?

Log in

No account? Create an account
 
 
29 July 2017 @ 08:40 am
Dentists' modus operandi  
About half a year ago my dentist told me that there is a decay below my tooth bridge. Therefore that the bridge needs to be re-done (at the cost of around $4,000). She insisted, that tooth decay is not reversible.
When I asked her if a tooth can heal itself - she said that it is possible, but only if decay did not reach below enamel.
In the following months I started to pay more attention to flossing and rinsing around that problem space, and yesterday went to another dentist for a cleanup and dental exam.

New dentist found decay below the bridge and recommended to replace it (at the cost of $4,814). He insisted, that tooth decay is not reversible. When I asked him if a tooth can heal itself - he said that it is possible, but only if decay did not reach below enamel.

The good news for me is that the new dentist did not find any problems with the bridge that my previous dentist wanted to re-do.
And my previous dentist did not find any significant problems with the bridge that the new dentist wants to fix.

In addition to replacing bridge, the new dentist suggested to pull my 4 wisdom teeth ($236 each) and re-do a filling ($350).

The question is - how do I know know what recommendation has a merit and what recommendation is just a money grab?

Originally posted at: http://dennisgorelik.dreamwidth.org/137270.html
 
 
 
krechkrech on January 6th, 2018 01:24 am (UTC)
>The question is - how do I know know what recommendation has a merit and what recommendation is just a money grab?

Try another one dentist?

>suggested to pull my 4 wisdom teeth ($236 each)

Price for removing seems more or less reasonable? Did medicare or something usually cover dantist's expenses?

BTW, as I read somewhere - modus operandi for 8th teeth in US - is just removing for everyone without doubts. Which is quite opposite to xUSSR, where third molars are removing only when they start to create a problems (This old approach may be was justified for times when life expectancy was less and stomatology have lack of equipment).

So, from this point - quite possible that dantist in US propose to remove 8th "just in case" because he used to do this - even if particular 8th teeth are grown normally and in right place.
But in cases if 8th teeth grown up screwed or not grown (through gum or bone) at all - then better to remove them preventively, because they can spoil or screw another tooth or even jaw.

There are some exceptions where 8th can be helpfull - like in case of absent 7th tooth, so 8th can carry bridge, and also move himself a bit into 7th place.
Also for few decades there was some more or less successful attempts to transplantate obsolete 8th into another place in mouth, instead of loosed tooth - but for now, as I understand, standard "neorganic" implantation technique seems more effective and reliable (May be you should consider implantation, instead remove-renew bridge?).

VALE.

Edited at 2018-01-06 02:14 am (UTC)
Dennis Gorelikdennisgorelik on January 6th, 2018 03:07 am (UTC)
> Try another one dentist?

That was another dentist already. Both dentists are eager to do something expensive and invasive in my mouth. They just differ

> Price for removing seems more or less reasonable?

The price for removal is reasonable, but removal recommendation itself does NOT seem reasonable.
If my wisdom teeth do not create problems for me - why should I remove them?

> stomatology

You probably meant "dentistry".
krechkrech on January 6th, 2018 01:21 pm (UTC)
>That was another dentist already.

I mean another one another one. Third. :)

>removal recommendation itself does NOT seem reasonable.

It is depends. If you third molars already grew normally and functionally, then dentist which suggest to pull them was probably wrong. But if they don't grew normally - then that dentist is probably right.

>If my wisdom teeth do not create problems for me - why should I remove them?

Yes, that was exactly my point - some time ago (I mean, I change my mind now).
If 8th teeth start create problems - it can be significant problems, not only for 8th, so risk/gain ratio doesn't seems good here.

Edited at 2018-01-06 01:22 pm (UTC)
Dennis Gorelikdennisgorelik on January 6th, 2018 08:03 pm (UTC)
My wisdom teeth do not create problems for me, so yes, that dentist's recommendation to remove my wisdom teeth is wrong.

Should that wrong recommendation be a good reason to leave that dentist?
krechkrech on January 7th, 2018 01:23 am (UTC)
> My wisdom teeth do not create problems for me

Look, it's not binary, like "create problems" or "not create problems".

It's also "may create problems in future", "certainly will create problems in future", and "already creating problems but user don't know it yet".

> that dentist's recommendation to remove my wisdom teeth is wrong. Should that wrong recommendation be a good reason to leave that dentist?

If you had enough space in mouth to place this teeth, and they all already grown healthy, without problems for another teeth, in right place and useful for chewing - then you lucky certainly shouldn't remove this teeth, and dentist made this suggestion to removing just by habit, working by hard template, which is bad sign for him, of course, and may be a good reason to try another one.

Otherwise - if not all with 8th teeth are perfect - then hard to tell for sure, was dentist right or wrong. There are small holy war between people who think that 8th need to be removed and people who think that 8th should stay.

VALE.

Edited at 2018-01-07 02:41 am (UTC)
krechkrech on January 7th, 2018 03:49 am (UTC)
"А теперь будут слайды!" (с)
Вот к примеру история болезни.

На снимке видны две восьмерки и две семерки с пломбами:
https://d.radikal.ru/d43/1801/5f/7a311039bfe4.jpg

Нижняя восьмерка начала прорезаться (с образованием "капюшона"), имеет по-видимому какое-то воспаление и в определенных условиях реагирует продолжительной болью, на смену температуры в частности.

За небольшое время до того как боль явным образом появилась - при механических воздействиях на соседнюю семёрку появилась быстро проходящая болезненность.
Очевидно оная болезненность могла быть вызвана либо какими-то проблемами с самой семеркой, либо влиянием воспаления на восьмерке, либо тем что восьмерка "подталкивает" семерку.

Причём диагностировать что именно болит было затруднительно, и дантист, исключив проблему с восьмым зубом, поставил диагноз пульпит на седьмом зубе - предложив вскрыть и запломбировать каналы. К счастью эти манипуляции проделаны не были, а в дальнейшем выяснилось что в основном болит именно восьмерка.

Таким образом, возможно, благодаря зубу мудрости дантистом могла быть депульпирована семерка без должных на то показаний, и возможно также что проблемы с семеркой - появились опять же благодаря зубу мудрости.

Снимок, что характерно, был сделан по поводу начинающегося пульпита в верхней дистопической восьмерке, которая хотя и была кариозной (ввиду её расположения зуб было затруднительно как чистить, так и лечить), но никаких проблем (в смысле боли и т.д.) ранее не доставляла. А затем за полтора-два дня она перешла от "побаливания" до исключительно сильной боли, так что её пришлось экстренно удалять. И, опять же, было затруднительно определить источник болей, так что мог бы быть ошибочно вскрыт и соседний зуб.

Но и это ещё не всё. Предположим, что не было бы ни пульпита на верхней восьмерке, ни капюшона с воспалением на нижней, и нижняя восьмерка спокойно росла бы под чуть другим углом, чуть ниже, не прорезаясь.
В этом случае при внешних признаках благополучия могла бы произойти другая относительно распространенная ситуация:
http://www.voka-stom.ru/sites/default/files/images/services/16/10/services-984.jpg

И эта проблема могла бы выявиться когда соседний зуб уже был бы необратимо поврежден.

P.S.
Ну а вообще ещё самое разное от зубов мудрости бывает, от проблем с прикусом (что звучит не слишком серьезно, но может создать серьезные проблемы для здоровья зубов) до перелома челюсти в результате появления фолликулярной кисты.

В общем думаю ясно на какой стороне баррикад я нахожусь в вопросе "удалять ли зубы мудрости" :))

Будь здоров.

Edited at 2018-01-07 03:51 am (UTC)
Dennis Gorelikdennisgorelik on January 7th, 2018 04:23 am (UTC)
Re: "А теперь будут слайды!" (с)
Описанные тобой проблемы прекрасно предотвращаются регулярными рентгеновскими снимками (раз в год).
Если зуб мудрости вредит - его, действительно, лучше удалить.
krechkrech on January 7th, 2018 02:02 pm (UTC)
Re: "А теперь будут слайды!" (с)
> Если зуб мудрости вредит - его, действительно, лучше удалить.

Я лично склонен считать что его лучше удалить _до_ того как он начал вредить.

В целом мой заход был на тему того, что проблем может не быть, а потом они раз - и появились.

Регулярные снимки, безусловно, позволили бы предотвратить значительную часть осложнений, связанных с зубами мудрости. Правда, там могут быть нюансы на тему того, насколько быстро развиваются эти осложнения, и насчёт лучевой нагрузки тоже.
Dennis Gorelikdennisgorelik on January 7th, 2018 03:04 pm (UTC)
Re: "А теперь будут слайды!" (с)
Что такое "лучевая нагрузка"?
krechkrech on January 14th, 2018 05:15 pm (UTC)
Re: "А теперь будут слайды!" (с)
Количество поглощенного ионизирующего излучения.
Dennis Gorelikdennisgorelik on January 14th, 2018 05:34 pm (UTC)
Лучевая нагрузка
Если даже делать рентгеновские снимки раз в месяц, то лучевая нагрузка будет ничтожной в сравнении с фоновой лучевой нагрузкой, присутствующей везде.
krechkrech on January 7th, 2018 01:36 am (UTC)
> I mean another one another one. Third. :)

Предположим что у дантистов есть две условно конкурирующие потребности, первая - хорошо лечить людей, а вторая - загребать побольше денег, и из-за влияния "денежной" потребности дантисты (сознательно или нет) не всегда рекомендуют оптимальный план лечения.

Тогда чтобы получить более правильные рекомендации, следует каким-либо образом элиминировать или хотя бы уменьшить влияние финансовой потребности.

К примеру, можно спросить бесплатный совет в интернетах или у родственника-стоматолога, или попросить рекомендаций у платного врача, но так чтобы при этом его доход никак не зависел от того что он предложит. Допустим, прийти на платную консультацию/диагностику, чётко дав понять что лечение будет проходить в другой клинике.
Dennis Gorelikdennisgorelik on January 7th, 2018 01:59 am (UTC)
> дав понять что лечение будет проходить в другой клинике

Dentists frequently give a big discount to initial visit, so I feel awkward to tell dentist that I am not planning to use their clinic to apply their recommendation.
krechkrech on January 7th, 2018 02:48 am (UTC)
You can discuss this matter with him before visit, or give him extra bonus.
He can be flattered that he is so important diagnostician. :)

P.S.
Можно почти прямо объяснить - поменял стоматолога, не уверен правильные ли он даёт рекомендации. О вас слышал очень хорошие отзывы от своего друга, но живу от вас далеко и ездить не имею возможности. Хотелось бы получить однократную консультацию дабы убедиться в надежности нового стоматолога. Как-то так.

Edited at 2018-01-07 02:49 am (UTC)
Dennis Gorelikdennisgorelik on January 7th, 2018 03:10 am (UTC)
If I mention another dentist, then new dentist is likely to ask what problems previous dentist detected.

Then I would have to explain why I do not want to share that information in order to not contaminate new dentist diagnosis.

Isn't it better to just let new dentist do the diagnosis and compare it with diagnosis of the previous dentist?
krechkrech on January 7th, 2018 04:01 am (UTC)
> Isn't it better to just let new dentist do the diagnosis and compare it with diagnosis of the previous dentist?

But in this case new dentist probably gonna work from that modus operandi, which you want to avoid.
Dennis Gorelikdennisgorelik on January 7th, 2018 04:16 am (UTC)
Then I would have to avoid visiting that dentist.
I suspect that dentists are unlikely to change their modus operandi just for myself. I have to either take their service as is or leave it.
krechkrech on January 7th, 2018 02:13 pm (UTC)
Then you in square one - "how do I know know what recommendation has a merit and what recommendation is just a money grab?"

But I still suppose that dentists _could_ change recommendations (at least partially) depending of external circumstances. For example they can propose one treatment plan or another - depending of client wealth.

And, by the way - I suppose good doctor should explain they suggestions. Particularly dentist which proposed to remove 8th - should explain why he want to do it.
Dennis Gorelikdennisgorelik on January 7th, 2018 03:08 pm (UTC)
> dentists _could_ change recommendations

The goal is to get right recommendation in the first place.
If I cannot trust dentist's recommendation in the first place - this is already a loss, because I do not always know if dentist's recommendation has merit.

> good doctor should explain they suggestions

I agree.
Unfortunately this doctor quickly gave up when I challenged him with my questions, and instead of addressing my concerns resorted to "you do not have to do that - it is up to you".
krechkrech on January 14th, 2018 04:00 pm (UTC)
> The goal is to get right recommendation in the first place.
If I cannot trust dentist's recommendation in the first place - this is already a loss, because I do not always know if dentist's recommendation has merit.

Yes, but you need some tool to measuring some dentist. Which tool probably can be another dentist, with reduced "money's need".
Dennis Gorelikdennisgorelik on January 6th, 2018 03:11 am (UTC)
> Did medicare or something usually cover dantist's expenses?

Probably. At least some of expenses.
But I do not have Medicare at this time.
krechkrech on January 7th, 2018 01:40 am (UTC)
> I started to pay more attention to flossing and rinsing around that problem space

Возможно, для лучших результатов "регенерации" следует использовать какую-нибудь специальную зубную пасту (если та проблема находится всё ещё в обратимой стадии).
Dennis Gorelikdennisgorelik on January 7th, 2018 01:57 am (UTC)
I do not even know if I have any problem.
My teeth feel fine.

Tooth care related articles generally claim that toothpaste does not really matter, and the most important part is to just keep teeth clean by mechanical action (by toothbrush or floss).
krechkrech on January 7th, 2018 03:45 am (UTC)
Hm. I start thinking about electrical "sonic" toothbrush, suppose they clean more thoroughly.
Dennis Gorelikdennisgorelik on January 7th, 2018 04:17 am (UTC)
I already use electric toothbrush. And yes - it helps (either saves time or does it cleaner or both).
krechkrech on January 7th, 2018 01:56 pm (UTC)
Then I certainly should buy similar stuff. Sonic or not - that is the question.

Edited at 2018-01-07 02:13 pm (UTC)
Dennis Gorelikdennisgorelik on January 7th, 2018 03:17 pm (UTC)
"Sonic" toothbrush
My toothbrush name is "Philips Sonicare".
What does "sonic" mean and what is the significance of it?
krechkrech on January 14th, 2018 03:53 pm (UTC)
Re: "Sonic" toothbrush
Yes, your is sonic.

First electric toothbrush work principles was moving(rotating) or vibrating similar to hand toothbrush moving - just automated.

Sonic toothbrush do vibrations at more high "sonic" (about half kHz) frequency, and here appears some new effect(s), so cleaning become more meticulous.

My doubts here - sonic or not - because sonic is more expensive and also some people with sensitive teeth can feel significant discomfort caused by sonic toothbrush.

Btw, also exists ultra-sonic toothbrush, with some another effects of ultrasonic waves.