Bryanna, please help!

I have now had a consultation with another (second) oral surgeon. I think I have become so disillusioned over the past year with dentists that I am extra scared to choose the person who will extract these teeth and possibly do the implants to replace them. I saw one person last week, and this week went to the one my dentist recommended. (I should add here that I am somewhat disappointed in my dentist here, as he allowed me to have the second root canal, and discouraged me from pulling the first one.)

Anyway, the two oral surgeons couldn't be more different, and I honestly don't know how to pick one. Before this all happened, I probably would have just gone with my dentist's referral, but now I am second guessing all my instincts.

One is older, sort of gruff, and says the procedure will take 1.5 hours. The other is much younger and says probably under an hour. This is not the only disparity, I just mention it because it seems like their whole demeanor is reflected in these estimates. One seems pretty old school, answering all the questions, but sort of with a patients just need to know these things attitude; the other is much more open to addressing questions. But this may be just a question of style? One is sort of casual about the whole thing, as if it's no big deal, just a couple of teeth, and you'll be fine. The other is already giving me RX's for pain and antibiotics (before I even scheduled an appointment for the extractions, and before he had given me an estimate of how much this is all going to cost) and telling me I should plan on being fairly unproductive for three days.

To be honest, neither of them has completely reassured me. Ideally, I think I would like some combination of the two of them, but these two are all I have and I really need to have this done as soon as possible. I also can't pay any more for consultations, especially when I also have this big bill looming for the extractions/implants. They both went to good dental schools (the younger one also has a MD). They both have nice offices. They use different kinds of IV sedation, which I am going to do some further research on, but other than that, I'm stumped.

I don't know how to choose one of these guys, and I am really running out of time, due to the pain. I am pretty sure both the teeth are fractured, and they HURT. If I could do this tomorrow morning, I would, even as scared as I am. But now it looks like I will have to wait til early next week for either of them.

I have to put myself in a chair and let one of these guys cut out my teeth. How do I know which one?

Have you done the reviews on them both? like on yelp.

Hi Sadie-

I am disappointed in my dentist (now ex dentist) of 10 years.

How long has the OS w/ the additional MD degree been practicing? The reason the older one does not have that, is they may not have offered that DDS/MD program when he went to school. How is the IV sedation different? I was an OR nurse for many years.

Stacy

Thanks Stacy and Penny,

First of all, one of the reasons I am questioning myself is that I found the younger one online (before my regular dentist was even giving me a name), and I chose him based on his flawless online reviews on yelp and many other sites. But then, I started wondering if the reviews were *too* flawless. I'm not sure whether I'm just paranoid after a year of bad dental advice, or whether this should be an actual concern. I mean, if he didn't have those reviews, I never would have found him. (The one recommended by my dentist has no online reviews at all. Different generation?)

The younger one has been practicing for less than 10 years I think, whereas the other one has more like 30 years of experience. I guess that explains the MD, Stacy? He uses IV valium (which I had for my wisdom teeth many years ago), whereas the other one uses propofol (which I have had for endoscopies, but not for 1.5 hours!);not sure which is preferable in general or in my particular case, but would love some advice on this too.

The other thing that bothered me about the older guy is that he couldn't give me a price, or even an estimate, while I was there, telling me he'd have to work it up. Maybe I am missing something, but it seems to me that if you pull teeth every day and have for thirty years, you would likely know how much you charge for a procedure, at least roughly. I saw him in the early afternoon but he was not going to be able to tell me the cost until tomorrow morning. I have to say that made me very uncomfortable.

Then there's his relationship with my dentist, who may be my former dentist. He was saying he was going to choose implants based on what my dentist preferred to work with, but I am not even sure that's going to be my dentist going forward (or if I am going to get implants). I guess I would have preferred him to tell me what the best implants are, and that's what we going to go with (if we even go with implants). There was also some other stuff I wasn't quite at ease with as well. On the plus side, he said they were extra careful with TMJ sufferers to place as little pressure on the jaw as possible, but would would likely carve the tooth and take out each root individually. (Though as I write this, it sounds horrifying, and makes it less possible that I will ever know if the tooth was fractured.)

Bottom line: either of these could probably do an excellent job, but after months of dental trauma, I don't have faith in any dentists anymore. I find myself questioning every statement they make. Bryanna told me to try to stay positive, and I'm really trying (honestly!) but it is hard not to feel somewhat victimized when you've been in pain for almost a year, spent thousands of dollars, and had dentist after dentist tell you they have no idea why. Today the oral surgeon says he thinks both teeth are cracked, something everyone else (except for Bryanna!) said was highly unlikely. It's difficult not to remind myself that the periodontist thought some gum surgery would help, and the endo thought it for sure needed a root canal, and the prosthodontist recommended we try a temp crown. I'm jaded, I know. I understand that the teeth HAVE to come out, and the sooner the better. But I am so scared to make the wrong decision now, because when I replay all my dental decisions for the past year, I don't have a very good track record.

Sorry for the ranting. Thanks so much to everyone here: I really do appreciate all the advice and support! I would like to be able to schedule something tomorrow for Monday or Tues at the latest. Throbbing teeth not helping my ability to reason here.

Hi Sadie-

Are both OSs in private practices? Are there other OSs whom work with them? I personally would stay away from the "chain" dentist offices, especially for oral surgery..but that is my opinion. Did they discuss bone grafting with you?

I will write more later..I am going to the dentist in about an hour to see why this lump of tissue has not gone away.




Stacy

Very sorry about your lump, Stacy. I hope they figure it out this morning.

Yes, both these guys are in private offices, with what I assume are all the bells and whistles of oral surgery. The staffs each seem nice, and the offices are clean. I did finally get an estimate this morning from the older one, and it is about 30% more than the estimate of the younger one. A big price difference is the cost of sedation, as the propofol not only more expensive, but that surgeon thinks surgery is going to take about three times as long. Concerned that either one could tack on things post-surgery, saying they needed more sedation or whatever. But how could there be such a difference in time estimates?

Something is making me uneasy about the idea of being under with propofol for an hour and half, even though I had no problem with it for five or ten minutes. But now I'm reading that patients using IV valium may actually be experiencing pain and just not able to report it or remember after the procedure. I know I'm getting into the area where I'm maybe reading too much stuff on the internet, but after a year of bad decisions for my teeth, I finally want to be able to make the right choice, and I don't know how.

Sadie,

Ok.... please take some deep breaths. You need to calm down because you are pumping out adrenalin like crazy and that will not benefit you in the long run. You become burnt out and then healing will take longer. When we become too over whelmed by the situation, all of the incidentals block our focus and we can't think straight. I know this is difficult and all you really want is to trust someone to take the best care of you... I understand. Let's see if we can help you sort this out.

Each one of these dentists runs their practice differently thus the wait for the estimate from one of them. Secondly their surgical techniques are different thus the variation in the length of time and different meds for IV. All of which is typical from one dentist to another.

If you have had both IV meds in the past with no side effects.... then cross that concern off of your list because you will drive yourself nuts worrying about the what ifs.

The length of time for the extractions is due to the technique that they use to remove them. In certain cases it is best to drill the molar in sections and remove each section one at a time. In other cases this is not advisable due to the individual case.... bone structure.... infection.... de-calcification of the tooth.... etc. Each dentist gave you an approximate time frame...however, they will not know exactly until they start the actual procedure.

Regarding the idea of "carving out" the tooth .... put your mind at ease with this as this is how it is suppose to be done and I am going to assume that each of these dentists will do it that way it's just that the one happen to mention it. All this means is that instead of using brute force to remove the tooth, it is going to be gently teased and eased out of the bone and this is irrelevant as to whether the tooth is drilled in sections or not. Their goal is to remove it with the least amount of trauma as possible.

My personal opinion on the dual DDS/MD degree is simply this...... those who have obtained that dual degree in dentistry wanted to be more than just a tooth carpenter or tooth technician. They wanted to learn the systemic connection and be able to apply this knowledge when taking care of patients. With that said, I know plenty of Oral Surgeons who do not have that dual degree who are excellent "doctors" as well as dentists.

My thoughts in choosing between these two dentists are these....

Dual degree or not.... do they both have update offices and state of the art equipment? I say this because.... dentists who practice in a rut..meaning they never learn beyond their original education therefore they see no reason to update their techniques which is often a reflection in the appearance or cleanliness of their office and equipment. Someone who has held on to the 70's or 80's decor in their office is most likely doing that with their techniques as well. This may seem unfair to be judging them like that ... but it is found to be true more often than not. Don't mistake this for someone having a lavish or over the top expensive office... that is all irrelevant.

The demeanor of the dentists.... were they calm... were they anxious or nervous..... did they seem rushed..... were they gentle during the examination.... did they take the time to sit with you and answer your questions to your satisfaction.....were they interrupted during your visit... did anyone else in the office come in and talk with you about the procedure or the financing?

I am glad that they both concurred with me about the possible fractures of these teeth!!!! Maybe we are all wrong about that... .but at least they are open to the possibility which means they will keep that in mind when removing them.

Sadie, I suggest that you take a piece of paper.... make 2 columns. One for dr old and one for dr new. Jot down all the pros of each .... and then the negatives of each that you can think of. Then read it out loud to yourself. See if helps. You can email that to me if you want.... bryanna007@yahoo.com. You can also email me both of their names and I can see if I can do some research on them for you. I may not be able to come up with anything more than you already have... but I am willing to give it a try.

Take a deep breath....... don't hold it..... let it out with a big sigh......
See how better you feel ~'.'~

Bryanna

Thank you so much, Bryanna. I know I sound like a crazy person, but it's been a VERY long road and I'm just feeling so much pressure (from myself of course) to get this right. I took your suggestion about the pros/cons list and also had a conversation with a friend (in which I heard myself leaning one way) and I think(!) I made a decision to go with dr. new (as you called, and I shall now call him).

It comes down to this: Dr. Old didn't make real eye contact with me during the consult. He stood in back of me (ostensibly to look at xrays) or to my side (while we were talking) and even during the very cursory exam (maybe 30 seconds?) was standing up. He never sat down. I paid quite a bit of money for this consult, so I would expect to be able to get at least 15 minutes of his unhurried time. (dr new spent much more time with me and also a couple of questions by phone on two subsequent occasions.)

Moreover, I felt dr. old rushed me through my questions and was sort of arrogant or dismissive about some of my concerns about antibiotics (I've had major stomach issues in the past) and painkillers (which I don't tolerate well). He also seemed to just take for granted that I would be booking this surgery with him, even though he never gave me an estimate until this morning; he came out to reception while I was paying to give me RX's for the drugs I would need for the immediate post-op, which, while very thorough, seemed strange to me since I told him I was still considering someone else and would wait for his estimate to make an appointment.

As I think I said above somewhere, when his estimate arrived this morning by email, it was more than 30% more than dr. new. Neither of them are exactly cheap, so the extra 30% (almost 35%) is a LOT of money. If I get back the money for the second RCT (which is still a big if), it will not cover even dr new's extraction/bone graft, but it will be less than half of dr old's.. And that's not even taking into account their different estimates for the implants.

Lastly, dr new was just more positive about the procedure in general, foresaw no major issues (though he pointed out that my nerve is very close to the root of the molar) ans seemed to think recovery would be fairly quick. Dr. old, on the other hand, said to expect at least three days of substantial discomfort, and the need for high dosages of painkillers (which, even without the surgery would make me uncomfortable, as I don't deal well with painkillers). I realize that this also may just be a personal style issue, but I was twice as scared leaving his office about the whole thing.

I guess what had/has me most worried was that dr old was too prepared for everything that could go wrong, and dr new was maybe not detailed enough or too casual? dr new didn't really seem to think implants would be a problem, whereas dr old thought there was maybe only 60% chance I would be able to get them. In sum, I guess, Dr. old scared me about the entire procedure and also was sort of dismissive about whatever personal concerns I raised.

I know I sound like Goldilocks: this one was is too old, and this one is too young. I made an appointment for Tues morning with dr new, as I just didn't get a good feeling from dr old. But I made it for Tues specifically in case I had some sort of epiphany over the weekend, and wanted to change my mind on Monday.

Bryanna, you've been a godsend. Really don't know how I would get through all this without you. Does all this rambling rationalization sound reasonable to you? Or does it sound like superficial way to choose a surgeon? I'm still trying to breathe, but I'm so stressed. I remember going into my first root canal last December trying to booster myself by saying "how bad can it be?/people do this every day" but unfortunately, now i KNOW how bad it can be, and I think that fear is somehow paralyzing.

Sadie,

You do not sound like a crazy person at all! You sound like someone who is fed up with the BS and the longer this goes on the more concerned you become. I totally understand!!!

Based on all that you have written about both dentists, I think you have made a good decision on choosing dr new. I would stop second guessing at this point and instead focus on the healing aspect so that you can be prepared ahead of time with your diet, etc.

I am 100% against giving a new patient any rx for pain prior to their dental appointment. That right there is a red flag for me as he obviously has a set protocol and is not taking into consideration the individual needs of the patient. For all he knew, you could have had a drug problem. What a jerk!

Regarding the stomach issues you mentioned..... it would behoove you to start taking a probiotic supplement asap to build up some healthy intestinal bacteria. Continue to take it every day for at least a month post op... or ideally indefinitely! Probiotics also help with the surgical healing because they restore health to the immune system. Don't rely on store bought yogurt because it is overly processed and has little to no beneficial bacteria in it by the time it reaches the store shelf.... besides that most of them are loaded with artificial ingredients and sugar.

Bryanna