My initial goal was 4 front teeth that fit, with a slightly higher gum line.
I need a DDS who will listen, W/O ANGER, and W/PATIENCE, to a gunshy PT who has been thru 3+yrs of grief trying to fix a prob starting 12/2005 w/a DDS whom I really liked but would not admit he was in over his head. He repeatedly tried to bond 4 teeth as well as doing 6 gingivectomies instead of recognizing a need for bone reduction. Serious inflammation resulted; as well, cords were found months later left in, contributing to the prob. I finally gave up despite assurances he could fix it. He has now left practicing after promising and failing to fix his errors.
Bone reduction has now been done; and I have been thru more mistakes and probs: including refusals to wk w/my oral surgeon and his mistakes (correctly done bone reduction, but poorly done gingv as well as corresp mistake on access tooth 11's gum). There is a gen reluctance to wk w/a type 1 DM PT; and ALL 6 DDSs HAVE DIFFERENT OPIONIONS.
The last has "personal problems" which "sometimes come into her prof life" gradually enlightened to me by the DDS' (now fmr) tech during the 2nd and 3rd of 6 unfortunately progressive (required prepd) TXs. She is potentially and unpredictably explosive in manner and I dare not return to her. I could (and can) no longer tolerate her anger. While she has in fact thankfully fixed some mistakes via provisional teeth (which I pd an additional $1000 for) described as nec for healing; and 2 + 3 addl gingivectomies, I have by far found her to be the most difficult DDS to talk or work with.
It was then inferred I was lucky to have had her accept me as a PT and I should accept whatever results she felt were an improvement.
The results at my last appt were unexpected.* She angrily told me they were acceptable, not that bad, and any further charges were mine. Exhausted, I accepted crowns 8+9 with an uneven gum line and resolved to look elsewhere for help.
*#9 had a repeat gingv 1.28.9, but the new trainee tech put in a temp that was too high and the gum line stayed with it. #8 had a repeat gingv 12.30.8, and while the same tech put in a lower temp, and the gum line has stayed with that as well. The 2 crowns were to be made alike 1.28.9; however, the difference in the gum line is now 2mm.
I would like #s 8+9 to be more alike as they are together and right in front. #s 7+10 are not "perfect" and that is fine!
Ideally, I would like to have #9 removed PRN ONLY, shaved off minimally 1mm+ (which she refused to do prior to seating), wearing a temp or #9 as a temp while the gum line comes down per past experience, and then reseated. If it can be done w/o removal, that of course is preferable.
#8 has typically been the worst area for inflammation.
None of 7 8 9 or 10 has "relaxed" per DDS' prediction.
She also has refused to address the length of all crowns, saying flatly she does not want to consider it as she likes them cosmetically as is. That's the least of probs.
I once had a DDS tell me the earlier the better for saving a crown. These 2 are still a little loose. I would prefer to work w/the crowns I have; they are well made. (I have also pd for this wk twice.)
Please help me. Is there anything I can, should or should not do while I try to find a DDS who w/wk w/this mess? I feel time is of the essence while these crowns are relatively newly done.
Thanks so much!!

Hi NAM1,

I've read your post a few times and to be honest, I am having a hard time understanding some of it. Obviously, you have some dental anxiety which is very common. You have had some very unpleasant dental experieces with difficult dentists and also believe to have had some poor dentistry not just once but several times. Is all that right so far?

I would like to try to help you, if I can, but I have a few questions first.

1) What do you mean by a DM patient?

2) Why were your 4 front teeth bonded in the first place? Had they been broken or decayed? Had they been root canaled in the past? Was the bonding done strictly for cosmetic purposes?

3) Why all the repeated gingivectomies? Did the gum tissue keep growing back? Do you have a problem with overgrowth of gum tissue due to medications?

4) Do you have periodontal disease? How is the health of the rest of your teeth?

I know this has been very difficult for you and I can hear your frustrations about the way you have been treated. It sounds like some "major" dental issues have been created by dentists who either performed poor qualtity dentistry and/or by dentists who in trying to remedy what someone else had done, messed it up or were still unable to help you achieve the proper esthetic look you were hoping for.

Before I offer you any of my personal insight into this situation, I really would need the answers to the above questions. I know you want to express how negatively you have been treated and I agree that you should not hold that in. But if possible, until we get a clearer picture of what is going on, please try to limit the personal stuff about the dentists because in this type of forum, it can be bit distracting from the pertinent issues which are your teeth. Ok...... ~'.'~

Look forward to hearing back from you........

Bryanna

Hi Bryanna
Thanks so much for replying. I SO appreciate your help.
Sorry for the confusion. My situation is quite complex; and I can well understand why you would be confused. I think my prev icon may have indicated I am confused, as well as unhappy and frustrated! I appreciate your patience, and I will answer as clearly as I can below to your corresponding questions:

Hi NAM1,

I understand that you are scared and worried. From what you have described, your dental issues are indeed complex and I think there is more to the situation than maybe you even realize.

To begin with, having diabetes especially uncontrolled, puts you in a high risk category for periodontal disease because diabetes impairs the white blood cells which are the main defense against bacterial infections. Periodontal disease is a bacterial infection. Chronic or uncontrolled periodontal disease causes bone loss. Also, healing from gum surgery may be compromised due to limited blood flow to the surgical areas.

Were all of these dentists aware of your diabetes prior to the dental work? It is risky for someone with uncontrolled diabetes to have elective gum surgery, never mind repeated ginigivectomies. I find it beyond comprehension that your dentists performed this surgery on you repeated times.

It is possible that the gum tissue just never healed properly since the first ginigvectomy was done and subsequently there after. The reason for this could be due to your diabetes and not the actual procedure itself. As far as the dentist leaving cord underneath the gum tissue for approx 11 months.... if that were the case, you most likely would have developed a severe, painful bacterial infection in those areas. The inflammation would have been severe and infection would have set in very quickly. So I'm not sure what the dentist thought he pulled out of there, but I highly doubt it was the cord used in the preparation of your crowns or bonding.

You wrote that #9 has been root canaled. Root canaled teeth harbor alot of bacteria in them which can spread from that tooth through the bone to the adjacent teeth. This is commonly seen in the upper front teeth due to vascularity and the thin bone in that area of the mouth. This could be another reason why the gum tissue over 8 and 9 never seems to heal properly.

My suggestion to you would be to avoid any further gum surgeries. The healing of the gum tissue is compromised because of your uncontrolled diabetes and you may never get the results you are hoping for. Perhaps even worse, it is a health risk for you every time you go through the healing process from the surgery. Unless your teeth are broken down, avoid any additional crowns or bridges because they tend to irritate the gum tissue and can be more difficult to keep clean. It is imperative that your plaque level be at a minimum to avoid the progression of the periodontal disease.

There is much literature linking uncontrolled diabetes to poor oral health and vise versa. Studies show that if one of these conditions can be brought under control, the other one is more likely to do the same with proper care and nutrition.

I know you are trying to achieve a certain esthetic look with your teeth, but perhaps you should consider a more conservative approach and seek a dentist who can achieve good esthetic results without surgerizing your gums or reducing your bone any further.

I often refer people to the website IAOMT.org because the dentists and doctors who partake in this worldly organization are more inclined to think outside of the traditional box and because of that, they see the cases that no one else sees.

I really don't think I can be of any other help to you due to the fact that we are in cyberspace and your situation is very complex both dentally and physically.

We are always hear to listen and offer whatever guidance we can.......... please keep us informed on how things are going.

All the best to you...
Bryanna

Hi Bryanna,

Thans so much for your reply. You are so right abt risk factors. I too have realized over the past 3 yrs how much repeat surgeries have been compromising my health.

Yes, all these Drs were very much aware of my medical and dental histories. I made it clear up front, esp since I have found an understandable gen reluctance to wk w/diabetics and compromised health issues.

There was some disc bt Dr H and her tech re whether the material found was actually cords. They disagreed; Dr H said cords while the tech thot stitches. The areas where the material was left were 8+10. #8 was by far the worst for inflammation.

There was no infectn per Dr H. She felt "provisional" (low fitting pre temp crowns) nec to reduce the severe inflammn in bt her 2 gingivectomies. She would not really elaborate on why she felt the 1st ging was nec other than "baby steps" to "just heal" the "train wreck" due to prev repeat trauma.

She had refused to rewk the crown for #9 herself, insisting another ging was instead nec when this crown was too pointed and the others were not. The gum height was not too high then. It now is. I elected not to cont w/her inc reasons previously discussed.

I am definitely not :-( wanting to have more surgery or bone reductn. What I had initially described in my 1st post was finding a qualified DDS to reduce crown #9 @ gum line to achieve a more balanced look for the 2 teeth in front.

That's my immediate goal while the crowns are still relatively new. Do you feel this is poss?

While the initial goal was for 6 front teeth tb balanced, I have given up on that. Any bridgewk I am considering is to replace old bridges while I still have insurance.

One would be to replace a bridge that inc #11 in lieu of a gum graft which Dr G has offered to redo in order to fix his error during his ging. Because of the error, #11 now shows the tooth underneath the tooth beginning that bridge. Quite honestly, not only do I not want more surgery, I'm not sure he can really do it and am apprehensive abt further error.

I do understand we r in cyberspace + your help is therefore limited w/a complex issue. I have prev been to the IAOMT site + found little real help there other than 3 names. Any receptionist feels their DDS is great.

Perhaps I don't know the correct Qs to ask. Can U help there? Since all the DDSs I have been to ALL have diff opinions I don't know whom to trust or turn to.

Any further suggestions you can offer re the above crown reduction Q + finding a DDS qualified to handle such a complex issue are greatly appreciated.

I hate to give up just (or esp) because I'm diabetic.

Thanks!
NAM

Hi NAM,

I wish there was some way I could convey to you how sincerely your situation touches my heart. I know your story well.... I've seen it too many times. The fact may be that you've had too much dentistry in the upper anterior of your mouth...... meaning the natural contour and integrity of the bone and gum tissue may at this point be compromised to the point that further gum and/or bone reduction could cause you to lose your teeth. This is the major concern that I have bases on the story that you have shared with us here.

I have copied and pasted some of your post, it is in the << brackets>>. My reply will be in CAPS.


<<Yes, all these Drs were very much aware of my medical and dental histories. I made it clear up front, esp since I have found an understandable gen reluctance to wk w/diabetics and compromised health issues>>. DENTISTS WOULD NOT BE RELUCTANT TO WORK WITH DIABETICS OR ANY OTHER COMPROMISED PATIENTS IF THEY HAD MEDICAL TRAINING. BUT DENTISTS ARE TAUGHT TO BE TOOTH CARPENTERS, NOT DOCTORS. UNLESS THEY EDUCATE THEMSELVES IN MEDICINE AFTER DENTAL SCHOOL, THEY UNFORTUNATELY KNOW LITTLE TO NOTHING ABOUT HEALTH ISSUES. MANY OF THEM DON'T THINK ABOUT THE CONSEQUENCES AND THEY JUST TREAT THESE PATIENTS LIKE ANYONE ELSE NOT TAKING INTO CONSIDERATION THAT THE TREATMENT OUTCOME MAY BE COMPROMISED. SOME DENTISTS ARE WISE ENOUGH TO REALIZE THAT THEIR LACK OF KNOWLEDGE ABOUT MEDICAL PROBLEMS SHOULD MAKE THEM RECONSIDER TAKING ON A PATIENT WHO FOR INSTANCE IS AN UNCONTROLLED DIABETIC.

Is this lack of knowledge fair to the public?? Absolutely not! Everyone has a right to proper dental care but how does someone in your shoes know where to obtain that? As you well know......... 10 different dentists looking at the same issue = 10 different opinions. How can that be????? I'll be damned if I know.

<<There was some disc bt Dr H and her tech re whether the material found was actually cords. They disagreed; Dr H said cords while the tech thot stitches. The areas where the material was left were 8+10. #8 was by far the worst for inflammation.>> IT IS POSSIBLE THAT THEY FOUND REMNANTS OF CORD UNDER THE GUM LINE SIMILAR TO TINY FIBERS. BUT NOT THE ACTUAL WHOLE PIECE OF CORD THAT WAS USED. SUTURES THAT ARE NOT DISSOLVABLE WILL GENERALLY DISINTEGRATE OVER A SHORT PERIOD OF TIME. UNLESS SOMETHING IN YOUR SALIVA PREVENTED THAT FROM OCCURING..... I GUESS ANYTHING IS POSSIBLE. THE ISSUE IS WHATEVER IT WAS, DID NOT BELONG THERE AND ITS PRESENCE INDICATES POOR DENTISTRY.

<<There was no infectn per Dr H. She felt "provisional" (low fitting pre temp crowns) nec to reduce the severe inflammn in bt her 2 gingivectomies. She would not really elaborate on why she felt the 1st ging was nec other than "baby steps" to "just heal" the "train wreck" due to prev repeat trauma.>> THE LOW FITTING PROVISIONALS WERE PLACED TO ENCOURAGE THE GUM TISSUE TO HEAL WITHOUT ANYTHING IRRITATING IT. THESE TEMPS SHOULD ONLY BE WORN FOR A SHORT TIME BECAUSE THERE IS USUALLY SOME ROOT EXPOSURE NEAR THE GUMLINE THAT IS NOW VULNERABLE TO DECAY OR INFECTION. THERE ARE TIMES THAT THE GUM TISSUE NEEDS TO BE "ROUGHED UP" FOR LACK OF A BETTER TERM TO ENCOURAGE THE IMMUNE SYSTEM TO COME TO THE RESCUE AND HEAL IT FROM A PREVIOUS INJURY OR TRAUMA.

<<She had refused to rewk the crown for #9 herself, insisting another ging was instead nec when this crown was too pointed and the others were not. The gum height was not too high then. It now is. I elected not to cont w/her inc reasons previously discussed.>> THIS SOUNDS TO ME LIKE SHE FELT THE CROWN ON #9 WAS NOT FITTING PROPERLY AND TO TRY AND ADJUST IT WOULD RUIN THE INTEGRITY OF THE CROWN. THE SECOND GINGIVECTOMY OBVIOUSLY HEIGHTENED THE GUM TISSUE TO MUCH.

<<I am definitely not :-( wanting to have more surgery or bone reductn. What I had initially described in my 1st post was finding a qualified DDS to reduce crown #9 @ gum line to achieve a more balanced look for the 2 teeth in front. That's my immediate goal while the crowns are still relatively new. Do you feel this is poss?>> I PERSONALLY FEEL THAT THE HEIGHT OF THE GUM LINE ON #9 IS NOT GOING TO CHANGE FOR THE BETTER IRRELEVANT OF WHAT IS DONE TO IT. COULD THE CROWN LOOK ESTHETICALLY BETTER? WITHOUT SEEING WHAT IT LOOKS LIKE, I REALLY CAN NOT COMMENT ON THAT.

<<While the initial goal was for 6 front teeth tb balanced, I have given up on that. Any bridgewk I am considering is to replace old bridges while I still have insurance.>> SOME THINGS THAT COME TO MIND WITH YOUR CROWNS AND BRIDGEWORK ....... ARE THEY PORCELAIN FUSED TO METAL? IF SO, IS THE METAL A HIGH NOBLE OR JUST A MIXTURE OF LESS NOBLE METALS? DO YOU HAVE ANY ALLERGIES OR SENSITIVITIES TO METAL IN JEWLERY THAT YOU KNOW OF? FREQUENTLY, PEOPLE ARE SENSITIVE TO THE MATERIALS/METALS THAT ARE USED IN DENTISTRY AND THEY CAUSE A NEGATIVE REACTION IN THE GUM TISSUE LIKE CHRONIC IRRITATION, INFLAMMATION OR RECESSION WHERE THE GUM TISSUE ACTUALLY PULLS AWAY FROM THE OFFENDING MATERIAL OR METAL. HAS ANY OF THAT EVER BEEN DISCUSSED WITH YOU? THERE ARE NON METAL, PORCELAIN TYPE MATERIALS THAT ARE CONSIDERED BIOCOMPATIBLE THAT ARE BETTER TOLERATED BY MOST PEOPLE. CROWNS, BRIDGES, AND PARTIAL DENTURES CAN BE MADE FROM THESE MATERIALS AND THEY LOOK GREAT AND WEAR TERRIFIC.

<<One would be to replace a bridge that inc #11 in lieu of a gum graft which Dr G has offered to redo in order to fix his error during his ging. Because of the error, #11 now shows the tooth underneath the tooth beginning that bridge. Quite honestly, not only do I not want more surgery, I'm not sure he can really do it and am apprehensive abt further error.>> SO DR G REMOVED TOO MUCH TISSUE IN DOING THE GINGIVECTOMY ON #11 SITE. IS THERE ANY WAY HE COULD PLACE A COMPOSITE MATERIAL AT THE RECESSION SITE INSTEAD OF REDOING THE ENTIRE BRIDGE?

<<I do understand we r in cyberspace + your help is therefore limited w/a complex issue. I have prev been to the IAOMT site + found little real help there other than 3 names. Any receptionist feels their DDS is great.>> THE IAOMT SITE IS LACKING ALOT OF HELPFUL GUIDANCE, I AGREE WITH YOU. THE REASON FOR THAT IS BECAUSE THE BIG DENTAL ORGANIZATIONS WOULD TRY TO SHUT THEM DOWN IF THEY WENT AGAINST THE TIDE TOO MUCH....... POLITICAL NONSENSE COMPLETELY. IT IS TRUE THAT MOST RECEPTIONISTS WILL TELL A CALLER THAT THEIR DOCTOR IS THE BEST..... WHEN IN REALITY THEY KNOW LITTLE TO NOTHING ABOUT HIS TOOTH CARPENTRY SKILLS!! AGAIN, HOW DOES THAT GET CHANGED..... I WISH I KNEW!

<<Perhaps I don't know the correct Qs to ask. Can U help there? Since all the DDSs I have been to ALL have diff opinions I don't know whom to trust or turn to.>> YOU ARE IN A SITUATION WHERE YOU HAVE TO FIND SOMEONE TO TRUST. THE ONLY THING I CAN TELL YOU IS TO ASK FOR ALL OF YOUR OPTIONS. MAKE YOURSELF CLEAR IN THAT YOU PREFER THE LEAST INVASIVE MEANS POSSIBLE. ANY NEW DENTIST IS GOING TO BE ABLE TO SEE WHAT YOUR DENTAL PROBLEMS ARE WITHOUT YOU REHASHING ALL THAT YOU HAVE BEEN THROUGH. I WOULD BE VERY PRECISE AND TO THE POINT..... AN EXAMPLE.... I'VE HAD X NUMBER OF GINGIVECTOMIES ON TEETH 3'S X,X,X. BONE REDUCTION ON TEETH #'S X,X,X. THIS IS MY # SET OF CROWNS WHICH INCLUDE PROVISIONALS. I AM TRYING TO ACHIEVE XXX.

<<Any further suggestions you can offer re the above crown reduction Q + finding a DDS qualified to handle such a complex issue are greatly appreciated.>> WHEN PATIENTS LIKE YOURSELF COME INTO AN OFFICE AS A NEW PATIENT, THEY HAVE ALOT TO TELL THE NEW GUY AND UNFORTUNATELY, THE DENTIST GETS HUNG UP IN THE "STORY" AND "DRAMA" OF THE SITUATION. THEY BECOME RELUCTANT TO DEAL WITH PEOPLE WHO COME IN WITH BAGGAGE BECAUSE THEY ARE AFRAID THEY WILL BECOME A PIECE OF THE LUGGAGE. THIS IS NOT MEANT TO SAY THAT YOUR BAGGAGE ISN'T REAL BECAUSE IT IS MOST DEFINITELY!! HOWEVER, TRY TO LEAVE ALOT OF IT BEHIND AND STICK TO THE PRESENT SITUATION SO THE NEW GUY CAN FOCUS ON YOUR DENTAL PROBLEM AND NOT YOUR BAGGAGE PROBLEM. DOES THAT MAKE SENSE TO YOU? I'M TELLING YOU THIS FROM LOOKING AT PATIENTS FROM THE OTHER SIDE OF THE CHAIR..... OK??

Where to look for a qualified dentist? Oh I really wish I knew! Word of mouth, family, your doctor's office??

Please keep in touch............... I wish you all the best!!!!!!

Bryanna




I hate to give up just (or esp) because I'm diabetic.

Thanks!
NAM