Bryanna - MrsD Suggested I Post
 

Bryanna,
I've been a member and posting for a few years, over at the PN forum.
MrsD suggested I ask you about this.
This was my post on the PN forum:

Tooth Loss from Meds?
Lately I've been having dental problems. My teeth seem to be healthy (not weak-walled or cavities) but at least 4 have come very loose in the past 10 months, and had to be extracted.
I currently have another loose one, that will be extracted next week.
My dentist has referred me to a periodontist for further treatment & I'll be seeing him the 2nd week of March.
I had severe perio problems (bone loss) about 10 yrs ago and had an extreme amount of work (some below gum-line, bone-grafts) done (about $ 6-8K), but every tooth that was worked on then, no longer is in my mouth - money down the toilet.
I'm not looking forward to another perio round.

Could this recent tooth loss problem, be due to calcium loss from the medications I'm taking? I recently saw a post here, that mentioned something of that sort, while discussing another topic.

I've been on 4200mgs/day Neurontin for 6 years, then switched to 600mgs/day of Lyrica, in the past 3 years.

I also take Tramadol, Zetia, & Terazosin.
I haven't taken any calcium supplements other than a multi vit.

Could this tooth loss be related to my meds?

Would you know anything about this?
any input would be appreciated
Thanks

Hi Bob,

I read your post and don't have enough time right now to properly respond. I will get back to you tomorrow....ok?

Bryanna

Hi Bob,

Periodontal disease is a progressive infection of the jawbone that causes severe bone loss and loosening of the teeth. There is a misconception that invasive periodontal surgery stops the progression of the disease. The problem lies with the build up of plaque along the gumline which irritates the gum tissue creating openings between the gum and tooth. The plaque seeps down into these openings and becomes infected. The infection has a variety of staph bacteria which destroy the jawbone. The teeth become loose as the bone deteriorates. This bacteria also enters the bloodstream continuously through the blood vessels in the mouth that travel to all of the major organs. It sounds to me like your periodontal disease may not have ever completely cleared up and has just gotten progessively worse over time.

In addition to the periodontal disease, any chronic illness will weaken the immune system making the perio disease more progressive and more difficult to keep at bay. Medication is also a big contrbuting factor to perio disease because it too burdens the immune system and creates an unfavorable condition in the mouth by supressing the flow of saliva. Our mouths have a built in cleaning system called saliva. Without it a condition called xerostomia.... or dry mouth occurs making us more susceptible to tooth decay and/or gum disease. Medications can also cause depletion in certain vitamins and minerals, calcium being just one of them.

I would suggest that before you undergo any periodontal treatment, that you speak with your physician and dentist about your medical and medicine history and how it relates to your oral health. Find out from the periodontist "what the factual long term prognosis is of your remaining teeth if you did have perio treatment and what type of maintenance would be involved in keeping the bacteria from progressing in the near future?" If he says your condition is severe, guarded, or hopeless, then it may not be worth going through the treatment only to lose the teeth soon anyway. One aspect that needs to be seriously considered is how this chronic infection is affecting your overall health.

I'm sorry this is not good news to hear :( I see alot of patients who have undergone various types of periodontal procedures in an attempt to halt the progression of the disease. It is difficult if not unrealistic to get a hold of the disease if there are too many other unhealthy contributing factors. It concerns me when people put themselves through these procedures when the long term outlook is very weak. So it's wise to find out what stage your gum disease has progressed to and if it has affected all of your teeth. Take those answers into consideration with your overall health, meds, lifestyle... and make the decision that is best suited for you.

Please let us know how things are going........ and always feel free to come back here and ask questions or discuss your concerns with us !

Bryanna

Bryanna,
Thank you - I'll see what the initial perio exam conclusion is.
My previous perio work was done at The U. of Maryland
School of Dentistry- Periodontics Faculty Practice. None of the docs who treated me then, are there now, & that's the reason I didn't go back. My family dentist is not a great diagnostician. He's good at cleaning and extracting, fillings & such, but when I went to him for the first time about a year ago (as a referral from my barber when I initially had severe tooth pain & loosening))
He's been treating symptoms, not my overall mouth health. (he's never even taken full x-rays of my entire mouth, just problem, areas) I think I need to have this perio evaluation. i have an appt with my PCP for my Welcome to Medicare physical at the end of March - so things will be discussed with her then.
I never thought about discussing dental or oral health with her.
I assumed she'd just say for me to see my dentist.

Hi Bob,

It is imperative for your physician to be aware of your dental health... especially since you have periodontal disease. It is unfortunate that too many phyisicians have no clue about oral health and generally shrug off the conversation. With that said, it is up to you to voice a concern about the infection aspect of your perio disease and how it can negatively affect your overall well being AND how your meds may be contributing to your dental problems as well. Chances are your MD will not have any helpful input but it is still important for your concerns to be noted in your chart. And who knows, perhaps it will enlighten her to be more interested in the dental aspect of her patients in the future?

It is a shame that your dentist is not treating you properly. Without diagnostic xrays, it is impossible to know the extent of your condition and based on what you have written here..... it has gotten worse under his care. Is he the one who has referred you to the periodontist??

I really urge you to not go along with any perio treatment until you feel you have been thoroughly informed of all your treatment options. Periodontal treatment stirs up alot of bacteria and if the condition is severe, hopeless or guarded, this bacteria will not be brought under control. When that is the case, there is nothing positive to be gained by having the treatment as it can actually lead or contribute to systemic infections. Sometimes it is wiser and healthier, to remove the teeth because then the bacteria will be eliminated which is better for your overall well being. I'm just putting this information out there to you because I'm not sure you will be given all of the facts.

Hopefully your condition will not be so severe...... please keep us posted :)

Bryanna

Bryanna,
My dentist is the one who referred me to the periodontist, after I told him that I had had perio treatment, and bone grafts 10 yrs ago at the Faculty Practice at U of MD.:confused:
He's just been pulling my teeth (about 6 of them) in the past year.
I went to him because he's located just a few blocks from my home, and was recommended by my barber when I had 2 teeth paining me severely. He suggested partials, as I had other teeth that had been pulled over the years, and the 2 uppers he took were in the back, leaving me little to chew with. He made molds and had flexible partials made for me :rolleyes:
I hadn't been to a dentist in at last 5 years and mine had moved away to another city (Annapolis MD). I live in Baltimore and didn't have a dentist since he moved his practice.:eek:
While in Ireland this past June, 2 front bottom teeth were bothering me (in the front this time) and I was forced to go to a dental clinic in Galway. They splinted the teeth and gave me an Rx for antibiotics to see me thru until I got back to the states. when I came back, my dentist pulled them and my plates went out to have 2 teeth added.
Around the Holidays an upper behind the canine was sore & loose & he pulled that one - plate went out to have another added.:(
Now I have another upper on the opposite side (also behind the canine) that is sore and loose. He sent my plate out to have another added, and will pul this one as sooon as the palte comes back from the lab, one day next week.:mad:
His procedure is to pull the tooth and then puts the plate in, immediately - rather than packing the socket with gauze. Its been a successful procedure the last 2 times, as I'm a smoker (I know- I gotta quit - SOON, its given me emphysema... I've just found out in tha past 60 days) and it protects the socket. I cut down on my cigarettes & leave it in for at least 24-48 hrs and eat soft foods for 2 days.
But he's not shown any desire to treat the cause - just has said that I have to see a periodontist again. :(
I didn't know of any, so he gave me a business card for the one that I've made an initial consult appt. on 3/10.
You may be right. further perio work might be useless and I'd be better off having done with it. After this extraction next week. I'll only have 8 uppers left of my own. The bottom plate replaces 5,.
I'm not insured for dental (altho I could try to bide-my-time & wait until next Dec to sign up for Medicare supplemental & dental) and am not in a position to rape my retirement fund for thousands that would be just throwing money down the tubes. It might be more economical not to go to expensive, extensive perio work and just get full dentures (and all that implies). Implants are financially out of my league. :eek:
(And I don't wish to do 'Gabby Hayes' impressions :cool:
no teeth, no plates, just gums :()

Sorry for the long post, but I haven't discussed this with anyone, and as I typed, it just became "War & Peace". Just venting, I guess - losing any teeth is a very personal issue with me and a little upsetting, if not a bit traumatic. Losing these many in a short period is unsettling, to say the least. :confused::rolleyes::cool:

Hi Bob,

Thanks for explaining your dental history in detail. It is pretty much as I had suspected it to be. The periodontal treatment that you had several years ago may have been of some help, but only temporarily because of the lack of dental care in the years afterwards to help maintain some stability. Your smoking habit also impeded the healing process which made the surgery only somewhat successful if at all. Perhaps you should have been better informed at that time of what the outcome would be if you didn't have continued dental care and kept smoking. More times than not this information is not presented too well by the dentist or his staff and the patient leaves thinking they're situation has been cured.

Your description of how your dentist has been treating you is very typical when a patient is reluctant to loose their teeth to a denture. This does not mean that there are any healthy teeth worth keeping, it's just a way to pacify the patient for a very limited time. The problem with this scenerio is that your perio disease is out of control which has caused your teeth and jawbone to become infected as well. This situation is not healthy and may be contributing to other health problems.

Again from your description of your dental and smoking history, any periodontal treatment that you have to retain your existing teeth is not going to cure your perio disease. I know the thought of losing your teeth is scary but you need to realize that you are hanging onto infected teeth that are going to affect your overall well being and you are going to lose them anyway. Since you are use to wearing a partial denture..... going into a full denture will not be much different.

I hope this information is helpful to you. Sometimes we need to re-evaluate what it is that we're holding onto...... because the alternative can often be more rewarding in the long run :)

Take care.... keep us posted!

Bryanna

Bryanna,
Thanks for your input. I'm not sure that its a hopeless case, yet -
but first things, first-I guess.
This problem tooth will come out, (as soon as my plate comes back from the lab with the added tooth)- one day this week..
Then I'll wait & see what the prognosis is, after the perio exam on 3/10. Not going to put 'the cart ...before the horse'.
Then I'll take it from there.

Hi Bob,

Of course it is wise to hear what the periodontist has to say. But just so you know, your case is very common. My concern with patients who have long term perio disease are what the systemic consequences could be. It is difficult for many people to associate their oral health with the rest of their body because that is not what we were taught by our dentist while growing up. Unfortunately the dental profession still often overlooks that connection and it is up to the patient to voice their concern about the subject.

That's really all I'm trying to make clear here.......
Please let us know what the dentist has to say!

Bryanna

I had my appt with the periodontist & he said that he could 'fix' the one problem quadrant (lower left) and hopefully save my molars and do a bone graft to build up where there is a deep pocket that is trapping food.
He's going to do laser surgery and a graft in 2 places.
($1450 after dental plan discount of $375).
I kinda felt that it was a rushed exam, but a thorough one,
and his practice is tightly timed.
I don't know if all periodontists are that tightly scheduled, but my wife says her dentist is always kinda rushed, too.
The general dentist that has been treating me isn't quite as hurried and is much more personable and friendly.
Hopefully after this perio has studied the x-rays (his asst. says he takes them home to have time to make notes), I'll have a better idea about the full mouth condition and the severity of the perio disease.
I'd have a lot more faith if this periodontist had a better 'chair-side manner' and been more personable, I might feel better about spending, what to me, is a sizable chunk of change.
Maybe the next visit will be more comprehensive,
but I'm scheduled for the surgery on the 25th.
If he says that a lot more needs to be done all over, I'm not so sure about throwing money down the tubes. I'd be better off saving it for a good set of full dentures.
At 65, saving teeth for a coupla years, only to loose them eventually- is an expense I cannot afford. I'll be dipping into my retirement fund for any and all of this dental work. I can't afford to retire, after the banking bust- gotta keep working to make ends meet ... and hopefully add to my retirement fund, not have to dip deep into it..

Hi Bob,

Well aside from his chairside manner and the money aspect...... did he discuss how smoking would affect the outcome of the bone grafting and perio surgery?

Your case is very typical as I have seen it many 100's of times working with a periodontist. There is no long term cure for your perio condition. The dentist is offering you a short term prognosis because he most likely feels that you are not willing or ready to remove your teeth. The fact that he did not give you the results of your exam regarding the rest of your mouth is in my opinion unacceptable. If you have advanced perio disease, which you do based on all that you have said, you cannot "fix" one portion of your mouth without addressing the others. The bacteria is rampant and to surgerize or treat one area when the others are infected also is not only useless but it is systemically unhealthy for the patient.

I agree with your statement....... it may be better to save that few thousand dollars to put towards full dentures.

Please think carefully about undergoing this perio treatment. In your case, it is not a long term "fix" by any means.

Bryanna

I don't know how this doc works, so I guess I'll have to go to the 2nd appt (for surgery) and see what he has to say after examining the x-rays about more areas to be addressed and the severity as well as prognosis. If he feels he can help in the other areas without serious surgery, but with scaling (or whatever they do to clean out pockets of infection) - I'll see.
I just have to wait until the 25th to get to talk to him about it.
I made an application for a no interest loan for dental work with Chase Health Advance (thru his office) and it was approved in 15 mins., so I don't have to shell all the cash out at once (12 mos @ approx.$125/mo for $1450 ), if I decide to have the work done. I'd like to hear what he has to say about what will be the best method of saving my teeth, permanently- if he can.

Bryanna,
I went to the periodontist on Weds. Discussion about the rest of my mouth was 'iffy'. He showed me the x-rays, but to tell you the truth, I couldn't really tell how severe the disease was, I had to take his word on it.
I had the surgery done on one quadrant. No laser, just dig and cut, & a lot of suturing.
His surgical assistant said he put 2 vials of graft material & an antibiotic treatment, in the void. It seemed to be large in her estimation.
He wants to do more surgery. I think he just wants to do surgeries ....to everyone !
I may be wrong, but when I said that I was looking to alternatives to surgery, he started a medical warning pitch about not wanting to loose the remaining teeth, especially the canines, as they help shape the face. I swear it was designed to scare me. When I was adamant about not being able to readily afford 2 more quadrants at $1500-1700 each, his hygienist popped in to say that they weren't there just to do surgery, but to help control my perio disease with other methods, as well. (I had to apply for no interest, 12 month loan, to afford this one surgery.)
I felt that she intervened, when his pitch wasn't working well on me.
I go back in 2 weeks for a follow up to the surgery, and will see how the appt goes and what the suggested ongoing treatment is.

Hi Bob,

Thanks for keeping us posted.

It sounds to me like your dentist is not willing to discuss treatment options. Perhaps the only option is removal of your teeth and you already stated that you don't want to do that.

I certainly do not think he should have told you that losing your teeth would mishapen your face. Although that is true with some people, that is not a valid or healthy reason to keep diseased teeth. I personally think he is taking heroic steps in doing this extensive surgery especically in a patient that smokes. Did he inform you of the shortcomings of this surgery or that it is most likely futile with a patient who smokes? I sure hope he did because this is alot for you to go through both physically and financially if he didn't.

I hope you are relatively comfortable and not in pain from the surgery. Please keep us posted on how things are going!

Bryanna




QUOTE=nide44;637031]Bryanna,
I went to the periodontist on Weds. Discussion about the rest of my mouth was 'iffy'. He showed me the x-rays, but to tell you the truth, I couldn't really tell how severe the disease was, I had to take his word on it.
I had the surgery done on one quadrant. No laser, just dig and cut, & a lot of suturing.
His surgical assistant said he put 2 vials of graft material & an antibiotic treatment, in the void. It seemed to be large in her estimation.
He wants to do more surgery. I think he just wants to do surgeries ....to everyone !
I may be wrong, but when I said that I was looking to alternatives to surgery, he started a medical warning pitch about not wanting to loose the remaining teeth, especially the canines, as they help shape the face. I swear it was designed to scare me. When I was adamant about not being able to readily afford 2 more quadrants at $1500-1700 each, his hygienist popped in to say that they weren't there just to do surgery, but to help control my perio disease with other methods, as well. (I had to apply for no interest, 12 month loan, to afford this one surgery.)
I felt that she intervened, when his pitch wasn't working well on me.
I go back in 2 weeks for a follow up to the surgery, and will see how the appt goes and what the suggested ongoing treatment is.[/QUOTE]

I hope it's ok to 'bug' in on this thread :o..... I know Bob from the PN forum... and wanted first, to voice my support.....I know this is a huge deal to you Bob, as we've shared briefly over on PN....

....and....to tip my hat to Bryanna :Tip-Hat: for all your knowledge and support you give....

I just HAD to quote what Bryanna said above and say 'BINGO' ! I'm a case-in-point on what you are saying there!
I had NOOoo idea that Dentistry and Medical Health issues were connected in any way.....I am probably the most dentally 'illiterate' person on earth :o And I actually put myself in a bind (and systemic infection risk) recently by not realizing this when I was getting a surgery procedure and dental work in the same time frame.... and I can't really point the blame to anybody but me, because I didn't really convey the two procedures to each of the professionals.....by "assuming" there was no real connection....
I wish more people could see that quote because it is so true!

Although my dental issues are somewhat different than Bob's, the 'chairside manner' he is receiving sounds just like mine (maybe we have the same perio's ? :p).....
It is SO frustrating to have to fork out so much $ and not really get much 'explanation' from the dentist! I had NO idea my family dentist was referring me to the Endo for a ROOT CANAL!.....He never TOLD me this!! The only way I found out exactly why I was being referred was because of the paperwork I got in the mail from the Endodontist's office giving me an 'estimate' on how much my 'Root Canal' was gonna cost. :eek:
It sure would have been nice for my dentist to have explained WHAT was going on in my mouth! And i (being naive with dental) didn't even have a clue what questions I should have been asking.

Also wanted to mention, Bob, that I myself think you are very wise in taking out that dental 'loan'.......even IF we were millionaires and could cough up the $ without thinking twice, I'm glad I opted for the same.....it made him and his office aware (up front) that I did NOT have this kind of $ laying around, so he ended up only doing the partial root canal, rather than seeing my mouth as some sort of gold mine....
there probably isn't really much of a connection there, but in MY mind, this is part of what I was perceiving....

Aneewayy, eviDENTALLY (pun get it :)) I needed to 'rant' a bit....
I apologize if this was inappropriate to jump on Bob's thread, but my intentions truly come from the heart and are meant as support....

Also, just wanted to thank you Bryanna for all you do, because there would still be many unanswered Q's in my mind because of being 'rushed' at the dentist's office. I tried looking stuff up online, but reading the posts you've shared with others here at NT pretty much filled in all the blanks....
and saved a BUNCH of confusion!

Good Luck, Bob :cool:......
I'll be praying for a good outcome with your appointments.

Rae

I didn't say that I didn't want to remove the diseased teeth, I probably would prefer that, to futile surgery & expense. I just don't want to rush in to a full removal and full dentures, yet- but that may be my best option in the future. He just seems to want to do surgery after surgery on 3/4 of my mouth. I get the impression that his practice is geared towards surgery and getting as much $$ as possible, as quickly as possible. A 'surgery mill'. He surely has his schedule available on just 1-2 weeks notice.

No, he hasn't said anything about shortcomings or smoking, except give me a paper for after surgery care, that says 'don't smoke'. He seems to spend as little time as possible and lets others rush me thru to the outer office to do the paperwork. I don't remember him saying much after the surgery at all - except that I might have pieces of the dressing feel gritty and become loose, but that was normal, he left the room fairly quickly after taking almost 1-1/2 hrs to do the surgery.
I'm thinking of maybe going back to the U. of MD dental school perio faculty practice, to get another point of view. I know they'll be honest and take time with me- they had before, about 10 yrs ago when I has my last bone graft surgeries.

At this point in time, not smoking is not feasible due to my addiction - I want to try to stop. I have an appt with my PCP on 3/30/10 to discuss how to get into a no smoking program and find out what she suggests
& what my options are. Chantix, patch, etc ???
As for this week, cold turkey is not an option after over 45 yrs of addiction.

Pain- well I took 2 of the hydrocodone on the first day, but can't deal with the constipation so I'm toughing it out. My jaw is sore and gives a sharp twinge now and then, but having PN has taught me how to cope with pain. I'm on a 14 day, 28 pill, 500mg tetracyclene regimen.

I go back in 2 weeks for a follow-up

Hi Bob,

Perhaps I should clarify.....I didn't say you wanted to keep diseased teeth...... I said you let it be known to the dentist that you didn't want to lose your teeth at this time. He may have sensed that you were resistant on hearing other options such as extractions/denture, I really don't know because I wasn't there.

Obviously the dentist has not informed you of the condition of your teeth as it relates to periodontal disease. Instead he scared you into thinking your face would become misshapen if you removed them. If he had been more informative with you, you may have reconsidered your options. But he obviously was not going to spend additional time with you explaining things for whatever reason. He also has not informed you of the contradictions with smoking and oral surgery. In my opinion, he has simply done as you asked....... not removed your teeth.

I personally am not an advocate of having extensive dental work done at a dental school. I have seen too many failures. But everyone has the right to make their own choice, I just hope it's an informed one.

Your quote: <<I'm thinking of maybe going back to the U. of MD dental school perio faculty practice, to get another point of view. I know they'll be honest and take time with me- they had before, about 10 yrs ago when I has my last bone graft surgeries.>> PROOF IN POINT... YOUR PERIO DISEASE WAS TREATED AGGRESSIVELY 10 YEARS AGO AND FROM EVERYTHING YOU HAVE STATED HERE, IT HAS ONLY GOTTEN PROGRESSIVELY WORSE SINCE THEN. THERE ARE MANY FACTORS THAT CONTRIBUTE TO PERIO DISEASE BUT THE TREATMENT TO BRING IT UNDER CONTROL IS ONLY THE BEGINNING OF WHAT IS REQUIRED FOR IT TO BE SUCCESSFUL. THE FOLLOWING IS IMPERATIVE: METICULOUS PERIODONTAL TREATMENT; METICULOUS ORAL HYGIENE AT HOME; FREQUENT DENTAL CLEANING VISITS FOR LIFE; CHANGE OF HABITS SUCH AS SMOKING AND DIET; AND EVEN IF ALL OF THIS IS BEING DONE.. YOUR OVERALL HEALTH INCLUDING MEDICATIONS WILL HAVE PROFOUND AFFECTS ON YOUR PERIO DISEASE.

My concern with your situation is this.... the aggressive treatment is not going to keep your teeth for long term given all of the other issues we've talked about. It just may be wise to reconsider what this disease is doing to your overall health and how truly futile this treatment most likely will be.

I truly wish you the best possible outcome! I wish there were more I could say to help you understand what your dentist is not telling you. But I do hope you manage to stop smoking.... at least that would be one good thing to come out of all of this!

Bryanna