing a denture anyway? I have read that debriding can only reach so far up into the gums (4) and that they will tighten and recede but that this is only going to abate not cure the disease. Some people say that the only way to get rid of the disease is to extract the teeth when the disease is severe. From what I understand, I have lost 70% of the bone in my right upper jaw and 30-50% in the left upper jaw.

At the moment my front teeth seem quite stable and I think that if I wait any longer, my fear is that the bone loss there will increase and I won't have enough to put implants into.

I have to say that the periodontist and I seem to have different agendas and I don't think I will be going back to see him as on reflection, I think he should have been enquiring about my general health and should at least given me some antibiotics to help bring down the inflammation so that I could move forward in the treatment plan more quickly. He seems to think that in a year not much bone would be lost but this time last year my teeth weren't noticeably loose, so I feel that the rate of deterioration has been quite fast and have too much to loose if he's wrong.

Hi Karon,

Since you have not posted any x-rays, I can only go by what you are writing here. So that is how I am answering you... based on the information you are providing. If you can post the x-rays I may be able to be more helpful. But that is up to you.

So if I'm understanding you correctly, the periodontist has not performed any dentistry .... he is basically instructing you on oral hygiene. If this is correct then I assume he is doing this because he feels that you are adamant about not wearing a partial denture even though he may feel that your better option would be to remove the hopeless teeth and put in the temporary partial denture. He has to be holding back regarding the implants for a good reason... and I think what I have stated may be the reason.

So rather than pushing you into something you are not comfortable with... even though he knows what the inevitable will be .... he is easing you into it by instructing you on how to take care of all of your teeth better than you have. Periodontal disease is a direct result of all or any of these things.....
poor oral hygiene, medications, lack of professional routine dental care, less than an ideal diet and hereditary factors.

I've stated a few times about the importance of having healthy bone prior to placing implants. You need to understand that you have a bacterial disease and it has infected your jaw bone. It is not limited to just one or two areas of your mouth. It is throughout your entire mouth, even in areas that seem to be okay to you. Although this disease is very common it is still very serious. Removing your teeth is only "part of the cure" for this problem and as I said, you may not have enough bone now or later to place implants.

When he said it would be a year before your mouth was healthy... I am taking this to mean that he feels within a year the hopeless teeth will fall out or be removed, he will scale/root plane the teeth that are salvageable, your oral hygiene will hopefully be very good and you will feel better about moving onto a partial denture. Which would definitely make going into a full denture easier.

I think he is trying to get the point across that you need to make some changes irrelevant of when the teeth are removed. The periodontist is more concerned about the bacteria than he is about your loose teeth because believe it or not, that is the worse problem of the two. Antibiotics are not going to "cure" this infection. At best they would only reduce the inflammation temporarily. The bacteria has to be manually removed every single day .... thus it is up to you to do that. He is trying to get you to take ownership of the problem... meaning if you don't make the necessary changes, the disease will progress irrelevant of what he does. If you are diligent with your oral home care, the bacteria will be reduced which means the rate of bone loss decreases as well.

Placing dental implants in infected bone can be disastrous. Not only will the implants fail, but the depth of infection can be difficult to eradicate. The physical pain from the infection and surgery can be lengthy and the financial aspect devastating. I am hopeful that your periodontist is trying to guide you in a positive, healthy direction rather than put you through oral surgery with a poor long term prognosis.

That is how I am interpreting your situation based on my professional experience and on what you have posted here. I think you could communicate better with your periodontist and that might put your mind at ease. Ask him to explain why he is going about things the way that he is and if it is because you are so against having a denture...??

Bryanna