[Silky]

Hi Bryanna,

I was wondering how you feel about this. An oral surgeon I am going to see for a consultation that is in my dental plan is not board certified. He went to a very good dental school in the area, and also seems to have done some teaching. Would you strictly stay with board certified oral surgeons and go elsewhere? Not sure of the importance of this. Also, he has just been out of dental school for oral surgery for about a year. Thanks!

[Bryanna]

Hi Silky,

Board certified is a prestigious title to the lay person because it sounds important and in some cases the doctor has gone to great lengths to become board certified. However, board certified means that a licensed doctor "has met the requirements of a particular board for that particular certification. This usually involves successful completion of a specific amount of training and passing an examination. Physicians who are not board certified may be as well qualified as those who are. Some specialty boards require the doctor to complete some amount of continuing medical education in order to remain board certified after her/his initial qualification."

With all that said, in my opinion it is not imperative to see a board certified dentist/physician as this does not make them a "better doctor". It is more important to see someone who is well experienced in their field and open to discussing options with the patient.

I know all doctors need "practice" to better their skill.... although I know some well established ones who can practice all they want to, they are just not cut out to be doctors..... but I myself would be hesitant to see someone who is just starting out.

What is it that you are consulting him for? You may have written about it here, I just don't remember.

Bryanna






I was wondering how you feel about this. An oral surgeon I am going to see for a consultation that is in my dental plan is not board certified. He went to a very good dental school in the area, and also seems to have done some teaching. Would you strictly stay with board certified oral surgeons and go elsewhere? Not sure of the importance of this. Also, he has just been out of dental school for oral surgery for about a year. Thanks![/QUOTE]

[Silky]

Hi Bryanna,

I'm seeing oral surgeons about getting tooth number 15 extracted. I've had a crown or temp crown on #15 for almost 2 years that doesn't fit properly. No matter what dentists try, it still causes irritation on the tongue every time I eat. As a last resort......because I don't know what else to try, I'm thinking of having it extracted so the tongue can heal, and I don't have the irritation/pain from eating any more. I don't know if it would be possible to make a crown so small that it wouldn't have contact with the opposing tooth, just so I could keep the tooth? The first oral surgeon I saw wanted to overdose on meds with valium, versed, brevatol, local anesthetic just to remove one tooth. I saw a review about him that someone ended up in the ER because they were given too much anesthetic. Before I saw him, I just thought that it was an isolated incident. But after hearing of all the meds he planned on using that review made more sense, and scared me away.
Other oral surgeons in the past would just plan on using local anesthetic for this tooth. That works better for me since I have a lot of allergies to meds, epinephrine, etc. They almost always use Carbocaine to avoid epinephrine with me. I did go for a consult with the doc that is just starting out, and he would just use carbocaine. I'm agreeing with you that it would be better to find someone with more experience, so I think I need to keep looking for a surgeon I feel comfortable with. Thanks!

[Bryanna]

Silky,

So I don't have to look through all the posts ...is tooth #15 root canaled or had an apicoectomy? Does this tooth stand alone with no adjacent tooth?

It could be possible to make this crown so that it was not occluding with the bottom tooth.... but how would that solve the problem with it irritating the tongue?

Carbocaine has a short acting cycle, meaning it does not last very long. So dentists are hesitant to use it for any procedure that may take awhile. Some people do not get profoundly numb with carbocaine.... others like myself, do.

This "new"surgeon you went to see.... did you like him? Did you feel comfortable with him... did he answer your questions? Did he seem hesitant to remove this tooth or give the impression that it should not be removed?

Bryanna

Originally Posted by Silky

Hi Bryanna,

I'm seeing oral surgeons about getting tooth number 15 extracted. I've had a crown or temp crown on #15 for almost 2 years that doesn't fit properly. No matter what dentists try, it still causes irritation on the tongue every time I eat. As a last resort......because I don't know what else to try, I'm thinking of having it extracted so the tongue can heal, and I don't have the irritation/pain from eating any more. I don't know if it would be possible to make a crown so small that it wouldn't have contact with the opposing tooth, just so I could keep the tooth? The first oral surgeon I saw wanted to overdose on meds with valium, versed, brevatol, local anesthetic just to remove one tooth. I saw a review about him that someone ended up in the ER because they were given too much anesthetic. Before I saw him, I just thought that it was an isolated incident. But after hearing of all the meds he planned on using that review made more sense, and scared me away.
Other oral surgeons in the past would just plan on using local anesthetic for this tooth. That works better for me since I have a lot of allergies to meds, epinephrine, etc. They almost always use Carbocaine to avoid epinephrine with me. I did go for a consult with the doc that is just starting out, and he would just use carbocaine. I'm agreeing with you that it would be better to find someone with more experience, so I think I need to keep looking for a surgeon I feel comfortable with. Thanks!

[Silky]

[QUOTE=Bryanna;830420]Silky,

So I don't have to look through all the posts ...is tooth #15 root canaled or had an apicoectomy? Does this tooth stand alone with no adjacent tooth?

It could be possible to make this crown so that it was not occluding with the bottom tooth.... but how would that solve the problem with it irritating the tongue?

Carbocaine has a short acting cycle, meaning it does not last very long. So dentists are hesitant to use it for any procedure that may take awhile. Some people do not get profoundly numb with carbocaine.... others like myself, do.

This "new"surgeon you went to see.... did you like him? Did you feel comfortable with him... did he answer your questions? Did he seem hesitant to remove this tooth or give the impression that it should not be removed?


Bryanna,

Tooth #15 is not root canaled and did not have apicoectomy. It does not stand alone. Tooth 14 is there with a crown. Wisdom tooth 16 was extracted a while ago.

I think the bite is causing the problem on the tongue when eating. I'm "guessing" that the back cusp of opposing tooth #18 might be irritating the tongue when eating, or the back cusp might be squeezing the tongue between the the crown on #15 causing the irritation. We've tried so many different shapes of crown and the sore also stays in the same place on the tongue. Another think I wondered......my original bite with tooth 15 and 18 was that these two teeth sat right on top of each other, and #15 did not dip inside of tooth 18 when chewing. (I know that's not the normal bite for most, but it's the way those teeth fit together. With the crown.....tooth 15 dips inside of tooth 18 which leaves the back cusp outside of the bite and could make contact with the tongue. It's sort of a shame to get it extracted....but I don't know what else to try right now. I asked the dentist about removing some of that back cusp on #18 almost as a last resort since I'm now thinking of extraction, but he was hesitant to do that.

The new surgeon was the one with little experience, so now I'm worried about that. He would not be hesitant to remove it. The surgeon with heavy handed meds approach was not hesitant either. I did see another surgeon previously that did not want to remove the tooth.

There does not seem to be a lot of room, so I'm not sure if it's possible to make the crown without occlusion to the bottom tooth.

Do you have something as an alternative to just carbocaine for someone who should not have a lot of epinephrine? I know one of the dentist's uses something other than carbocaine because it lasts 4 or 5 hours, but he tells me it's just carbocaine because I told him about the epinephrine sensitivities.

Anything ideas are greatly appreciated! Do you think it's still best to find a surgeon with more experience than the guy that's been out of school for less than a year? He said he's extracted a lot of #14 and #15's in the past two years, so it sounds like he's only been extracting for two years in his residency.

[Bryanna]

Hi Sily,

I'm trying to picture your description of how 15 an 18 meet and how the tongue is involved. I don't know why these two teeth cannot be shaped to occlude together bette especially since #15 is a crown. The lab can make it any shape that the dentist requests.

Also, if the oral surgeon (2 of them) had no hesitation about extracting #15, it makes me wonder if they see something wrong with this tooth other than what you have described. What is their diagnosis of #15?

Any chance you could post an xray of the upper quadrant showing #15 and a bitewing xray which shows the upper and lower left side biting together?

Bryanna




Tooth #15 is not root canaled and did not have apicoectomy. It does not stand alone. Tooth 14 is there with a crown. Wisdom tooth 16 was extracted a while ago.

I think the bite is causing the problem on the tongue when eating. I'm "guessing" that the back cusp of opposing tooth #18 might be irritating the tongue when eating, or the back cusp might be squeezing the tongue between the the crown on #15 causing the irritation. We've tried so many different shapes of crown and the sore also stays in the same place on the tongue. Another think I wondered......my original bite with tooth 15 and 18 was that these two teeth sat right on top of each other, and #15 did not dip inside of tooth 18 when chewing. (I know that's not the normal bite for most, but it's the way those teeth fit together. With the crown.....tooth 15 dips inside of tooth 18 which leaves the back cusp outside of the bite and could make contact with the tongue. It's sort of a shame to get it extracted....but I don't know what else to try right now. I asked the dentist about removing some of that back cusp on #18 almost as a last resort since I'm now thinking of extraction, but he was hesitant to do that.

The new surgeon was the one with little experience, so now I'm worried about that. He would not be hesitant to remove it. The surgeon with heavy handed meds approach was not hesitant either. I did see another surgeon previously that did not want to remove the tooth.

There does not seem to be a lot of room, so I'm not sure if it's possible to make the crown without occlusion to the bottom tooth.

Do you have something as an alternative to just carbocaine for someone who should not have a lot of epinephrine? I know one of the dentist's uses something other than carbocaine because it lasts 4 or 5 hours, but he tells me it's just carbocaine because I told him about the epinephrine sensitivities.

Anything ideas are greatly appreciated! Do you think it's still best to find a surgeon with more experience than the guy that's been out of school for less than a year? He said he's extracted a lot of #14 and #15's in the past two years, so it sounds like he's only been extracting for two years in his residency.[/QUOTE]

[Silky]

Hi Bryanna,

The surgeons don't see anything wrong with tooth 15. They just know that it's been causing inflammation and a sore area for several years, and would take it out if it's to the point that I can't stand it. The tooth is good as other dentists have said. I'd be concerned about tongue cancer if this goes on much longer.

I don't have a bitewing xray, but I have an icat scan.

Thanks!

[Silky]

I have a lower porcelain crown #18 that is irritating my tongue because the cusp has too big of space in it. The upper tooth #15 has been extracted. Was wondering if there is anything that can be added to the porcelain to build it up more, so it won't irritate the tongue. I seem to be hearing that nothing sticks to porcelain, but I saw on the internet that maybe it can be etched and material added to it?
Thanks1

[Bryanna]

Hi Silky,

Sometimes composite material can be added to the porcelain on a crown but it usually doesn't stay on too long especially if it is placed on the cusp. Has your dentist tried reducing the cusp (with a drill) on the porcelain?

Bryanna

Originally Posted by Silky

I have a lower porcelain crown #18 that is irritating my tongue because the cusp has too big of space in it. The upper tooth #15 has been extracted. Was wondering if there is anything that can be added to the porcelain to build it up more, so it won't irritate the tongue. I seem to be hearing that nothing sticks to porcelain, but I saw on the internet that maybe it can be etched and material added to it?
Thanks1

[Silky]

[QUOTE=Bryanna;1060015]Hi Silky,

Sometimes composite material can be added to the porcelain on a crown but it usually doesn't stay on too long especially if it is placed on the cusp. Has your dentist tried reducing the cusp (with a drill) on the porcelain?

Hi Bryanna,

The dentist didn't try reducing the cusp. He said he could try to smooth out the cusp, but wouldn't that make the space bigger, and then possibly irritate the tongue more. Would you try smoothing first,or try to reshape the crown in some way?

Thanks. Carol