Archives for December 2020

Full-Mouth Reconstruction Disaster

Posted on December 30, 2020 by writeradmin.

I had every tooth crowned because of some rather severe problems. The back teeth were crowned down to nubs and the front teeth were chipping daily. My jaw ached and clicked. As a result, my dentist said my bite needed to be opened. He did the bottom crowns and bridges first. That seemed fine. It wasn’t until he bonded on the upper crowns and bridges that the problems developed. On one side of my mouth, the teeth hit way too soon. With the other side, though, the teeth don’t touch at all. I’m in worse pain than ever. Is there a way for him to file down the ones that are hitting too soon? My pain is unbearable and I have already spent a fortune on this.

Kevin

Dear Kevin,

What your dentist did is known as a full-mouth reconstruction, usually it is done with a combination of dental crowns, bridges, and sometimes dental implants. It is a technically advanced procedure that takes significant post-doctoral training along with experience. Doing this wrong can throw someone’s bite off and create painful TMJ problems. It sounds like you were already dealing with some TMJ symptoms and the way your dentist handled this case has exacerbated it.

Complex procedures have to be done carefully. It is important they get the occlusion of your teeth in line perfectly with temporary crowns first before anything is bonded on. He should adjust the temporary crowns until you are perfectly comfortable and there are no problems with your speech. Only then should the permanent crowns be made to replicate the temporary crowns.

While theoretically the teeth that are touching too soon could be ground down a bit, that is usually something reserved for minor changes. The description I am getting from you is the teeth on the other side of your mouth don’t touch at all. This means the amount of grounding necessary for them to meet would go past the porcelain.

Please bear in mind as I answer your question that I haven’t examined you. Based on what you have described, I think this case need to be completely re-done. I want you to get a second opinion. But this time, see someone who is an expert in reconstructive dentistry. For instance, Dr. Thomas is a fellow with the International Congress of Oral Implantologists. It takes a high level of training and expertise to get to that distinction. Looking at his bio, you can see the amount of advanced post-doctoral training he has invested in.

It is helpful if you get your second opinion from someone out of town so there is less of a chance the two dentists are pals. That way there won’t be any conflict of interests. Once you secure the second opinion, you will be armed with the information you need to secure a refund on your case and get it done by someone who can do it properly.

This blog is brought to you by Sugar Land Dentist Dr. Thomas Siny.

Sinus Perforation with a Tooth Infection

Posted on December 21, 2020 by writeradmin.

I had a molar extracted. Four days later, I called letting them know there is a popping sound in the right side of my nose, which is the side of the extraction site. That is when they told me there was a small sinus perforation, which they described as routine. They suggested I take Sudafed, which I did. By the next day, I had a 102-degree fever. They called me in an antibiotic, but by day 10 of this, I was getting worse instead of better. I called asking for a referral to n ENT, which they provided for me. Should they have to pay for this?

Carol

Dear Carol,

Your dentist has not handled this properly. I’m disturbed by the fact that they didn’t tell you about the sinus perforation with your tooth extraction until four days later. Even then it was only because you called and told them there was a problem. There is a standard treatment for this type of thing, which does happen sometimes. In most cases, with the right course of treatment, it is no big deal and heals quickly.

First, they should have informed you right away and asked you not to blow your nose for a few days in order to aid healing. There is also a biocompatible resorbable sponge they can pack the area with called, Gelfoam, which will help the tissue to regrow sooner.

When healing doesn’t take place, it can mean there is a piece of bone that not only broke through your sinus cavity but was left there. This can lead to infection. I suspect this is what happened in your place.

Going to an ENT is the right course of action for you. It also sounds like you may be on the wrong antibiotic. The infection should be healing by now. When you call the ENT, let them know what is going on so they can write you a new prescription for the proper antibiotic. You’ll want to get this under control before it turns serious.

Additionally, I would insist your dentist pay for this treatment that is now required. If he doesn’t do that, let him know you’ll be in touch with the dental board. That should sober him up and help him see how reasonable you are being.

Tooth Replacement Options

At this point, I do not have confidence that your dentist has given you all the correct information here. As such, you should know that it will be important you replace your missing tooth as soon as possible. With an open space in your jaw, your adjacent teeth will eventually start to shift or tip into the open space. When this happens it can lead to painful TMJ Disorder and expensive orthodontics. Replacing the tooth now will save all of that.

Your top two tooth replacement options are a dental implant (that best option) or a dental bridge (the second-best option). Though, there are times that second-best is a good idea if you already have a tooth adjacent to the missing tooth needs a dental crown already.

If you decide on the dental implant, please make sure your dentist has the training to do this properly. Too many dentists do not, which is one of the reasons implant procedures are one of the leading causes of malpractice suits.

This blog is brought to you by Sugar Land Dentist Dr. Siny Thomas.

Clear Choice or Costa Rica for Dental Implants?

Posted on December 2, 2020 by writeradmin.

I have some trouble with my bone structure so I need a place that does all-on-4 dental implants. I was looking at Clear Choice Implant Center, but a friend told me they went there and felt pressured and then there was no follow-up afterward so she felt a bit on her own. I am wondering if I am better off going to Costa Rica. I could travel there and still save money on the procedure. Do you have an opinion?

Fanny

Dear Fanny,

You just have to read some of the reviews and information on Clear Choice Dental Implants to know that your friend is right in her assessment. They do have a habit of both high-pressure tactics and leaving patients on their own once the procedure is completed. However, if you think you won’t get follow-up care at Clear Choice, how much do you think you could expect from the dentists in Costa Rica?

Placing dental implants are difficult under the best of circumstances. There is a lot that can go wrong with it. In fact, it is one of the leading litigations in malpractice suits. To give you a basic list of the potential problems, take a look below:

You could lose practically all your jawbone, leaving you a dental cripple.
The implants can be improperly placed in the nerve canal.
An infection could set in.
The implants could be loaded prematurely.
They could place cheap, faulty fixtures.
They could lack precise tolerance that allows an infection to seep in or the implant to come loose.

There are so many things that could go wrong. Even though dental implants are not a recognized specialty, we at least have laws and regulations to protect patients and guarantee at least some quality. But, in Costa Rica, you lose all those safety measures. There are no regulations and you have no recourse if things go wrong.

It is even trickier with all-on-four dental implants. If something goes wrong with one fixture the whole case will have to be re-done. If you want my advice, I am going to suggest that you see a dentist in solo practice. But, even then you have to be careful. You want to see a dentist with real post-doctoral training and experience. Ideally, you should see someone who is a fellow with the International Congress of Oral Implantologists. These are the top implant dentists in the country.

You aren’t stuck with all-on-4 implants because of your bone. There is a bone grafting procedure that can be done which will enable you to get traditional dental implants.

This blog is brought to you by Sugar Land Dentist Dr. Siny Thomas.

Another Full Mouth Reconstruction Disaster

Posted on December 1, 2020 by writeradmin.

I have been grinding my teeth for years and my dentist told me it has gotten to the point that I need to have all my teeth crowned. He had to extract some teeth and place implants. For the rest, he did what is he called temporaries at first. I mentioned they felt odd and he told me that is because I am used to them being shorter. I trusted him. Now the permanent ones are on and these feel even worse. On one side of my mouth the teeth don’t touch at all, but on the other side they seem to touch too soon. I don’t know if I’m making any sense. What I do know is it hurts when I bite down and my jaw hurts all the time. My dentist insists my procedure passed all the checkpoints. I don’t know what to do from here.

Miranda

Dear Miranda,

When your dentist crowns all your teeth it is known as a full-mouth reconstruction. It is a very advanced procedure that has to be done carefully. Most dentists don’t have the training to pull this off. It takes extensive post-doctoral training to be able to do this correctly. I think your dentist is in over his head but isn’t ready to admit that.

One thing that concerns me is you said you’ve been grinding your teeth for a while and your dentist said it’s NOW time to do something about it. Does that mean he’s known about your grinding habit for a long time and hasn’t intervened? When a patient has a teeth grinding habit, the first step is to get them a night guard. This is like a special mouthpiece that helps protect your teeth from the grinding, which mostly happens during sleep. The fact that he didn’t do that really bothers me. That step could have saved you a lot of lost tooth structure, depending on how soon you received the treatment.

That is all water under the bridge now. We have to deal with your full-mouth reconstruction disaster. The fact that your teeth are not occluding correctly is a big deal and will lead to serious TMJ complications. I want you to see a dentist who is an expert in these type of issues. One way to find one is to look for a dentist who is a Fellow with the International Congress of Oral Implantologists (ICOI). These dentists have expert training and massive amounts of successful experience. You’ll find most also have done TMJ training as well and understand the proper way your teeth need to meet up with one another.

Look for an ICOI fellow. Have them make a determination about your case and help you secure a refund. Then, you can get this done properly.

This blog is brought to you by Sugar Land Dentist Dr. Thomas Siny.