Tuesday, August 9, 2011

Chewing Over My Sore Tooth

     I've been going to my dentist for several years now. It's a group practice, where they do not guarantee you the same dentist every time you go, but I've managed to mostly see a young woman who I trust and who seems to know what she's doing. There's a degree posted on her wall. She graduated from University of Maryland dental school in 1999.

     I went to her the other day with a sore tooth. She poked and prodded and reported that it didn't look good. It's a tooth that had a root canal procedure done a long time ago, with a crown that's pretty old. She thought part of my bone was deteriorated, in which case my tooth would have to come out. But she wanted to send me to a periodontist for a second opinion. It's not that clear cut, she said, I want to know what he thinks, and I'm wondering if just maybe he has a new technique to save the tooth. If it has to come out, she went on, you'll need an implant or else a bridge. Or, I could just leave a gap in my teeth. But she didn't recommend that. An implant is the best solution, she told me, but she did warn me it's expensive and usually not covered by insurance. (I have minimal dental insurance that goes along with my health insurance, and sure enough, it doesn't cover dental implants.)

     I went to the periodontist. He was very decisive. I had a "broken root" and the tooth had to come out. The remedy is to replace it either with a bridge or else a dental implant, he said, confirming what my regular dentist told me. The periodontist said he could do it; or else I should go to an oral surgeon. But he told me, no matter who did the job, to make sure they replaced the part of my bone that was decayed. He billed me $85 for the consultation and gave me a price for his work:  $3,605. And that did not include the new crown that would have to be put on the new implant.

     So I went back to my dentist, as she had asked, and we discussed my alternatives. We agreed the dental implant was the best thing to do, but she said I should go to the oral surgeon that was part of their practice.

     Why not go to the periodontist she'd sent me to for the second opinion? I asked.

     Because he's a periodontist, she said. You should go to an oral surgeon. Besides, she said, by keeping it "in house" I would get a little better price.

     It so happened I could get in to see the oral surgeon right away. He was in the office two days a week -- Monday and Thursday -- and this was last Thursday so he was there.

     I was escorted into one of the little rooms. The assistant told me she wanted to take an x-ray. I told her my regular dentist had taken an x-ray, and I didn't like getting too many x-rays, so maybe the oral surgeon could just look at hers. He could do an x-ray if he thought it absolutely necessary, but I'd rather not.

     The oral surgeon rushed in about five minutes later, without doing an x-ray. He was a young guy with a beard. Pretty abrupt manner. He confirmed that the tooth had to come out; that a dental implant was the best option. And it so happened that he had a cancellation and could get started right away. Would I like to do it?

     I balked. I thought, well, it's gotta be done. No reason to delay. But it all just seemed too fast. So I told him, no, I needed time to process all this information. Could I make an appointment for next week?

     Sure, said the oral surgeon. No problem. He was actually going on vacation next week, but we set up an appointment for the following Thursday, August 18.

     Then he said he'd give me a prescription for an antibiotic, and a mouth rinse. Start taking the antibiotic three days ahead of the surgery, he told me, and do the mouth rinse as well. He assured me that mine was an easy case, with a 95% success rate. He'd never had a problem. He would scrape away the infection and the diseased bone, pack in new bone and set the screw. As far as I was concerned, the procedure would be like getting a cavity filled. Some Novocaine and maybe a bit of a sore mouth. Then, after the bone healed, in three or four months, I'd come back to get my new tooth.

     As I left, I stopped to pay the bill for the consultation. $161. (I noticed the bill was almost twice as much as the periodontist's) And I got the estimate for the treatment. The oral surgeon would charge me $2,869 (Which I noticed was a few hundred dollars less than the periodontist.) And then the charge to get my new crown would be an additional $2,160. The dentist doing this special crown would not be my regular dentist, but another person in the practice -- someone I'd been to before and liked.

     I went home, still stunned by the cost of this implant, wondering if I should do the less expensive bridge (although no one told me how much less expensive it would be). And I was thinking I'd been given a little bit of a sales job, feeling they'd been trying to rush me into this treatment.

     So I turned to the internet and googled the name of this oral surgeon. I found out he practices in The Bronx. He has a partner who's connected to New York University. But this oral surgeon was not listed as a member of the American Dental Association. My regular dentist was listed; so was the periodontist she recommended me to; so was the other dentist in her office who would do my special crown.

     I tried the American Association of Oral and Maxillofacial Surgeons. I found his partner, the dentist connected with NYU. But I did not find this particular oral surgeon.

     I finally did find a reference to this oral surgeon. He was listed as a "new diplomate" in the Summer 2010 issue of the publication of the American Board of Oral and Maxillofacial Surgery, which certifies that the person "has attained competency in a  recognized specialty through education, training and clinical experience," and "represents a practitioner's commitment and expertise in consistently achieving superior clinical outcomes."

     That was somewhat comforting, to know this oral surgeon had attained this "diplomate," even if it was only a year ago. But I wonder, how much experience does he really have.

     So I'm at a loss about what to do. I am still shocked at the price of the dental implant. But I could come up with the money. And I really, really do not want to get the cheaper bridge and live to regret it two or three years down the line if it starts causing problems. But I don't want a problem with a dental implant either. And I'm a little worried that the oral surgeon at first wanted to operate right away, and then, only when I delayed, decided to give me the prescription. If it's important why was he willing to proceed without it? And why isn't he listed, as all the other dentists are, in the ADA or the AAOMS? Just because he's new and hasn't gotten around to it yet?

     And yet, I trust my regular dentist, as well as the other dentist who's slated to do my special crown. And she didn't hesitate to send me for a second opinion with the periodontist, which to me is a good sign.

     So, I don't know. I guess I'd appreciate any reaction from anyone who's had experience with a dental implant or bridge, or even just anyone who reads this account and gets the feeling that either I'm being overly cautious and gun shy, or whether I have a legitimate concern and should start looking around for another solution -- although I don't know what it would be, because my tooth hurts and I don't want to have to start at the beginning and do this all over again, with a still perhaps less-than-guaranteed way to proceed.

     Thank you for your input.


Anonymous said...

I'm in a similar situation. I lived with a bridge for 30 years, and finally one of the teeth began to decay when the dental cement eroded. Nothing could be done to save the bridge.

I had to have a root canal, and then my option was to have another bridge, or an implant. I chose the latter because, without a doubt, a bridge is a pain the butt. Food constantly gets stuck underneath it, it's high maintenance, and it will eventually wear out or the teeth underneath it will decay as they are hard to clean. Most bridges do not last 30 years.

My cost for it all will be about $4,500. That's after insurance, which only covers $1,500 in dental work a year. The work involved removing the old bridge, a root canal, a crown, then for the missing tooth - bone grafting & implant, followed lastly by the crown.

If at all possible, see if you can stage your procedures. Have part of them done this year, the rest next year when your new benefit dollars kick in. If possible, live with a `flipper' on your implant for a few months before you have it crowned. This is very common, and not difficult.

If your dentist, whom you like and trust, recommends a particular surgeon or peridontist, I would trust that recommendation. Your costs do not sound unreasonable. Dental work these days is darned expensive!

Good luck!

Deb in Portland, OR

Anonymous said...

I had an oral surgeon (same full title) for a jaw cyst. I also had a endodontist save another tooth with a crown. The tooth was decayed below the crown and he drilled through the crown to do a root canal. Never had your problem, but I do have a bridge. What a bother, go for the implant if you can afford it. On the other hand, I do not have an implant, so what do I know. Good luck.

June said...

You could ask the oral surgeon why he isn't listed. Maybe he thinks he is and it's a failure of the listing processor? It happens.
All the same, it does seem as if you were getting rushed a little bit, and I don't like it.
My inclination, if the tooth weren't visible when I smiled, might be to just leave a gap. They'll tell you everything will shift, but realistically, how long's that going to take...for all your teeth to move around? If your teeth were that likely to shift from place to place, you'd have worse problems than a gap.
I have had bone grafting done in my jaw. Maybe the process has improved, and mine worked out fine, but there's a chance it won't, too, you know.
Last, I always prefer somebody who's been doing medical things for years and years.
I'd go back to the periodontist.

Douglas said...

We are at the mercy of alleged experts and professionals... who just may not be. What do I know? I only have 4 teeth now, these hold my lower partial in place nicely though, so I guess I will try to keep them.

Nance said...

I have no experience yet with your particular dental problem, but I will give you a psychological perspective on your ambivalence and caution and it won't cost you a cent. Nice and simple, too.

You're a grown, educated, intelligent and experienced man. If you're not sold on the young oral surgeon, trust that instinct. Always, always trust that instinct in medical matters; it's part of being an empowered patient. Just as the insurance companies are not looking out for us, neither, as a rule anymore, are we the most important consideration in our doctor's (dentist's) decisions. Their student loans, their overhead, and their liability insurance come before you.

Let your dentist know that you'd like to speak with someone more experienced who is fully referenced.

Dr. Kathy McCoy said...

Tom, I can really empathize with your pain, ambivalence and sticker shock.

(I wrote a post on dental implants with a video a few weeks ago.)

In my case, I lost 9 teeth in about two years -- bridges going bad and the like. One oral surgeon tried to convince me to have an implant at the time of extraction and quoted me a price of $10,000 for two teeth. I was aghast and said "No." Like you, I knew I needed implants but was taken aback by the cost. I started saving up and researching who might be good. My advice would be: go with your instinct in terms of oral surgeon. If you don't feel confidence in that person, don't go to him. The oral surgeon I turned down worked with my regular dentist whom I liked a lot, but I still didn't want to work with him.

After some research, I found a practice in Beverly Hills (Secure Smiles) that specializes in implants -- an oral surgeon and cosmetic dentist in one office. The total cost of an implant -- which included the implant AND the crown -- was $2450. I also had one bone graft in my upper right jaw that cost another $300. In all, I had 8 implants done all at once. (I worked an extra job to save up for it!) Still, it was less than half of what it would have cost with other oral surgeons. The work was excellent. The implants look great and feel just like regular teeth. I haven't had any problems at all with them two years post-surgically. These doctors took a great deal of care -- including waiting six months from implant to crown -- just to make sure I had healed properly and during that time, I went in every 3-4 weeks for a checkup at no extra charge.

I'm sure there are similar places in New York that could offer you excellent care at a reasonable price (for an implant).

It's important not to feel rushed to make a decision. You don't want to wait years, but a few months to check out all your options makes sense.

Sightings said...

Thanks for all your advice. I decided to phone my regular dentist to discuss my concerns with her -- I figure she will be straightforward with me, and either reassure me or if I still have concerns I'll have time to bail on this procedure and find another. I put in a call yesterday, which turned out to be her day off, so hopefully she'll call me back. (I looked for Secure Smiles, which looks like a reasonable solution, but there doesn't seem to be anything like that around me in New York.)

JBO said...

My husband went to a "new" guy for his tooth. It had been crowned for 30 years. The guy was impulsive and ripped the crown off - finding NO decay. Anyway- he ground the tooth down-- then started to grind another down for a bridge. STOP!

He talked to an older dentist. That dentist said, "you have a gap where a molar should be?" "yup" and all of your other molars are hitting and in good shape (crowned or otherwise)." "Yup" "Then (opening his mouth and pointing in) welcome to the club!"
Now my husband, his brother , the dentist and a good friend are living nicely in their 60's with a bit of a gap in the back of their mouth. No big Deal.

JBO said...

BTW- the dentist also told my husband that making bridges actually kills two teeth that were probably perfectly healthy to begin with--in order to do the bridge. Sort of like the federal government---make it look pretty now-- but neglect to say that you will pay dearly for it in the end.

all on 4 dental implant said...

I can understand your problem and I feel sorry for the pain you are going through. It is good to go for the dental implant than for the bridges. Yes, implant is quite expensive than the bridges I agree with you but in long run it is good to go for the implant. I would suggest you to have treatment with the dentist you really trust.

Olga said...

I'm glad that you plan (or have already) discussed your concerns with the dentist you trust. Dental work is so expensive--like everything else these days, I guess--but also really important to overall health. Good luck with whatever course you take.

comgal said...

If you're in NYC, go to Oral and Maxillofacial Surgery, www.mfss.net.Your total work with crown will be around 3600 or slightly more, bone graft additional, and if you like less expensive in NJ, I can recommend you a couple surgeons in Clifton. NYC surgeons have to pay very high rent, no wonder the prices are high.
Glad to help people with such simple case. Of course, group practice is not the best place... at your age, you probably know that.

Robert the Skeptic said...

I am a bad one to input on a subject involving dentistry as I am extremely fearful of them. I would prefer to be completely put under just to have my teeth cleaned.

For me I would research the least painful and intrusive alternative, regardless of cost. I just can't deal with dental issues... it was all I could do to make it through the end of your post without fainting.

Anonymous said...

hmmm - I knew you like the care I provide here at my office and I also knew that you were quite an intellect for your age but this detailed ??

huh huh -

Anonymous said...

My father was a dentist for 42 years and recently sold his practice. At a conference with 400 kids of dentists they asked who wanted to be a dentist like their father? Not one single hand. My father was an incredible dentist and charged less than half of the newer generation of dentists who are paying for the sales classes. My recommendation: find the oldest, most honest dentist you can find and don't look back. You'll get the best work without the sales pitch (national sales companies weren't around when my father graduated dental school). The good, honest workers are running from dentistry into research and teaching careers after watching our fathers get hammered by the insurance industries and corporate dental facilities. Good luck.


I am sure you can get the works done in a tier II-III city in India like Bhavnagar. Even if you factor in an economy r/t air, hotel, food etc. you would come out cheaper than what was quoted in USA. I am 66, retired and living here. The dentist who has treated me and my brother-in-law, an internist practicing in KY. We both had satisfactory crown and other dental work.

Eddie Storms said...

You have the right to receive all the proper medical and dental care. It's good that you did your research, but it would be better to do it before you have the operation. It's better to be safe than sorry, right? Now you have learned your lesson.

Anonymous said...

This is the answer to your future dental problems-http://www.curetoothdecay.com. The author of the website, and the book of the same name, started doing research into good dental health after his young child started losing her teeth at a very young age. Apparently, the vast majority of diseases(dental and otherwise) stem from the lack of basic healthy nutrition. And healthy nutrition does not mean reading the ingredient labels on products. It now means pretty much staying away from the average grocery store altogether and buying directly from a good health food store or an organic farmer who knows what he is doing with his crops. One of the best websites for good general health is Http://www.naturalnews.com. It turns out that in health, as in many other fields, the experts have been led astray. So, trust your instincts since they are already warning you to stay away from the exorbitantly expensive conventional dentist, periodontist, and oral surgeon. I advise you to do some research into what really causes one to have good health throughout one's life. The two websites above are good places to start.

Periodontist Beverly Hills said...

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Jamar Schaffer said...

So, what have you decided? I check on your other post to see, and I noticed you didn’t update on how this dilemma of yours turned out. Just the title of this entry makes me wince for an imagined pain. Either implants or bridges would be a great option, instead of suffering from chewing over your sore tooth.

Jamar Schaffer

Kent Davis said...

“Chewing Over My Sore Tooth” - Ouch! I hope you found the right option and your tooth is okay now. Bridge, implants or even false teeth, they are better options than being miserable over a sore tooth. Implants can invade your other tooth, and not everyone are suited for this. But when they're done, they're perfect and quite permanent. Bridge, on the other hand, is simpler and safer but can break over years. I hope your talk to your dentist enlightened you. Kent@DenturesDoneRight.com

Kenneth McGee said...

So, what have you decided to do? Seems all the pros that’ve been referred to you are legit. If I were you, I would choose either a bridge or an implant and have the procedures done rather than spend another day suffering from chewing over the sore tooth. Kenneth @ AvenueDentalGroup.com

Denis Smith said...

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Eric Smith said...

People who are suffering from the gum recession disease, he/ she must recommend the Pinhole Surgical Technique as in this technique a small tissue is placed from the mouth and it is placed over the area of recession to stick the gum tissue until it heals.

David Hook said...

The method of Pinhole Surgical Technique relies on neither incisions nor stitches. This treatment is suitable for your receding gums. Dentists conduct this treatment through the use of micro needles.