Hi Bryanna,

I'll take your adv on the endo MD OV. He has found my case tb very challenging and hopefully w/welcome the chance to R/O or DX periodontal disease as the cause for uncontrolled DM 1.

(Should have a gd start w/lab wk.)

However, the busier he gets the less he feels able/willing to help w/areas outside his expertise, so I w/do my best to get guidance w/the above in mind.

Altho he has always been a very good MD,... best endo in area... and very open minded w/me, he tends to gravitate twd tradl medicine. (If you recall, this is the MD I believe sent me to Dr G, the MD/OS/DDS, who also did not info me of infectn. Dr G has an excellent rep!)

Thus, any further recommendn by my endo for a DDS may be a trad'l one.

My Qs/Comments I referred to earlier:
Pain: I notice (ahem) you referred only to the pain of extraction. I am most concerned abt the pain of further ging.'S, bone graftS, post placementS, and the surgical procedureS, WITH IV anesthesia(S) req'd over 12-18 mos of time, PLUS an appliance PRN.

Denture and/or Implant placement and material:
U did not answer whether U were talking abt removable or post implanted dentures.
Both look terrible!
I can't imagine they feel much better (I have had a removable bridge).
I am not at all crazy abt the idea of dentures.

IF we are talking SINGLE IMPLANTS:
Is there any other implant material than titanium? Still metal! if we're talking bio dentistry.
By your prev post you state up to 6 mos resting/healing time S/P extraction. W/NO temporary ANYthing, If these teeth are in front, I am w/o teeth there to the same 6 mos!!!! Not to mention other areas not as noticeable, but problematic for chewing, etc.

Yuck, and !@#$%^!

Remember Dr T wants to redo every single tooth w/implants.

(Note, for what it's worth, Dr G said 2 mos for healing prior to rod placement, then more prior to crown placemt. Dr E said 3 mos. Regardless, Still a LONG time.)

I think I was editing a few days ago while you were replying so perhaps this bears repeating:

I am SO TERRIFIED of a a repeat w/Dr. H. I can NOT find myself part way thru extensive TX and find I have another temperamental, irate DDS. I can NOT go thru such extensive TX and Expense, and find it has been done wrong... AGAIN!!!

What "instincts?" I have very few left... Who to believe?

OK, trying not to panic and overwhelm again just yet... way too much stress in the rest of my life right now. So, closing that dental box for now again.

Thanks so much!!!

NAM

Update to Below Post

Hi Bryanna,

Just noticed you replied to me on Jon's post...
Yes, I realize her case is much different from mine, aside from the fact I (was!?) considering dentures to one degree or another.

The fact that food can get trapped underneath even the dentures w/posts is a big drawback for me. (I feel every small pc of food the way it is now.) Cleaning them must be a real bear.

I do have lab results now but have not yet seen endo MD:
Fibrinogen is WNL @ 282.
Sed rate is WNL @ 2.
CRP is WNL @ 0.2.
Homocysteine is WNL @ 7.8.

However, total Bilirubin (@1.3) and direct Bilirubin (@.3) are slightly elevated.
As well, Creatinine clearance is high @ 138.1 while Creatinine is WNL @ .78.
Fructosamine is elevated as well @ 353. There's that Uncontrolled DM 1 again.

Acc., looks like my hepatic and renal functions could be affected by either DM 1, (or perio disease or both). This is the 1st time I recall ever having lab results like this for these factors.

All other values (5 pgs worth; + there w/be more) are presently WNL.

Curious what you think abt lab results while I await MD appt now 4.16.9.

Some results may be skewed by the fact I started coming dn w/a cold w/in 24 hrs after the blood draw :-(

Hope I was not out of line w/Jon.

Thanks,
NAM

Hi NAM,

I know how hard it is to get doctors to "work with us" on anything out of their norm. But if you are comfortable with him and trust his judgement, hopefully he can be of some help to you in areas that are out of his norm. His referral to Dr G may or may not have been anything more than a name he was somewhat familiar with. I could be wrong, he may have a professional or peer relationship with him. The fact that Dr G did not inform you of some of the things that I did does not surprise me knowing what I know routinely goes on. But you would have to ask Dr G specifically about those areas I mentioned to get an answer to that question.

I know it's a difficult decision but I think only you can decide whether to seek traditional dental care or not. Traditional MD's are not going to refer you to any one else, so that's a given. But if your Endo MD did refer you to an non traditional dentist, would you feel comfortable going?

Your text<< My Qs/Comments I referred to earlier:
Pain: I notice (ahem) you referred only to the pain of extraction. I am most concerned abt the pain of further ging.'S, bone graftS, post placementS, and the surgical procedureS, WITH IV anesthesia(S) req'd over 12-18 mos of time, PLUS an appliance PRN. >>
I CAN OFFER YOU SOME INFORMATION REGARDING PAIN OR DISCOMFORT WITH REGARD TO CERTAIN DENTAL PROCEDURES. BUT EVERYONE HANDLES PAIN DIFFERENTLY AND I WILL NOT TELL YOU IT WILL BE PAINFUL BECAUSE IT MAY NOT BE. WITH THAT SAID...... ANY ORAL SURGERY IS GOING TO BE UNCOMFORTABLE FOR A FEW DAYS POST OPERATIVELY. GINGIVECTOMIES CAN BE MILD TO MODERATE DEPENDING ON HOW LARGE THEY ARE AND HOW THEY WERE DONE. PAIN FROM BONE GRAFTING DEPENDS ON WHETHER OR NOT THE BONE IS HARVESTED FROM YOUR OWN MOUTH (OR ELSEWHERE ON YOUR BODY) OR FROM A SYNTHETIC MATERIAL IN A STERILE VIAL. WHEN YOU SAY POST PLACEMENT, I ASSUME YOU MEAN DENTAL IMPLANT. DEPENDING ON THE CIRCUMSTANCES, THE PAIN CAN BE MILD TO MODERATE. THE ENTIRE TREATMENT PLAN SHOULD BE PLANNED OUT AHEAD OF TIME AND IT COULD TAKE UP TO TWO YEARS TO COMPLETE, BUT IT MAY TAKE LESS. THE IDEA IS TO NOT GO WITHOUT (FRONT) TEETH AT ANY TIME. SO THIS WOULD MEAN THAT TEMPORARY PARTIALS WOULD BE FITTED
PRIOR TO ANY SURGERY SO YOU COULD WEAR THEM IMMEDIATELY POST OPERATIVELY.

<<Denture and/or Implant placement and material:
U did not answer whether U were talking abt removable or post implanted dentures.
Both look terrible!
I can't imagine they feel much better (I have had a removable bridge).
I am not at all crazy abt the idea of dentures.>>
YOU MAY OR MAY NOT BE A CANDIDATE FOR DENTAL IMPLANTS. ONCE THAT IS DETERMINED, THEN THE DENTAL WORK IS PLANNED ACCORDINGLY. ANY TYPE OF DENTURE IS GOING TO FEEL STRANGE AND THERE IS DEFINITELY A TIME PERIOD OF PERSEVERANCE AND ADJUSTMENT. I WISH IT COULD BE EASIER :-(

<<IF we are talking SINGLE IMPLANTS:
Is there any other implant material than titanium? Still metal! if we're talking bio dentistry.
By your prev post you state up to 6 mos resting/healing time S/P extraction. W/NO temporary ANYthing, If these teeth are in front, I am w/o teeth there to the same 6 mos!!!! Not to mention other areas not as noticeable, but problematic for chewing, etc.>>
DENTAL IMPLANTS USED IN THE US ARE PREDOMINANTLY TITANIUM. YES, THAT IS A METAL BUT IT IS CONSIDERED A BIOCOMPATIBLE METAL AND MOST PEOPLE CAN TOLERATE IT. EUROPE USES ZIRCONIUM WHICH IS A NON METAL MINERAL. THIS TYPE OF IMPLANT CAN BE PURCHASED FROM EUROPE AND USED IN THE US BUT ONLY BY A DENTIST WHO IS FAMILIAR WITH PURCHASING AND WORKING WITH IT.
DENTAL IMPLANTS NEED TIME TO INTEGRATE WITH THE JAWBONE BEFORE ANYTHING CAN BE ANCHORED ONTO THEM..... INDIVIDUAL CROWNS OR BRIDGES OR DENTURES REQUIRE THE SAME TIME FRAME. DEPENDING ON THE INDIVIDUAL, THIS CAN TAKE 4-6 MONTHS FROM THE DATE OF THE PLACEMENT OF THE IMPLANTS. DEPENDING ON WHAT AREAS OF YOUR MOUTH ARE DONE (ESPECIALLY THE FRONT), REMOVABLE PARTIAL DENTURES CAN BE MADE TO WEAR DURING THE HEALING PHASE.

<<Remember Dr T wants to redo every single tooth w/implants.>>
I RECALL YOU SAYING THAT HE WANTED TO DO AN FMR BUT I WAS NOT AWARE THAT HE WANTED TO REMOVE EVERY SINGLE TOOTH AND REPLACE THEM WITH IMPLANTS. BUT IF SO, THEN HE DID INFORM YOU OF THE SAME ISSUES THAT I DID OR SOME FORM OF WHICH.........

<<I am SO TERRIFIED of a a repeat w/Dr. H. I can NOT find myself part way thru extensive TX and find I have another temperamental, irate DDS. I can NOT go thru such extensive TX and Expense, and find it has been done wrong... AGAIN!!!>>
I UNDERSTAND COMPLETELY AND WISH I COULD GUARANTEE THAT WOULD NOT HAPPEN. YOU'VE BEEN TO MANY TRADITIONAL DENTISTS AND HAVE NOT HAD POSITIVE EXPERIENCES. THE BEST THAT I CAN OFFER YOU IS TO SEEK A DENTIST WHO THINKS AND PRACTICES DENTISTRY FROM A DIFFERENT PERSPECTIVE OTHER THAN WHAT YOU HAVE ALREADY HAD.

I think you have very keen instincts and need to trust what they are telling you. You know you need to do something and you want to avoid a repeat performance........ the only way to know if you want to explore a different path is to cautiously step onto it..... one step at a time.

I'll read your next post now and may have to get back to you later......

Bryanna

NAM.....

It is important to me that others jump in on these conversations to offer any help or support they possibly can. My post to you about your post to Jon was intended to say to you...... hey, her case is different than yours, please don't let her experience defeat you. Your level of bone is different than hers so dentures would fit you differently. You both have been through dental hell and back, but under very different circumstances. So please...... always feel that your input is important here!!

ALL dentures take time to adjust to. They fit according to the existing bone level. That is one reason why I harp on telling people to think twice before getting root canals because they cause bone deterioration from the lack of blood supply to the tooth and surrounding bone...... another topic, another time. I also try to inform people the importance of getting their periodontal disease under control before the bone deteriorates. Once the elevation of the jawbone is gone, it is often too late to try to rebuild it and that is when dentures can be a real nuisance.

With regard to cleaning dentures..... it is very simple. They come out.....so brushing them is no problem.

I agree with you on your lab results. Your cardiac inflammatory markers seem ok as does your sed rate. There is something going on (inflammation(??) within the liver(??) and renal system. Hopefully your MD will be able to give you some insight into that.

Was your vitamin D level tested.... 25(OH)D??

Bryanna

Hi Bryanna,

Jon's experience does not defeat me...it solidifies what I've been thinking:

I do NOT want dentures!
I do NOT want dentures!

I don't want to have to learn to eat all over again.

I don't want to have to take out my teeth like an 100 yr-old person.

I don't want to have food stuck under my "teeth," hurting or uncomfortable until I can get somewhere to clean it out.

I am to eat several sm meals a day as a DM 1 PT. I don't want to have to remove these "teeth" and brush 4-6x QD or more!

I don't presently like the feeling of something in my mouth that doesn't belong there...much less the thickness of a denture designed to make up for bone loss.

I don't like the look of either full, posted or snap in dentures. One doesn't dare open one's mouth very far. They still look like dentures either way...horrible!

Dentures do NOT address the underlying BITE issue; presumably it would continue and infection along with it! (Remember Dr T and his DX of BITE Probs=Infection.)

Of course TX does not have tb w/Dr. T. Any other opts available I should know of other than the following?:

As much as I don't want to do so, it looks at this pt I would prefer implants and crowns as much as possible. I do not look fwd to ANY of this! However, the more research, the more I do NOT want dentures.

My Vitamin D level was not tested this time. (It was prev WNL.) I elected to go w/starting labs at this pt., and wait on MD for further guidance. Creatinine tests are gen not considered abnormal until 2 of 3 tests w/in a 6 mo period are consistent; hopefully the fact that I was coming dn w/a cold and was very stressed had something to do w/ these 1st abnormal results. Since I've been eating less due to these !@#$%^! teeth, I've been having more bld sugar lows, thus the liver may have kicked in and dumped even more sugar into my system, creating yet further skewed results w/both hepatic and fructosamine levels...I'll see what MD has to say.

SH**, I Hate These Teeth! #8 is really starting to bother me again. Trying not to think abt Dr H.

At the risk of sounding like a broken record...
I do NOT want dentures!:-(

Any further ideas/comments you have are welcome as usu.

Thanks!
NAM

Hi NAM,

I wholeheartedly understand and validate ALL of your concerns about dentures. The association between old age and dentures is something that we perceive in our head because the only people we think we know who has them are older than us. We grew up thinking our old relatives and grandparents all wore dentures. Right?

I can tell you from professional experience that many people in their 30's, 40's and older wear some type of removable partial or full denture. For those who are healthy candidates and can afford implant retained dentures, that is the path of choice for many of them. As I mentioned before, not everyone is a candidate for dental implants and that is an issue that needs to be thoroughly discussed between dentist and patient.

You make an important point about the appearance of full dentures. Generally, they don't look that good. But the dentist can alter the appearance to a certain degree if the patient makes that request. There are various tooth options the dentist can choose ffor the shape and size which does make a difference in the overall appearance. The size of the teeth have to be able to fit into your anatomical structure but even that can be altered to a certain degree. Fabricating dentures is a very complicated procedure.... it is definitely not one size fits all.

On the subject of appearance...... do you like what your teeth look like right now? My intention is not to imply in any way that dentures look better than what you currently have.... my intention is to bring attention to what you have now from an esthetic perspective since you are very concerned AND RIGHTFULLY SO about what your teeth will look like post any dental treatment.

Just to make you aware...... Implant crowns in the front upper portion of the mouth may not always look ideal as one would imagine them to look especially when there is bone loss in that area. In order to place an implant there has to be adequate, healthy bone. Number one, root canaled teeth, periodontal disease, and other types of oral infections lower the crest level of the bone due to the chronic irritation and inflammation. Secondly, 50% of the bone is lost when a tooth is extracted because there is now a hole where the tooth use to be and for the bone to fill in naturally, it has to take it from the sides of the socket which makes the crest level lower. Bone grafting of that socket can minimize that amount of bone loss but #1 not everyone is a candidate for bone grafting due to certain health issues which could actually cause the graft to be rejected and #2 sometimes the bone surrounding the socket is too diseased from long standing infection and a bone graft could become very infected and again rejected.

With regard to bite issues with dentures and still having infections..... I'm not sure what you mean about this. Can you elaborate for me?

With regard to Vitamin D.... it is imperative to maintain optimal levels for our overall health as it plays a significant role in so many common health conditions. I don't know what your previous level was but the optimal daily level in our blood should be between 50-65 ng/ml (some people higher). A level <50 ng/ml is considered deficient.

NAM, I think you may be jumping the gun a little bit with contemplating the loss of all of your teeth and how you are going to replace them. You have some healthy teeth and some unhealthy teeth. From a dental standpoint, I don't think you are ready for a full denture and should not have your good teeth removed.

I encourage you to weigh out the pros and cons of hanging onto teeth that are not healthy or have guarded to hopeless long term outcomes and get help in getting the periodontal disease under control. From my perspective, those are the two biggest issues that need to be addressed first. In taking care of those things, your good teeth will thrive in a healthier environment and your DM may become more controlled also.

Since you do have some healthy teeth, you may be a candidate for precision partials. This is done when several teeth are missing or removed. The teeth remaining are usually crowned and the partials are fabricated to snap into little male/female attachments on certain crowned teeth. These partials do not move around when eating or speaking.

Your thoughts..............

Bryanna ~'.'~

Hi Bryanna,
(Having trouble posting...may be some trial and error)
W/ regard to your prev post/answer:
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