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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 27, 2012 - 07:27pm PT
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Tooth, Scott,
Much thanks for responding in detail per medical tourism.
Tooth,
No to the 5 bruxism therapies you outlined.
There was some mention of drug therapy by my restorative dentist and orthodontist, but not with much expectation of outcome.
I do a light active resistance jaw excercise and a jaw stretch.
Dr. Jim Beck. Copy.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 27, 2012 - 07:51pm PT
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Would you two Dentists please comment on the part of the OP dealing with Discount Dental PLans?
Do you guys contract with any of them?
BTW
The lay public aren't so aware of this, but prosthetic surgeries, hips for sure, require antibiotics be taken prior to any dental work, cleanings included, for 2 years following the surgery.
I am 2.5 months out from my second of bi-lateral hip resurfacing (3 months between them), so I would presume perio health to be doubly important for me, Yes?
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Karl Baba
Trad climber
Yosemite, Ca
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Nov 27, 2012 - 08:16pm PT
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ps. I hardly ever see a tooth that has been crowned in India that hasn't also been root canaled. Can anyone tell me why that is?
Because you don't see it unless there's a problem. It's like a judge saying he sees 95% guilty lawbreakers
What do you think makes USA trained dentists who go back to their homeland suddenly do such horrible work? It's sorta like the good cops, you don't hear abou them because nobody rants about them on the net.
Sure I'd prefer to get work done in the USA but spending 1000s of dollars would be a significant injury to my life. Lots of us climber dirtbags are like that so we have to strike a balance.
Peace
Karl
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micronut
Trad climber
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Nov 27, 2012 - 08:46pm PT
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Karl,
That's not exactly true, your comment about "Because we don't see it unless its a problem."
I agree with Tooth. I see hundreds of Indian patients annually for gum disease, we have a large Punjabi population here in Central California. They come to see me for gum disease primarily. If I were to go back and look through radiographs of the Indian patient population of mine, I would say that of teeth that have crowns done in India, 80% at a minimum also have a root canal. This is just a quick number after Tooth brought it up. But I've always wondered the same thing.
I looked at 20 patient records a few minutes ago and saw about a 90% correllation. Interesting. The bad part is that this seems to be an ethos in training in that part of the world, or in the business model sadly.
A good root canal, when indicated, can last a long long time if done properly, aseptically, with great barrier technique. If done poorly, often the case both here and abroad, it can weaken the tooth, introduce microfracturing, and increase the propensity of the crown/filling to "leak" or allow bacteria into the pulp, tooth and surrounding structures.
In my study sample, I totally agree that dentistry in India often, very often, is quite poor, including the overtreatment of many teeth with root canals that were not indicated.
It sounds like you have had good experiences there, and I'm stoked for you. I hope the work lasts a long time. Its a fascinating place and there are some good dentists there for sure. Last week, I had a physician from Delhi as a patient. Nice guy. Endocrinologist now here in Fresno. It was a painful talk to show him with new radiographs that he had a mouthful of terribly done dentistry in a nice practice in Delhi two years ago. about 10k worth of dentistry there. By a friend of his who was "as highly trained as they come" in his words. So, you gotta undertand where Tooth and I are coming from. I'd love to get an Angie's List of Delhi/Mexico City/Rio good dentists to refer folks to. It would be nice to know where the good ones are.
P.S. "What do you think makes USA trained dentists who go back to their homeland suddenly do such horrible work? It's sorta like the good cops, you don't hear abou them because nobody rants about them on the net."
Cost and accessibility to good materials. And greed sadly. It costs a lot to do good dentistry, many dentists, well trained or not, do crummy work because it takes a long time and costs a lot to do good work. So their ethic and traing take a back seat to making money. Sad but true.
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micronut
Trad climber
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Nov 27, 2012 - 08:58pm PT
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Tarbuster,
The only way one can work for the discount dental plans is to
1. Use cheap materials
2. Work really fast, cut corners on safety, cleanliness, and quality
3. Have low overhead in staff (pay low wages, occupy low rent, etc..)
4. Live very sparingly due to not earning much when the day is done.
Since most dentists refuse to do #4, they cut cost in the 1, 2, 3 range.
OR
They are new dentists with large debt and are glad to have any work at all and have not begun to live too extravagantly. This is good, but most grow out of it after a year, working for a clinic, with a boss who IS watching the bottom line.
I don't personally know many dentists who last long on those plans and eventually go through the process of painfully extricating themselves. It is a very poor business plan and one that is hard to recover from.
I personally do not work for any of these discount plans. I run a tight ship, do great quality work without compromising ethically or technically, live within my means and give a way a ton of pro bono dentistry to good, kind, grateful patients who are struggling financially. And I go to the poor and needy countries of the world to donate my time and God given talent when I can. That's the best I can do, but I'm proud of the work I do on both ends of the spectrum.
Stay away from the discount dental plans. They're a real scam. Save up for your dentistry the old fashioned way. It's not a great answer, I know, but it really is the best way.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 27, 2012 - 09:21pm PT
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Scott,
Bingo. Much as I suspected. Thanks.
Question please:
What exactly is the downside of false teeth? Ie. What's it like having severe bruxism and false teeth? Gum night guards upper and lower? If we (those of us with severe bruxism and all the attendant lifetime maintenance and extra financial burden) agree cut rate dentistry and medical tourism is a risk to the process of maintenance and long-term oral health and in turn come to a point in our lives where we simply cannot afford or save up for good work, is there any call for ripping out good teeth and going to dentures simply as a matter of expedience and necessity?
What's that trade-off look like in real time and real money?
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tooth
Trad climber
B.C.
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Nov 27, 2012 - 10:19pm PT
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Truthfully Karl, most of my patients are recall patients, an incredibly high percentage, including the patient whose x-rays I posted today. That means, I see them every 6 months for hygiene appointments and have radiographs of every tooth and have been caring for them for a couple years, unlike the judge who is comparable only to an emergency room doc or a hockey team dentist.
These aren't people coming in for a toothache. They also are choosing to ignore these teeth until they fall out.
I have just put 3 people in complete dentures because of situations like this, one was a 20 something year old female.
I do understand how dentistry is expensive, and how you say it does you harm. What I'm saying is that I deal with the long-term effects of the dental harm every day, and urge people to balance that harm which they cannot understand until they go through it with the current cost of treatment.
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tooth
Trad climber
B.C.
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Nov 27, 2012 - 10:45pm PT
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Tarbuster, they don't have discount dental plans in Canada thankfully - or a recession. I purchased a practice from a guy 3 years ago that was doing discount dentistry and committing insurance fraud. I refused to, and lost 1/3 of the patients within the first year. But now I enjoy doing the best dentistry I know how, and get to spend at least 1 weekend a month taking more classes to add more services for my patients or at least do the regular things better. It also means I identify more problems before they start and refer to specialists more.
In my practice we spend 30min-1hr on education with each new patient, that with the free toothbrushes etc. means that they should never have to get any more work done once we eliminate their disease processes. And the tools are free. Funny thing is, everyone pays for the expensive part, but fewer use the free tools we gave them to prevent more expense.
Bruxism. Basically it's all in your head. I'll see people with a terrible bite and they are fine, I could stick a rock in there and they will chew away just fine. Others are sensitive to teeth that are microns higher after a filling and grind away in a day until their tooth feels like it will fall out.
You are one of the grinders. You can't expect to stop your mind from squeezing your jaw entirely. There are many different ways to trick your mind or protect your teeth or botox your muscles.
False teeth and bruxism isn't a good idea because the bone that your teeth sit in is unique in that it needs something wiggling INSIDE it to keep it strong. SO when teeth are pulled out, the root no longer wiggles inside it, so the bone melts away. It melts even faster when you push on it. With a denture. Even faster if you are clenching on it with a denture. Once that bone is gone, you'll have a flat, flabby tissue surface to try and set a hard, plastic denture on and then somehow function with. It will basically be for looks at that point.
Which is why implants rock. They go inside the bone, wiggle, and the bone responds by staying bulked up.
I have a 60-year old patient whose bone on the jaw has melted away to the point that her jawbone nerve is sitting on top of her jaw bone, her denture sits on top of that, and when she bites, it pinches the nerve. Not very fun. She has no alveolar bone left. Her chin bone is as thick as a pencil. Life gets pretty short at that point since nutrition = milk shakes and pudding.
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John M
climber
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Nov 27, 2012 - 10:58pm PT
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And I go to the poor and needy countries of the world to donate my time and God given talent when I can.
Could we get Tarbusters body declared a third world disaster area and get him some real help? If his body were an automobile then I'm pretty certain that it would be covered under the lemon laws. :-)
And if anyone on this forum deserves help, then I believe that Tarbuster ranks high on that list. I haven't met him in person, but I have experienced how decent of a person he is as he helped me get my head screwed on a little bit straighter when I was in the midst of my own lemon body experience.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 27, 2012 - 11:33pm PT
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Tooth:
That about says it all; I needed a refresher on that cascade of problems. Thanks.
(I had forgotten the details but surely heard them in the mid-late 90s when I got started on straightening things out with my bite and gums).
I'm rather fond of chewing food and absorbing proper nutrition.
Those were very nice words John M thank you.
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fear
Ice climber
hartford, ct
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Nov 27, 2012 - 11:39pm PT
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Hey Tarbuster,
Are you just grinding at night or do you clench through the day too?
Definitely try the NTI if it's a night thing, essentially an way-overpriced twist on a rigid guard. I shattered two attempts but I know a couple people they worked magic for. Easy enough to try if you have the front teeth left to support it. And if it works... worth every penny.
There's all different kinds of grinding and multiple causes IMO. Mine is a violent gnashing just as I'm crossing over into deeper sleep. I've actually videotaped myself. It's creepy, almost seizure-like. Other folks gnaw away all night long with peaks during times of stress. Some people have jaw/TMJ problems and others like myself have no problems at all, aside from shattered/flat teeth...
I'm working on a making a guard that simply closes a switch under pressure and gives me a little feedback via a tone and now a vibration. I know... a strange hobby. Not much luck so far for me other than lost sleep but maybe it's something that would help others one day...
A good dentist or a good Oral surgeon is an extreme rarity these days. Any doctor for that matter. When you find one, you're going to pay for it. Trying to "dirtbag" it when it comes to your health as some have implied makes about as much sense as Chinese-made climbing ropes to me.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 27, 2012 - 11:48pm PT
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Good question fear.
My dentist and his assistant who does the adjustments to my night guard both say I grind during the day because of "keying" or lock and key or key holing or some such, which indicates sideways grinding and a forensic pattern if you will which shows up in the teeth.
I have never, ever found myself grinding during the day or even clenching. Keep in mind I'm a climber and fairly body aware and I just don't see how I would never at one point or another become aware of it happening.
That said, what I do at night is like a violent clacking. As I wrote upthread I can literally see hatchet marks in my upper splint (night guard) from my lower teeth hitting it while I'm asleep. If I take a nap I always put my splint in; if I forget, I can observe myself clicking my teeth together as I'm falling asleep.
I probably also grind and clench in my sleep, because when I awaken in the morning sometimes I'm holding onto the guard. Clenching.
I only became aware of it because my dentist described the motion and I started looking for it and my wife said she hears it if I fall asleep first. I first heard about this one was 12 years old, but, that being 1972 the dentists apparently didn't really have a program for me and I didn't get re-apprised of the situation until in my 30s.
This thread has been very productive.
Thanks to all who have been participating!
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 27, 2012 - 11:54pm PT
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I have a sort of sad/funny story that goes along with my first understanding of periodontal disease in my mouth. I was born with fairly straight teeth and decent gums. Luckily my parents never had to pay an orthodontist for instance.
In my early 30s I was building a small business, working long hours with very low pay and skipped dental for a few years. When I went back in for a cleaning with a new dentist (I had moved to a new state), this young, very pretty, very polite hygienist started out on my teeth and was saying how good everything looked. Then she started doing the depth checks around my gum line and her mood went from bouncy and industrious to one of sad disappointment. It was like she was crushed from what she was learning about the truth of my condition.
The Perio disease was not patently obvious. I had no pain. But it was there all the same.
I felt bad for her. One moment she was merrily doing her job and the next moment she's witnessing a real health hazard in sore need of attendance. Obviously I knew I was in trouble.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 28, 2012 - 12:01am PT
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... I have even postulated to the many doctors I've seen that bruxism might be at the root of my ongoing arm problems but nobody bites on that one.
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tooth
Trad climber
B.C.
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Nov 28, 2012 - 12:11am PT
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Jim Beck talks about the arm connection. His exam includes watching you walk, doing parachute tests for balance/strength, how you hold your head, determining if the sutures in your skull are loose and pumping CSF or jammed together from excessive tension by your temporalis/masseter muscles, etc.
IT doesn't necessarily mean that your grinding/clenching is causing it, it can mean that you have tooth caused problems that radiate out and meet spinal or posture caused problems and between the two of them you haven't been able to solve anything.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 28, 2012 - 12:17am PT
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I saw an osteopath who did some craniosacral analysis on me, if that's what you mean by the sutures in the cranium, and said that the night guard wasn't good because it was like putting the gas and the brakes on at the same time per the natural flexion of the sutures (and their interactions with jaw muscles). I know that function is disputed. He wanted me to cut my night guard in half to allow for some natural flexion.
He said my spinal durum was as tense as any he had ever seen.
Of course my dentist said no way and stay way from that quack. From his perspective I understand it because the night guard is continually adjusted to take the strain away from areas where I tend to come down hard. It needs to have lateral torsion to do that job. (If I have that right?).
I went no further with that tact.
I've seen well over 30 doctors from many disciplines and never get any answers on my arm problems.
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Mighty Hiker
climber
Vancouver, B.C.
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Nov 28, 2012 - 12:19am PT
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Looking at the (sort of) bright side, tarbuster's posting again. Even if about challenges of another sort than his usual TRs.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 28, 2012 - 12:24am PT
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That won't last Anders.
Even with voice control software I still have to use my hands occasionally to do editing, corrections, and manually engage where it just won't work. It doesn't take long at all for that effort to kick out the pain in my radial tunnel or lateral epicondyle (bilateral). I stay away from computers, desk work, writing, cooking and cleaning up after meals, driving and other basic functions like that as much as is possible. I'm really in deep shitt over here.
These occasional trip reports wherein you see me actually climbing are not indicative of my daily experience. Short bursts of activity are okay but sustained fine motor skill activity is absolutely out. To attain any short burst of activity is like a hat trick for me: many days of rest on either side of an hour or two of activity. Believe it.
Maybe my expensive mouth is pointing back to my expensive arms.
Time for some expensive therapy with Dr. Jim Beck it seems. I am not being facetious.
This is not a culture or a planet wherein one can gamely retire at 47 years of age with no savings in hand. (I'm 52 now).
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Patrick Sawyer
climber
Originally California now Ireland
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Nov 28, 2012 - 06:51am PT
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Back in 1995 I had work done at the University of Pacific dental school in San Francisco (as my mom had retired and the onset of Alzheimer's).
The first student was a joker, so I insisted on another student, but they said since the treatments were free, I had no choice, but I stood my ground.
I was appointed to Charles H. (his father was a dentist my mom had worked with), he was first in his class at the time. Excellent, though while free, it's a pain to sit there with a dam on your mouth while the student waits for a professor/lecturer/supervisor dentist who may have at least several other students in line.
Same here at Dublin Dental School (part of Trinity College). Free, but long waits for both appointments and also sitting in the chair waiting for a dentist to come supervise the student's work. I had one root canal (endo) that took two students over two terms to finish (it had four canals and the supervising endodontis never showed up), and it is now bugging me and my dentist thinks I will lose it someday. Bummer.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 28, 2012 - 12:38pm PT
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Tooth:
I'm in touch with Dr. Jim Beck's office; spoke with his wife in detail.
They can't see me (are not taking new patients and the distance between would otherwise be a significant hardship for me (that is, beyond a couple of trips and they are not interested in doing just the workup). She's going to ask Jim to give me a reference in the Boulder Denver area.
Micronut:
As you suggested above, yes please read all of my individual posts and you will get a good sense of my history. I don't think there's much more to discuss however. Please e-mail me directly if you see anything out of sorts in what I've said about my condition and treatment history per se. My email is persona "at" interfold.net
 Thank you both for your professional opinions and attention.
My questions have been well answered. I don't think there's much more to say.
Fear:
I'd like to talk about your experiences with bruxism along with your general health as it may pertain to that condition, yet all of this Q and A in real-time on the forum is shredding my arms.
(I didn't even get into the chronic hypertrophy of the medial side of my forearms, potentially a case of borderline chronic exertional compartment syndrome, or the way the voice commands required from Dragon NaturallySpeaking exert a sort of repetitive strain on my esophagus, which seems to cross-link with chronic heartburn. In short, my complaints are legion. If you are open to it we should compare notes).
303-258-3455. Not a cell phone, please leave a message and be prepared for phone tag. I may be down in Boulder doing PT for my hips. Call anytime.
Karl:
Although your debate has been a distraction from the pointed questions in the OP, your position on the matter is sort of the elephant in the room. Thanks.
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Darn good job everybody. My arms and my voice need a break.
Let's give it a rest.
Roy
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