My impressions have been taken so something may have already been made, but I need to know the difference in acrylics and porceline. (Refer to prior message.) Meeting with the head of the pros department and his intern was seemingly a waste of time. They wouldn't be specific, they just said I was getting acrylics. Period. Didn't answer my questions. Are acrylics okay or will they look terrible or what?

Also, the surgeon said I would need to be put to sleep after everyone had agreed that I could do it without the drugs. I'm afraid of being put to sleep because of prior bad surgical experience. He said if we had to do any more than pull the teeth, he'd rather ansthesize(sp) me.

My appointment is on the 15th, but they're going to get me in sooner if they have a cancellation. My time is running out, and that's exactly what I feel like doing!

Anxiously - Jon

Hi Jon,

I feel so bad that you are having to put up with such nonsense. Just because you have chosen to receive your dental care at the dental clinic does not in any way mean that everything should not be fully explained to you prior to consenting to treatment.

The acrylic teeth will be ok ....... that is what is used most often. Porcelain teeth are more costly and only used if the person is willing to spend more for them. The long term wear ability of either material depends on the person's bite and if the appliance fits well into their occlusion then either choice would be ok. The one issue that I would stress to you would be esthetics. If you are concerned about the "natural" appearance of the teeth, then you need to stress that concern making sure that you have been heard. If esthetics is not a major concern for you, then don't worry about it they will look fine. Don't worry about the material of the teeth..... it's the least of what is going on!

As for being put to sleep.......... again, they should have been very specific with this issue and asked you about all of your concerns with it. The IV meds used in dentistry of this type will induce a "twilight" sleep which is different than the heavy general anesthesia meds used in a hospital setting for other types of surgery. The twilight meds allow the patient to become very relaxed and have no recollection of the procedure. Some people do fall asleep, but it is not exactly medication induced it just happens due to being in a very relaxed state. You are still given adequate amounts of novocaine to numb the areas of your mouth that are being worked on. Once the surgery is done, most people are easily alerted and fully conscious within a few minutes. There are no lingering affects of these meds like general anesthesia.

However, whatever your previous issues were with anesthesia of any kind, it is important to convey them to the oral surgeon prior to him giving you the twlight meds in your IV.

Jon, it is so important that you go into this feeling positive about the outcome. The doctors have not been accomodating to your questions and concerns, but that doesn't mean you stop expressing them. If this is the path that you need to take to get your dental work done, then make your thoughts be heard irrelevant of whose toes you may be stepping on. The outcome will be ok....... it's just getting to that point that is unnecessarily stressful. Believe me, what you are experiencing is common practice for dental schools all across the country!! But it will be ok!!!

Please keep us posted on how you are doing! Try not to worry, it will be ok!

Bryanna

Bryanna, thank you so very much for hearing me, for your quickness in giving me the information I badly need, and for some reassurance while I'm in this condition.

The aesthetics aren't all that important at my age. If the acrylic will allow me to eat without fear of breakage and pain, it will be acrylics!

I have PN along with other things, so I'm feeling it already when he talks about the possibility of moving a nerve, doing a bone graft, etc. I have no choice in the matter, seemingly, so again, if that's what has to be done, it will be.

Put me on your prayer list along with all the others who are surely there. I'll let you know what happens.

Again, many thanks! Jon

Hi Jon,

Well you are certainly welcome..... glad to be of some help to you!

If I remember correctly, you are having dental implants placed to help retain a denture. There may or may not be a need to place bone graft material. It all depends on how thick and solid your existing bone is in the places they want to put the implants. The condition of the bone can be seen pretty well on the radiographs that they have already taken, so they should have some idea of what they are dealing with. Sometimes, the bone looks a bit different once the incision is made an the area is exposed. Did they talk to you about your options with the bone graft material? There are various types, some are synthetic from things like coral calcium and others are from cadaver sources. Generally, a surgeon prefers to use one over the other, but it depends on the circumstances of the case. If they haven't already discussed this with you, then please ask them to inform you of what they will be using before they start the procedure. Make sure that they know about your full health history and the PN, etc.

You mentioned "moving nerves" during the surgery. Please do not be concerned about this. I really cannot think of any reason why that would occur. They may be concerned about nicking a nerve in the mandible canal of the lower jaw but generally they don't place implants in that area of the mandible. There are lots of nerve fibers everywhere, but they regenerate quickly providing your immune system has the ability to heal them. But don't stress about that at all..... it will be ok!!

I wish you could feel more confident about the work you are having done and about those who are doing it! This is a HUGE undertaking and you should have been treated better. If it's any consolation....... many private practices handle their patients similarly alot of the time. Patients often feel like they are not entitled to ask questions because it takes up too much of the dentists time. Well BS to that!! Take up his time until you feel confident in what is being proposed. Believe me...... no dentist has ever just sat willingly in the dental chair without knowing and understanding what his options were. There are times when the xrays only tell part of the story and the mouth tells another.. so not all treatment is textbook.

If you feel unsure about anything, please write down your questions and take them with you at your next appointment. Tell the dr you have some concerns and want to address them prior to starting anything because you want to go into this with a positive attitude so you come out with a good outcome!

I remember my mother going into heart surgery and saying to her surgeon.... <I have to trust that you've done this before and by now should know what you're doing. However, trade places with me for just one minute.......... pretty scary huh?> He sat down next to her and said....... <what can I do to make you feel more comfortable?> She said, <during the surgery simply reassure me from time to time that I'm doing well.> He said <you got it.> Well, after her surgery he came to me and said... <your mother did remarkably well! She had no blood loss and her arteries grafted beautifully!> He said from now on, he will always reassure his patients during their surgery because he has no doubt that it works! Such a simple thing that can make the world of difference!

Since you cannot seem to rely on your oral surgeon to do too much of any patient sensitivity stuff, you need to reassure yourself and it would be helpful if you started to do that today and every day until this whole ordeal is behind you.

Please keep us informed on how you are doing. I will certainly keep you in my prayers and I know you will be ok!!

Bryanna

They recommended 5 implants in lower jaw with permanent bridges between. I asked for ALL implants, and they said that just wasn't necessary, it would take too long and this would work just as well. That was the pros department.

The surgeon offered no options. Said he'd remove bone from my jaw and implant immediately if necessary. That I would not feel pain from where he took it. That part is hard for me to believe since I have PN and no immune system. (Not necessarily from the PN.) That he couldn't tell definitely about the nerve until he got in and saw it. That would be what would take more time. He mentioned a $300 xray which MIGHT show him more, but he didn't recommend it. Said I might just have the extractions and implants to deal with. He just didn't know. The present xray shows the nerve very close to the implant depth, but, again, he won't know until he sees it.

I did write now all my concerns and made an appointment with the pros department. Our discussion did nothing to assure me. The department head is very much in the "power" mode and that along with talking down to some one is not a nice thing to do. I gave him my concerns, he addressed them, told me what was happening and dismissed me quickly. My drive was almost 2 hours each way. Can I put our a contract for him????

When I had the first 6 teeth extracted, I told the surgeon pretty much what your mother did. I was just under local anesthesia, and he did talk to me all through it, told me what he was doing, what else had to be done, etc.,etc. I agree that it helps speaking to them JUST before they start, and I will certainly do it again.

I'm the only one who can deal with my attitude. You've helped so much by giving me some information that they didn't. If I hadn't found you when I did, I'd probably be dealing with a stroke instead of this surgery!

If you thing of anything else relevent, please let me know. I'll keep you posted. Maybe some of this can help someone else in a similar situation.

Jon

Bryanna, I have another catastrophy. Two 'topless' teeth have become infected. They and the other three remaining teeth in my lower jaw are the ones due to be taken out and the inplants put in on Tuesday

The dentistry school is on vacation this week because of the Masters Golf Tournament. I've called and called. No answer.

My GP gave me a shot of antibiotics with followup pills of amoxycillin. That was yesterday, and I still see infection and feel more pain than I should at this point. Is there time enough by Tuesday for this infections to be gone? I know all the problems that can be caused by infection during surgery, but I don't know if there's more I can do to help cure it quicker. I'm taking the antibiotics and I'm rinsing with salt water.

I'm afraid the infection will have subsided to the point where they can't see anything. Doesn't it still lurk around? And, should I call off the surgery if they don't. I'm terrified to put this off any longer, so my inclination is just not to tell them. Also terrified that they'll say it's okay when it isn't.

I'm between a rock and a hard place! Any suggestions, please. Anyone.

Jon

Hi Jon,

I have to be honest with you....... I have so many reservations about people having their dental work done in a dental school and your current situation is one of my biggest issues with it! It is insane to not have someone or at least an answering service covering their phones!! Fortunatley you were able to see your GP......... and amoxicillin was a good choice for oral infection.

Due to many anatomical factors, antibiotics are not going to cure your tooth infections but it can help to temporarily subside your symptoms and it may take a good 48 hours for you to notice some relief. Keep rinsing with the warm salt water about 3 times a day.

It is important that you understand that teeth do not become infected over night. In your case, they have most likely been infected for a very long time but were asymptomatic until now. I'm sure your radiographs show the infection and so the dentists are aware of the situation. Therefore, they had full intentions of placing implants in areas of bone that are not exactly healthy to begin with. Because the infection has started to "show itself" means that it's looking for a place to release the pressure from the inflammation. HOWEVER.... definitely tell them about this flare up and what you are taking.

I'm going to be very straight with you here.........it is not a good idea to place dental implants in an area of bone that is infected. I know some dentists (especially in dental schools) will put them in irrelevant of the condition of the bone, but I also know how high the failure rate is when the bone is not healthy. I think you have every reason to be concerned about proceeding with this surgery on tuesday. But I also think that your dental situation is not going to change for the better which means that the infection will linger and spread as long as those teeth are in your mouth.

If you are going to proceed with the dental implants, then it is better to have them done while you are taking an antibiotic. SO on tuesday, tell the surgeon the latest episode and express your concerns about placing implants in infected bone. I wish I could be there to support you throught this!!! I can only tell you to go with your gut instinct and try not to make decisions out of fear. I know how hard that is to do, but it really is all you can do!

Let us know how you are doing. I try to peek in here at least once a day... sometimes I miss a day or two with my hectic schedule. But keep us in the loop of everything that is going on!

Bryanna

Bryanna,

I'm trying to repeat the letter I just wrote that somehow didn't get posted.

I think I understand what you are saying and implying. What if I just get the teeth extracted Tuesday and wait till the infection is gone before I get the implants? The lower denture they have al ready should help me eat and speak until the next surgery.

Another thought is to get them to put the implants in the non-infected side. That way, they could screw the tops on them at the time they do the other implants. The infection is in two teeth on the right side. Two front teeth on the right side seem to be fine. There's one back tooth on the left side way back that I'm using to chew on.

I'm not such a pig, but I have a bad stomach condition that has become much worse since I can't chew well and my diet is limited - as you can imagine. These dentists have my condition and my medications on their computer, but I don't think they consider anything but my mouth. I think I will have to be MORE than pro-active. You're a life-saver, Bryanna! Hopefully, I can be of help to you in other fields.

Jon

Hi Jon,

I think you should discuss your concerns about placing implants in infected bone with the oral surgeon on tuesday. Let him know without any hesitancy that you do not want to risk implant failure or serious complications since the bone is not completely healthy. Ask for his opinion on what he thinks would be in your best "long term" interest....... have the teeth extracted now and let the areas heal before placing the implants OR proceed with some of the implants OR proceed with the original plan?

It is hard for me to give you more information than this because I have not seen your xrays or your mouth clinically. But without any doubt, I do know that you have valid reasons to be very concerned about your long term dental health and how it is affecting your overall well being.

I know you are having lots of difficulty eating...... it is almost impossible to chew food without teeth!! But I have to tell you....... lower dentures (without the implants) are not easy to eat with because they move around alot. Implant retained dentures don't move at all.

Jon, you are going to have to trust the oral surgeons recommendations. Just be sure to express your concerns to him!

Let us know how you make out on tuesday! I'll be thinking about you ~'.'~

Bryanna

Well, here's what happened today. Arrived on time for 9am appointment.
Was given 5 pages to fill out before I had surgery. I'd left my glasses ( my daughter drove me ) so I hadn't finished them when they called me. Put my dentist's name in appropriate places, left some places unchecked because I didn't understand them - in other words, working very slowly. They took me to a room and a strange man introduces himself as Dr. X. He says he's going to do the surgery. I tell him Dr. Y is doing it. He says Dr. Y has been called to the hospital for an emergency. My daughter and I asked him lots of questions. He excused himself and came back with Dr. Y who basically said it couldn't be helped - that Dr. X could do it or we could try another day.

By this time, Dr. X is pouting and says he can't do it now we've wasted too much time. That we can make another appointment or it may be that some time will open this afternoon if we want to wait. We waited.

We'd told him my concerns. He says he was told what to do and if I want to change it, he just can't do it. That he wants to know what he's expected to do when he starts. I'm ready to die rather than go home with a mouthful of infected teeth. Briefly, he removed my lower teeth, put in 4 of the planned 5 inplants, had me xrayed and gave me appointment for next week.

He saw bad bone at the 5th site but decided he'd try it anyway. He tried to screw the inplant in 4 times. It came out on my tongue side. He put some "ground bone" in the cavity and around all the other ones that were already in, stitched them up and said I'd done well.

Some other things happened. The nurse who started with him disappeared in less than an hour. He had to pull, drill and cut pieces from the last tooth to get in out. This is when the nurse left and a man in a green surgical outfit took her place until all this was over. Total time for surgery -almost 5 hours.

The man in green did the xray. He poked my mouth, teeth and skin more than I've ever been poked by an assistant. He couldn't keep the water and blood even almost out of my mouth. I felt like I was choking. Dr. X says to just swallow it. The man in green turns out to be a junior at the local university majoring in biology - but has no credentials in any medical field.

I've never had any trouble with a dentist numbing me a little more if I asked. I asked Dr. X at least 10 times because every procedure was hurting more and more. He numbed me 3 times. Each time I asked, he said it was only going to be a little bit longer. The last 4 stitches, I felt everything.

Part of me wants to sue the pants off the place so they won't treat anyone else like this. My other part feels so insignificant that I can't imagine anyone treating me with kindness. Powerless to do anything but continue down this path.

More things happened, but I've already written too much. LONG, LONG VENT! No need to answer. Thanks for listening again.

Jon

Written yesterday. Sent today.