NeuroTalk Support Groups - Problems with DDS, gumline: HELP!

Hi Bryanna,

Haven't passed out. Not yet anyway! Believe it or not, you are making perfect sense; and in an odd sort of way it's a relief... I finally can know what's going on. The unc. DM 1 despite 10+ years of GOOD MD interventn now comes together; and assuming your DX is correct, the puzzle now seems to have the right pieces. It would explain A LOT.

You never did tell me--perhaps intentionally--if you are a DDS? (A tech would likely never know all this!)
OK -- responses below = ***

Quote:

Originally Posted by Bryanna (Post 476914)

Hi NAM,

I hope you can download that photo, but in the meantime, I cannot get you off of my mind.

***THANKS!

***photo(s) still coming, hopefully later today

I need to tell you what is evident on the radiographs that you posted. Please read carefully what I write and know that I am only giving you the most obvious pathology on your radiographs. These radiographs are only two dimentional and depending on the angle of the film, different pathology can appear. Some of them are of poor diagnostic quality but the teeth I am making reference to show up fairly clear in at least one xray or another.

***Understood.
I believe you recall these rads are from 11/08 at the onset of Dr H's TX(?).

I understand why Dr T suggested the FMR and why it was so expensive. You have a multitude of dental issues that can only be properly remedied by a complete FMR. However, my FMR suggestions would probably be very different than Dr T's simply because I firmly believe that your diabetes is out of control in part to your oral health and dental restorations. To keep anything in your mouth that is causing infection and/or inflammation will cause your diabetes to remain out of control.

***This is the part that makes the most sense!
Dr. T did not address any infection issue other than #s 8-9; however he did go thru all or most of rads.

***I want the least invasive but most effective TX, yes.

Again, my intention is to give you the honest truth about what is present on these radiographs. I am also assuming that the radiographs have been done in the universal pattern which means the upper right quadrant is #1 thru 8, the upper left quadrant is #9 thru 16, the lower left is #17 thru 24 and the lower right quadrant is #25 thru 32.

***Believe so. It corresp w/my understanding to what's been done.

I'll do this in quadrants to help make it easier to understand.

The Upper Right.......You are missing several teeth in this quadrant and have alot of drifting going on with the existing teeth. You have a "cantilever" bridge. Tooth # 3 is crowned with an attached "small" fake crown in the space of #4. There is a food trap there and evidence of periodontal disease. This is not a stable chewing prosthesis especially against your lower right bridge.

***Yes. #3 had dropped (due to missing tooth underneath on lower Rt) and required shaving off considerable length to adj bite. This DDS was extremely reluctant to deal w/DM; & he and his recomended endo disagreed on TX. Wound up extracting a lower Rt tooth (#27?) per this DDS' advice. (This DDS did add upper cantilever) but then subsequently could/would not do lower Rt bridge and Dr R took over:

The Lower Right....... You have a 4 unit bridge with two missing teeth in the middle. Tooth #31 the molar is root canaled and has an apical lesion (infection/small cyst) on the mesial root with a large furcation in between the roots. Furcation is the area where the middle of the three roots come together and it is suppose to be covered in bone. The bone has deteriorated and there is an opening there collecting bacteria. This typically occurs in root canaled molars especially when periodontal disease is present. The xray is a bit blurry, but there might also be a fracture in that mesial root as well. This is the anchor tooth to that 4 unit bridge. Tooth #28 the other anchor tooth to this bridge may be dying because there is evidence on the xray that the lower portion of the nerve canal has calcified.

***Yikes. There was disagreemt bt 2 DDSs 15 yrs ago on #31 re how RTC was done...caused me a HUGE amt of pain; subsequently finishing 2nd DDS said it was because DDS 1 had done RTC in 1 step vs 2.

***Note as well this is the only area Dr H mentioned to me having bone loss.

***The then obvious cysts (x2, @ 9 and bt 10-11 prev removed by Dr G) now make much more sense.

FYI..... this type of bridge, two anchor teeth holding 2 fake teeth in the middle when placed in the posterior portion of the mouth is very difficult to properly align in the bite. Especially when the upper teeth are not stable as in your particular case. It looks like these two bridges, upper and lower, do not line up in occlusion at all.

***For sure they do not line up. This is partially why Dr. T wants FMR. I do have several diff "bites" making it difficult for Dr H's tech to adj bite. Dr. T says further adj could result in going thru #8's crown completely.

The Upper Left........ It's hard to tell but I think that is a 5 unit bridge from #'s 11 through 15.

***Actually a 4 tooth bridge spanning that area, yes. Sm mouth.

Tooth #15 is the last molar and it appears to have some significant bone loss at the distal (back) portion of the tooth with root exposure and moderate/severe periodontal disease. This tooth may be at best partially non vital.

***Bleeeeep...

Tooth #14 is missing. Tooth #13 is root canaled and has an apical lesion (infection/cyst) at the end of the root. Tooth #11 is root canaled and was overfilled with gutta percha material

***#11 is the tooth that Dr R mistakenly did RTC instead of listening / recognizing cyst. Took myself to Dr G and had cyst removed acc. Ret to Dr R to finish RTC. Dr G said would poss/prob have rec RTC anyway as result of cyst.

***Does not surprise me Dr R used a presumably substandard material...am finding out this has been SOP.

(see the hook like white material at the end of the root) and also has an apical lesion at the end of the root. From the bite wing xrays, it appears that this bridge does not align properly with your lower teeth.

The Lower Left....... Tooth #18 the last molar is root canaled and it appears to have a fractured distal root with moderate root resorption

***what is this?

as well. It has a large furcation, with moderate bone loss and periodontal disease. It appears to have something wedged along the margin of the crown in between the teeth almost like a misplaced mercury filling. This has caused a food trap and bone loss. This is not a healthy tooth. Tooth #19 has a crown with a metal pin in the distal (back) root underneath the crown that appears to be placed in or near the one nerve canal in that root. There also is a shadow on the xray that may indicate an apical lesion at the end of this root. It is typical for these metal pins to irritate the nerve and eventually cause it to die which typically shows up as a lesion at the end of the root.

***Believe RTCs were done on 18 + 21 (would have to go way back in recs; teeth #s are somex off due to tooth loss). I'm fairly sure #18 was prev filled w/lg composite, #21 as well. Re #19 and pin: unk., prob RTC.

The Upper Teeth #'s 7 through 11.......All of them show apical lesions. It appears from the angle of these xrays that all of these teeth have been severely prepped in or near the pulp chambers. When this is done like this, the gum tissue needs to be cut back...... gingivectomy..... because too much of the tooth structure has been removed to hold a crown so by removing gum tissue more tooth structure is exposed. However, the gum tissue will not respond favorably because the tooth and surrounding bone has been very traumatized and there is an abundance of chronic inflammation. Thus the repeated gingivectomies to gain some tooth structure because there is literally no tooth structure left out of the gumline to hold a crown. Typically (in conventional dental practices) what is done in this case is all of these teeth get root canaled and posts are put in to hold the crowns on. The crowns would have to be PFM because the posts would show through an all porcelain crown. Tooth #9 has a root canal and moderate root resorption because of the infection. This tooth has been poorly patched up with composite material again to help hold this crown on.

(***Recall again these rads were taken just prior to Dr H's TX):

***Dr R had in fact tried repeatedly to redo both ging AND bonding to 7-11 to make them fit. Even tried a "better material" (ceramic(s)); but could not seem to understand why it did not wk, insisting it would eventually. Even said he tho't I was "healing too fast" for DM, and atypically as the gum line kept coming back over the teeth, esp #8. As for #9...well, that + #10 were the only areas he could keep up "higher" @ gum line w/bonding. Initially he wanted me to accept #s 7+10 at apx 1/3 their orig size, saying as he was no longer in private practice could not control lab wk. Then sent crowns to his fmr lab but still could not get them to wk.

***Remember also that cords or ??? were also left in at sites 8 + 10.

***Dr H insisted #6 had been veneered until took it apart & found the bonding which was now deteriorating after apx 9 mos.

***Dr R did no post on #9; Dr. H did. Seem to recall Dr R saying no post nec. That's when Dr R did initial crowns on 8 + 9; later redid them 7-10 inclusive w/ging. Then the obvious inflammn, etc became apparent.

***Dr H said there was no way! to tell when/if 7,8,10 would need RTC, but that it was poss later due to overtraumatized teeth/gums. (I asked.) I recall other DDSs using rads, "ice" testing for DX. However, I did not dare press; at that time it was apparent I would have to move on anyway.

***(This could also explain the rather unorthodox "form?" I was required to sign up front for crowns prior to seating, assisted w/only a cotton roll or gloved finger to agree these crowns (all 5 at once at the time!) looked and fit properly. I have never before been asked to sign such a form up front (prev DDSs only after seating) and it was not known until that point I would be asked to do so. Too late to discuss it; and conflict resulted when I tried or any questions were asked of her. Allowance for final approval was inadequate at best. This became still more evident when #s 8+9 were returned re-done then w/uneven result - as gum line had moved.
(I needed to leave her practice ASAP. The crowns were done; pre-pd as required. I also had no idea what further trial/error might bring.)

***It was clear she did not want me to come back; and I did not want to return as well. While I can understand DDSs - or she - did not want PT(s?) returning after the fact or endlessly, this gave me few options, and no recourse... and this disclosure was NOT made clear @ TX onset.)

***OK, this is where I start thinking $%^&!!!! again!

***ALL this makes "poor dentistry" look like a bleeping joke.
I don't know whether to hope all these DDSs were dense, or each just trying to make a fast few hundred or thou! "Mainstream dentistry" BITES.....pun intended. Either way...%^&*!!! still applies.

The Lower Front teeth......... look ok.

***Dr H says the reason she wanted PFM was because the lower front teeth would further erode (on top) w/ceramic coated crowns 7-10. Her recept/biller said PFM because it matched material on bridge 11-15. Somehow this all wound up being my fault...I can now understand Dr H's nervousness / attitude. I don't know which is worse...Dr H not knowing or not wanting to tell me; and I don't know which happened, maybe both.

***I can't help but recall again at this pt Dr H at no time noted to me any infection on exam for past present or future. Neither did any other DDS except Dr T.

***Continued infection is not exactly a viable "option." Breaking crowns repeatedly is not exactly an option either!

***Dr T says PFMs were used because Dr H knew ceramic crowns would break, period.

***Dr T also says these bottom teeth need redoing because they will continue to clash w/ 7-10 and cause continued infection.

***(Per Dr T above) This is what I don't understand:
How could all this infection possibly relate to BITE?
????Red Flag: I have learned to pay ATTN to these!
I note one of Dr T's perios (altho not the 1 he would send me to) was the only perio Dr E used. I did see this perio - & after ging/crown length'g proc he would have sent me back to Dr E - FOR CROWNS 7-10 - with the same BITE issues I STILL have.

***I still don't know what type of infection this is?!

***I do understand periodontal disease. The above perio and Dr G disagreed on whether poss or not mine had progressed to pt of affecting major organs. Fmr said I was not to that pt. Dr G said studies were inconclusive, and deferred acc.

***I have had 2 cysts removed. One was analyzed but believed not infected. I don't believe the last was analyzed. It WAS in the area most swollen bt #10-11 where Dr R mistakenly DXd abcess and did unnec RTC. (After cyst removal, seemed to calm & do OK after finishing RTC.)

***Here's where I try not to panic: What can or has already happened due to this app chronic unreported infection @ roots etc! Fear of the Unknown:(((((((((((

***I don't understand the BITE issue relating to virtual full mouth infection.
Does repeated irritation equal automatic infection??????????at the roots too?????????

***The next obvious and perhaps hardest Q: How do I find someone qualified to do this? An Entire FMR is hard to swallow. 12-18 mos TX is hard to swallow. Depleting finances is HARD TO SWALLOW! I DO NOT want any unnec procedures (such as implants or bridge on bottom front teeth). Dr. T says he "takes no shortcuts."

***Dr T's ofc has said they are redoing their website; which may acct for no email @ present. If I can get his current rads s/p TX (7-10 only taken 3.2.9) R U interested or does it matter at this pt?

***Red Flag and/or Fear of the Unknown not withstanding!
Perhaps this is the time for PM: Would it help to have Dr T's full name etc? (By the way, I have not yet seen a way to "attach" anything thru that pg.)

***I definitely do not :((((((((((( need someone else who is unqualified, or simply collecting $$$$ repeatedly.

***HOPEFULLY this has now become a MEDICALLY NEC procedure for which health ins w/cover part. Do you think that's a poss? If So, the flip side to this is I found out while still have health ins...thru 11/09.

***Meantime, it looks to me like I w/have to find a way to have this done. If health ins w/assist, that w/be a help. If it w/increase or solve control of DM 1, it's a must. It is of course also very overwhelming. IF I can in fact go thru this, I can NOT do it twice.

***I do NOT want them, however feel must ask again: One does presume dentures w/not resolve bite or esp bone issues? Infection?

Hopefully you haven't passed out from reading this. I'm going to stop here and let you absorb what I have written. Please don't panic. If it's any consolation........ your situation is a common occurance in mainstream dentistry. I know that doesn't make it better or easier to accept, but you are most certainly not alone and others will be able to identify with what they are reading and seeing here.

***Hope it will help someone else! I know I've never seen it before, or I would've known better. There IS way more protection for DDSs than PTs; that's clear. Looks like it's understood by DDSs how hard it can be for PT to resolve poor dentistry. Also needs tb changed by law or public outrage...something! Can't believe it's gone this far for so long. Too late is not good enuf. I can understand how people give up. If not for infection, I 'd be so tempted to do just that. I know I'm exhausted.

***However, I DID see a pc on news abt DDSs and MDs now requiring PTs to sign up front they will not post any comments/reviews on self help sites such as Axxxx's List, etc. (Am I allowed to say which?) !!!!!!!!!!... As the newscasters felt, if there is nothing to hide, why not welcome the review? From this (DISAD)vantage viewpt I'd have to say PTs have to use any tool avail to them.

***Closing that dental box for now...

I am so sorry you are going through this....... you have no idea how much this bothers me.

***THANK YOU! You have no idea how much I appreciate your time, compassion, and honesty.
NAM1

Please take a day or so to go over this and we'll talk some more then.

Bryanna