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Tarbuster
climber
right here, right now
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Side note/question about anti-inflammatory and pain meds:
Last year I was being treated by a spine Dr. for herniated disc at C6 (clinically determined not the root cause of my particular long-term forearm issues) and was taking Gabapentin/Neurontin for nerve compression pain and also Diclofenac (said to be much stronger than ibuprofen) and their protocol was to include an antacid along with the Diclofenac. They are saying some micro-bleeding always occurs in the stomach with ANSAID use so they are recommending Ranitidine/Zantac as a prophylactic for that insult (reducing stomach acid in the presence of micro-bleeding).
Also had both hips resurfaced this year and the surgeon/hospital instituted the same program, prescribing Ranitidine along with OxyContin and Oxycodone/Vicodin. (And of course with those painkillers also laxatives, SENNA is a good one (sennosides 8.6 mg, simple vegetable extract).
Tooth, Micronut: are you perhaps familiar with the prophylactic use of acid reflux drugs for mid/longer-term use of anti-inflammatories and painkillers? I'm suspecting this has something to do with the longer-term use (i.e. 5 to 6 weeks following joint replacement), as distinct from dentistry wherein it's usually short-term use following the work, (i.e. acute pain).
Perhaps of interest, acute dental pain is just about the ONLY pain in which ibuprofen has been effective for me. It never does anything for chronic musculoskeletal issues in my case.
Thank you.
BTW & off-topic:
Here's a heads up dissuading the use of ibuprofen in a ROUTINE prophylactic capacity for sports related pain, these studies have been coming out for some time:
http://well.blogs.nytimes.com/2012/12/05/for-athletes-risks-from-ibuprofen-use/
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tradmanclimbs
Ice climber
Pomfert VT
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50yrs old. Currently under employed carpenters helper. tooth in the back lower right sometimes but not always very heat/cold sensitive. how long can I put off dealing with this?
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Spanky
Social climber
boulder co
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Hey Micro,
Just wanted to say thanks for the advice.
cheers
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TwistedCrank
climber
Dingleberry Gulch, Ideeho
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My teeth are ok but I need to know why it hurts when I pee.
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micronut
Trad climber
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Topic Author's Reply - Dec 7, 2012 - 11:36pm PT
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Tarbuster,
Thanks for the Ibuprofen article. Pretty good read. I'm not a big fan of chronic use of anything, including NSAIDS, especialy for athletes (I swam on the US team in the 90s) but if you are really suffering as an athlete for a season/phase of tear down, I've always told folks to mix it up with Aleve, Tylenol, Ibu..etc. Not sure this helps, but they are metabolized slightly differently and that might help a bit in my humble opinion. But yeah, long term anything is gonna get you somehow.
And your thoughts on antacid use with long term NSAIDS, interesting. I don't have much experience with that concept, because, as you alluded prior, my surgeries are usually pretty intense for only 3-5 days, and 800 ibu twice daily does wonders. Rarely do my patients take narcotics for more than a couple doses, if any. I believe this has to do with the fact that I tend to try and be really gentle with the tissues and a maniac about micro-suturing to "perfection". My assistants hate me because I dink around closing things up, making em look like stitching on an ArcTeryx Gamma SV.
I really wish you had a way to see my guy in Fresno who is really good with cases like yours. It's over my head and not in my specialty to deal with the dental scenario you're dealing with, but keep your chin up and let me know if you are ever in central California. I can get you in to see a real genius when it comes to dentitions like yours.
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micronut
Trad climber
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Topic Author's Reply - Dec 7, 2012 - 11:38pm PT
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Spanky, you're welcome.
Twisted Crank, send Tooth a urine sample.
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micronut
Trad climber
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Topic Author's Reply - Dec 7, 2012 - 11:46pm PT
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Tradman,
It depends on a lot of things. The most important is WHY are you having the sensitivity. If its a little bit of gum recession, and it isn't moving quickly, you may be fine for quite a while. Put it off too long and you might need an expensive gum graft.
If its decay, and it's moving toward your pulp, it can become a big dela quickly and you don't want to put it off unless you want to risk an expensive root canal, and crown, etc...
If its a microfracture in the tooth, same thing.
If its a bigger fracture (though you still won't be able to tell yourself, I'm not talking about a crack you can feel), it can be a real time bomb and you can end up with a costly extraction.
YOU NEED A GOOD DIAGNOSIS TO ANSWER THIS ONE CORRECTLY.
The bottom line is that all of dentistry is easy to fix when its a small deal (and costs accordingly, and that things almost always progress to bigger procedures and more expense. Its just the way it goes. Just like a car. That sensitivity is your "check engine" light. Ignore it, and the consequences tend to grow with time. I hope its a small fix, you just gotta get in there now and have it looked at. Its worth the couple hundred $ to have it looked at, diagnosed, and cost estimated. If you end up there on a Saturday with a jaw swollen up or a cracked tooth you'll kick yourself and your wallet will get dinged even harder.
Hope it works out,
Scott
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Tarbuster
climber
right here, right now
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Tooth, Micro!
You guys rock. This thread needs to be a "sticky", one that sits always at the top like on other forums.
...(OK, maybe on the side, but handy).
Floss the ones you want to keep.
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JOEY.F
Gym climber
It's not rocket surgery
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Micro, your advice for ice was the bomb. Did that and pain/swelling went down and finally slept. Also, today did IB and rinse. Just a sore jaw now, nbd.
You and Tooth are the best and can't thank you enough.
A long time ago a dentist told me,"I'll trade you 2 flossings for 1 brushing"...
Thanks again.
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tooth
Trad climber
B.C.
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Jopay,
I wouldn't worry much at all about an oral surgeon removing that top wisdom tooth. They will go over risks with you, but even if the roots of the tooth entered the sinus, (I've seen that a lot) you are at an oral surgeon's, they can more than handle that. They place 50mm implants through the sinus into the cheekbone (zygoma) and do other things to it more invasive than simply removing a couple root tips from under it.
So often what you see on the internet about anything is similar to two blind guys describing an elephant while one is hanging onto it's tail, and the other it's tusk.
Most of the wisdom teeth I remove are fully-formed teeth. Very rarely is it stuck to the bone, this week I did one that was, I cut up the tooth into pieces, removed the pieces from within the bone, and today the patient told me that the needle was the most he felt with the procedure.
Those things you mention are issues that can arise, but I haven't seen it with an errupted max wisdom tooth.
Tarbuster, I haven't had any experience with the drugs you are talking about - I was kinda surprised to find out that they don't have Vicodin in Canada - T3's is the strongest I have prescribed while up here, and most people don't even fill it out.
Tradman,
50 year old stick frame house. Sagging roof. You can't look in the attic or behind the drywall. How long can I leave it?
I guess I would have to know what your "leave it" means to you. "Leave it" before you lose the tooth? Before you need a filling? Before you need a root canal/crown? Before you need crown lengthening as well? Before you need an implant/denture? Before you need SuperSeal treatment or gingival grafting to cover the exposed cementum or dentin? Before it blows up with an abscess? Before the abscess rots the nerves in your bone and causes nerve damage?
Even if we knew any of the problems that could be causing these symptoms, we can't predict how fast the problem will progress with you -- everyone is so different. When my patient has a problem I can only recommend treatment, I can't recommend waiting at all because I see too many problems blow up overnight.
If your roof is sagging how do I know that it won't fall in tomorrow, or that it won't snow heavy tonight and then thaw tomorrow and start dripping inside?
TwistedCrank, if it hurts when you pee, urine trouble.
edit: this took me 6 hours before i posted, so I didn't see the last 6 posts or replies from Micronut. Best save the sample for him -- postage to Canada is too expensive and it would arrive as a solid right now.
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Crimpergirl
Sport climber
Boulder, Colorado!
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Thanks again to both of you. Left message with excellent endodontist (did I spell that correctly? Spell check says no) today. We'll see what he says. Of course I called after hours. Doh!
Good luck to the others of you. Happily, I have insurance (marginal as it is - everything still costs a danged fortune) mine is in no way an emergency. Just a pain. Literally. :)
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jopay
climber
so.il
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Thanks for the reply Tooth, so by your answer I'm assuming age at time of removal is not that big a deal,I did mention I'm 66, but I understand it's better to remove them when one is younger.
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steveA
Trad climber
bedford,massachusetts
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Micronut,
It was very kind of you to start this thread.
I'm very lucky that my daughter-in-law is a skilled dentist, (graduated top in her class at UPENN).
I won't be bothering you with any questions.
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JOEY.F
Gym climber
It's not rocket surgery
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Dec 28, 2012 - 07:14pm PT
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Quadrant 3 done today, 1 more to go. The ice and IB work well. Thanks again Tooth and Micronut.
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JOEY.F
Gym climber
It's not rocket surgery
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Jan 14, 2013 - 08:30pm PT
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#4 done! The doc was half way into it when he said I needed a bone graft. I wiggled my fingers (how much), he put it in gratis as he had leftover from a pt before me. How cool.
I guess it says something about being a long term patient with the same doc. Very lucky indeed to have the insurance too, very lucky.
(lots of great info up thread thanks to our resident dentists btw...)
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mouse from merced
Trad climber
The finger of fate, my friends, is fickle.
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Jan 14, 2013 - 09:31pm PT
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Joey F, good show!Will all this improve your belay responses?
Massive :)!!!!
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Phil_B
Social climber
Hercules, CA
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Jan 29, 2013 - 10:35pm PT
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Here's a question I haven't seen asked yet. I got a scaling and root planing last year. The dentist tried to talk me into a set of injected antibiotics too. I balked when I saw that they wanted me to pay about $100/tooth. Gah, I was getting two crowns at the same time so I told her no.
I researched it on the Net and it seemed that there is a little bit of controversy on it. Not all folks are convinced that it works.
Besides, I'm not really a fan of using antibiotics if I don't already have a bacterial infection.
After the procedures, I didn't notice anything and have concluded that it's another way for the office to make money. The dentist I was going to seemed to part of a larger corporation and not in her own office. Didn't know that going in.
So anyway, what do you guys think of antibiotic prophylaxis for root planing and scraping?
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splitter
Trad climber
Cali Hodad, surfing the galactic plane ~:~
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Mar 23, 2013 - 04:31pm PT
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I probably should have followed the advice, "Pull them all out and be done with it, you'll save yourself a lot of money and pain." which was the opinion that prevailed among the old timer's during my youth in Cape Breton. Well, I got off to a good start in that direction, regardless.
My first toothache, and therefor dental visit, presented itself shortly before my 9th birthday. I woke up one morning and the first molar my on my lower left side was aching.
I had to wait for my father to get home from work, at which time he arranged an after hours appointment with a dentist. It was early evening when we arrived at his office. I recall him being an older guy, and he was extremely drunk. I climbed into the dental chair at which time he attempted to stand up from his office chair but almost hit the floor, but managed to sit back down. He never left that seat...thank God!
Long story short, he told my father where the pliers (what they looked like to me). He then told me to point to which tooth it was. Then he simply told my father to, "Yank the sum'bitch out", plain and simple. No novocaine, no nothing. My father made quick work of it. But all it really needed was a simple filling. It is still the only tooth missing on my lower jaw.
Okay, here is the real doosie! We lived in SLC, Utah when I was 13 through 15. I woke up one morning (when I was 14) with this ache in my gum just below the bottom of my nose. I immediately went into the bathroom and looked into the mirror. I didn't recognize myself. My face was swollen to the size of a volley ball. I was immediately taken to a dentist.
The dentist said that it was an abscess, and that he would have to do a root canal on one of my front teeth to release all of the fluid. I remember sitting in the chair and the dentist telling the nurse not to bother to prepare a novacaine injection because he feared that it would mix with the infection fluids causing the swelling and might go to my brain. She looked shocked. His response, "Don't worry, the pain will knock him out within the first minute." It didn't, never did.
It took him around 45-50 minutes to drill up through the whole length my right front tooth (follow the nerve root) to the gum/jawbone. I will never forget what the three (3) main drill bits looked like. of which he rotated back and forth with. There was a tiny one that had a high pitched whining noise. A medium sized one, and a particularly dreadful one that was the largest, was round, and had these little rectangular nobs protruding from it.
There is absolutely no words that can describe the hideous pain that I endured. Believe me, it was pure torture. I have, over the years, described the experience in more detail to doctors, dentist, etc, and they all responded the same way. One, it was malpractice, two it was torture. Well, if that (drilling through my right front tooth) wasn't torture, what he did next was.
After the drill bit, the big one with the bumps, popped through the end of my tooth into my gum/jaw bone and nothing happened (he was expecting all the fluid and puss to drain out, he instructed me to suck as hard as I could to help initiate it. As painful as it was to do so, I gave it all I had, but nothing happened. Man was he pissed.
He began pacing back and forth, telling me that I wasn't trying hard enough, etc! Finally, he told the nurse to bring back the drill bits, and he laid them back out on the tray in front of me. He said that he was going to take a 15 minute break and if I hadn't managed to get the fluid draining by sucking on that tooth as hard as I could, that he was going to drill through my left front tooth. Believe me, as painful as it was to do so with those three instruments of torture staring me in the face, I gave it all I had but nothing happened.
It took him another 45-50 minutes of constant drilling to, once again, drill all the way up through the center of that tooth to the gum/jaw. Pure torture. No pain medicine, not even an aspirin. The nurse and my mother put cold wash cloths on my head and looked like they were about to weep. At first, the dentist instructed them to hold me down, but they didn't need to because I was holding onto the chair with all of my strength and every muscle in my body was contracted, that's about all I could do.
When he finished the second tooth, and nothing happened, once again he paced back and forth, looking very frustrated. Suddenly he stopped, looked as if a light had come on/something had dawned on him and he walks over and lifts up my top lip. I wonder what he thought, felt like when he saw the dark blue abscess that was at the top of my inner lip/gum just below the nose. All I could see in his face was a slight trace of disgust.
He then took out a small scapal and simply lanced/poked it and everything came gushing out. That's all he had to do in the first place, simply lance it, a relatively painless procedure which would have also saved me from later losing my two front teeth.
He then, once again without any novacaine or pain meds, inserted and sutured into place a 6 inch section of surgical tubing so any of the remaining fluid would continue to drain. He didn't bather to fill the two front teeth for the same reason. He sent me home with zero pain med's, not even any antibiotics/prescriptions. I thought that was rather odd, since it was an infection.
I remember being curled up on the living room couch in a fetal position for two days and two nights, in horrible pain and not being to sleep. I couldn't breath through my nostrils because they were swollen shut. And I couldn't close my mouth because of the tube protruding from it. With each breath this searing pain shot through my head.
On the third day my aunt and uncle arrived from California on there summer vacation. Just a few minutes after they arrived I heard her exclaim, "Poor boy." and she dug through her purse and gave me a pill. Not sure what it was, but it knocked me out and I awoke a day or so later and the pain seemed to be only half as bad.
To be continued (you won't believe what happened to me about 15 years later)...
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tooth
Trad climber
B.C.
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Mar 23, 2013 - 08:11pm PT
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Phil B.
Micronut is a periodontist so this area is his specialty.
I provide my hygienists the tool Arrestin, the antibiotic at $100/ tooth. Works wonders on stubborn areas that won't heal up to 2-3mm pockets. We also use lasers, scaling, root planing, and all other tools that we can find. I've seen many patients who we have helped stop perio dz and get to a stable, healthy state using a lot of tools. I also read research a lot and have read research showing that almost every single procedure I do is ineffective. Yet people's bodies heal when they start taking care of themselves after we help educate and then treat them.
If all you have is a hammer, every problem looks like a nail.
When you get 4 dentists in a room, you will have 5 strong opinions on what to do.
What I tell my patients is that there are lots of options. Let's educate you on what is going on in your mouth, then choose the best solution/plan. Next, we find the guys who do those procedures the best. Everything can work to a degree, but some guys try ortho (braces) and don't succeed at first, then never do it. Others keep doing it and study it, figure it out, and then excel at it. I refer my patients to the best guy for their best treatment option.
I can do a study here that shows that mini implants suck. They fall out. Our oral surgeons hate them because all they do is remove them. They have this opinion because only one guy around does them. And doesn't do them well. I know another who does do them excellently and has followed up on everything and hasn't lost more than 1% over 14 years.
So pick the treatment you want, and get the right guy for the job. No dentist can specialize in even a tenth of the stuff that is out there now, it's just too much.
Oh, and antibiotics before prophy, etc? If it is 2g Amoxicillin, research is showing more and more that the systemic pill therapy isn't doing much for people. Doctors just do it to cover their butts because as we all know, medicine is primarily driven by legal precedent in the US, not by research. Dentistry is beginning to get there thanks to lawyers. To your detriment.
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