I need NINE fillings replaced?

[Vincristine]

Hi dental people,
I need a second opinion. I visited a new dentist today for my first cleaning in 2 years. (I know, I know, shun me, but I'm sure dental school is as busy as medical school and so you'll understand.) After a full set of x-rays and my cleaning, the dentist came in and told me that I need a crown and 10 fillings. I about fell off my chair. The crown is on a tooth (the last lower tooth on the left) that currently has a large filling and is now also cracked. The 10 fillings are 9 fillings that need to be replaced and actual new cavity.

My past dental history includes obviously more than 9 fillings in my early teens which makes my fillings all about 10-16 years old. We don't have an answer as to why I had so much tooth decay since I got routine dental care, brushed my teeth, used flouride rinse, and didn't eat lots of sugar. My teeth were always much worse than my siblings, and my mom has always had this thought that it had something to do with the chemo I recieved when I was 3 yrs old (for a Wilms Tumor -- no radiation). I've had at most 3 cavities in the last 8 years, and I currently do not have any pain or sensitivity.

So my questions:

1. How reasonable is it that all of the sudden almost all of my fillings need to be replaced?
2. Should I seek a second opinion? (Are second opinions as common in the dental world as they are in the medical world?)
3. Am I going to need all my fillings replaced every 10-15 years?
4. The vast majority of my fillngs are almalgam, and previously the only filling I needed replaced was a cracked composite resin filling. For that reason I'm a bit hesitant toward composite resin fillings. Have they gotten any better? Besides cosmetic does one have an advantage over the other?

Thanks so much,
Kristin

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[Dr.SpongeBobDDS]

Well for one thing it probably wasn't "all of a sudden". You haven't seen a dentist in over two years; a lot can happen in two years. Sipping Mt. Dew all night to stay awake studying, and falling asleep with Netter's on your chest before you even get a chance to consider brushing your teeth may have something to do with it. It isn't uncommon for fillings to get recurrent decay under them.

But if you do feel uncomfortable with the recommedation, a second opinion is perfectly in order. Keep in mind though that the second dentist may make the same diagnosis but only mention the worst of the worst. He'll let you know about the less urgent problems after you are more comfortable with his practice. Be sure to be upfront about your reasons for the exam to avoid that possibility.

 

[Dr.SpongeBobDDS]

Another thing. A filling that lasts 15 yrs. is generally considered to be a pretty successful restoration; so, yes, they will probably need replaced again. DOH!!!

 

[Yah-E]

Yes, get a second opinion or even a third opinion! If you indeed need all that work done, it will cost you mucho $$! Since it's an investment in your health, then it's worth to get second or third opinions.

Good luck!

 

[Dr.SpongeBobDDS]

As for which is better amalgam or composite. That's a hornet's nest you don't want to stir up. I'd choose composite for myself; especially if I already had composite in that cavity. But that's just me. Ask your dentist what he would put in his own mouth.

 

[c132]

Hey just a suggestion. If there is a dental school within reason from your medical school, go to it. They will not steer you wrong and it will save you a heck of a lot of money!
As for white vs. silver fillings. White are MUCH more likely to fail, but the silver fillings are NO where near esthetic. If you are worried about looks, and have some money to spare, and the lesion extends past the occlusal, then look towards a porcelin inlay or indirect composite inlay. I have seen/done a few of these and they look great. The studies say that it will last ~15 - 20% longer than simple direct composites.
Also ask for some aids in keeping your caries rate down. Maybe a chlorohexidene rinse. Also look to motorized toothbrushes. Not the 10 dollar cheapo style, get a good one. I personally have a sonic care, and my plaque score went down 5% alone just using that. Also try an essential oils rinse (Listerene). Maybe try some better toothpaste, maybe with some triclosan in it (colgate total). Do some reading on triclosan, its a great thing. Also chew some sugar free gum with xylitol in it (orbit). That sub "sugar" halts strep mutans from replicating in the krebs cycle. Strep Mutans is the bug responsible for your cavities.
In your case, you need to get those fixed asap. If they are on the front on your teeth, then maybe ask for a glass ionomer filling. They are weak fillings, but they release flouride and keep recurrent caries from happening. They are tons more ways to reduce your recurrent caries.
Let me know if you need any more tips!!!!!!!!!!

 

[trypmo]

H[....]Also ask for some aids in keeping your caries rate down. Maybe a chlorohexidene rinse. Also look to motorized toothbrushes. Not the 10 dollar cheapo style, get a good one. I personally have a sonic care, and my plaque score went down 5% alone just using that. [....]

Hmm. At the risk of sounding ignorant (so what else is new?), what exactly is a plaque score? Do you have to take a plaque test?

...And if so, does the ADA administer it, like the DAT?

But seriously, I've never heard the dentist I shadow talk about one before, so I'm interested to know what this fabled plaque score is.

 

[UBTom]

to Keraven:

Some simple tips for keeping tooth decay under control:

1) the most important time to brush your teeth is right before you go to bed. Those who do not are basically turning their mouths into an incubating biological weapons factory for 8 or so hours each night.

2) Brush your tongue. All the papillae in your tongue gives it plenty of surface area and nooks and crannies, making it a great reservoir for bacteria.

3) Brush each tooth and all its surfaces assiduously, spend at least 3 minutes brushing. Make sure you no longer have a white film to scrape off your teeth by the time you finish brushing. That white film is bacterial plaque and is a chief causative agent of tooth decay and periodontal disease.

4) chew sugarless gum. It's not just the xylitol (which helps as c132 mentions).. More importantly, chewing sugarless gum promotes salivation, which contributes the bulk of protection against tooth decay because saliva has goodly amounts of acid-neutralizing bicarbonate and helps buffer against acid attack.

5) FLOSS. If you don't floss, you will get cavities from the space between teeth, no matter how well you brush. The best time to floss is right after dinner (after you brushed your teeth of course), while you are relaxing in front of the TV. Might as well use that downtime for something good.

6) 6-month checkups!!!! And ask a dentist to explain to you the proper brushing strokes.

7) If you have any premolars or molars that has never had fillings done on them, GET THEM SEALED ASAP. Sealants on intact teeth decrease cavities on biting surfaces by 30%.

8) The most useless thing people can do is brush their teeth before breakfast. What they should be doing is brush AFTER breakfast.

Good luck.

 

[DcS]

Most people have hit the nail on the head but I will reiterate. As far as a 2nd opinion, by all means get one. As tom said, this is a significant amount of money you will spend, so it's worth it to get a second opinion if you think it might be necessary. As far as getting the work done at the dental school, I think it's a great idea. For one thing, it's cheaper. But that decrease in price does NOT come with decreased quality work. On the contrary, we dental students are checked over and over at every stage of the game to make sure things are going smoothly. I've seen patients come in with horrible looking amalgams done by experienced dentists, and the one I place looks outstanding next to the others. If you can get admitted in their patient care pool, it's something to be considered. Negatives are that it will take much longer to get all of that treatment done.

As far as the amalgams lasting 10-15 years, that's a pretty acceptable lifespan. How happy would you be if you car's tires lasted 10-15 years...after all, you probably pay just as much for 1 tire as you will 1 restoration.

As far as amalgam vs. composite...a lot is personal preference but there are pros and cons. The amalgams will last much longer than the composites, ie 10-20+ years per amalgam while the lifespan of composites vary (it's very technique sensitive so one dentist may be 10+ another 3 years). Composites, although with newer technology have shown increased retention, still will fail before amalgams do. Second, people will experience much more post-op sensitivity from composites in the posterior than the amalgams. That sensitivity can last for years. (I had a composite give me sensitivity on eating for 2 years, just got it replaced w/ amalgam big relief). Basically, IMO if you don't mind the esthetic compromise of having amalgams in your posterior teeth, I would recommend getting the amalgams.

Good luck

 

[no2thdk999]

Keraven,

I would highly recommend getting a second opinion. Not because it's unheard of for a twenty something to "suddenly" have 9 cavities but because you need to be able to trust your dentist. I would not mention that your seeking a second opinion at the beginning of the appointment. I would just ask for a new patient exam, let them take new x-rays (or bring your own but the cost and radiation is low), and if the second diagnosis doesn't agree with the first then I might mention the reason you're there. But don't bias them by telling them you have 9 cavities. I have a network of excellent dentists across the US from another forum, if you would like a recommendation let me know.

Second, quit getting cavities! If you would like my pamphlet on how to never get another cavity, let me know. It's really easy and has nothing to do with chemo, soft teeth, parents with soft teeth, medicine you took as a child, etc...

I would tend to stay away from the dental school. I hope the people recommending it here don't think they are currently at the peak of their skills. Do you think you're not going to be better at this after doing 8 hours a day for 5 years? Having been there myself I can promise you, you will get better and look back at stuff you did and wonder what you were thinking. If you're broke and have no other option go for it but if you don't feel like going through 4 appointments before you get to see the student and then only have one of your nine fillings done in a 2 hour appointment pay for the experience. I AM NOT SAYING STUDENTS PROVIDE BAD DENTISTRY, just that I think it's reasonable to think a seasoned dentist could probably do it better and certainly faster.

Nothing a dentist does lasts forever. 15 years is pretty good, but they can last longer with the appropriate care. Ask the hygienist to show you how s/he brushes and flosses their own teeth.

Silver vs. white: In the right situations a well done composite can last at least as long as a well done amalgam, and has other benefits an amalgam does not. The secret is in the meticulousness of the dentist placing it. Go with what your dentsist recommends, it is probably what s/he is more comfortable with and does a better job at. Ask what they would want in their mouth and why.

JMHO
Rob

 

[c132]

TRYMPO, a plaque score is simply a %age of plaque that is on your teeth. What we do is put a "stain" on your teeth that will only stain plaque. Then rinse it off nicely and boom it shows where plaque is on your teeth. A good plaque score is under 20% but it is highly variable. I keep my teeth VERY clean but by not brushing for one full day, I had a 75% plaque score.

What I do is take a plaque score then tell the patient to go and brush their teeth. Then do another. It shows the areas that they miss.


To Tom and Keraven:

The ADA does not recommend brushing for 3 minutes, but rather 2. I have a hard time getting my patients using their motorized toothbrush for 2 full minutes must less 3!!!! Too much brushing and brushing wrong for extended periods can be very bad on your teeth. And in a matter of a couple of years, you can show some severe wear on them. Telling someone who has not been "shown" the modified bass technique is not a real good idea. On a personal note, I told my father in law to brush for 2 minutes a day when I learned this my first semester, well, after I got to see him as a patient, he had some severe wear marks on his teeth that I feel was sorda my fault.

Keraven, remember it shouldn't be the brush that cleans your teeth, but rather the paste. A bunch of the motorized tooth brushes have a built in 2 minute timer and sonic care will beep every 30 seconds to let you switch quadrants. Taken that you are a younger person, IE medical school. I am sure that you are producing an adequate saliva count, so go for the xylitol containing gum, its been "proven" clinically to reduce strep counts....

 

[UBTom]

Shhh! Don't let the cat out of the bag, man! I'm telling them to brush for 3 minutes so that they will brush for at least 2. There is a method to my madness, y'see.

And yes, every one of my case completions and recalls get OHI on proper brushing strokes so they can brush as long as they want without fear of damage.

Seriously though, yes to prevent attrition is why I also mentioned that Keraven should ask her dentist to show her the proper brushing strokes during her 6-month recall. God knows how many Class-V restorations I have placed in the past 2 years.. And how many crown preps I've cut that incorporated a cervical abrasion that is pretty much a perfect ready-made buccal chamfer or shoulder margin.

 

[Vincristine]

Okay, to shed a bit more light on my situation:
Soda: I haven't drunk regular soda ever. Nope, bad teeth as a kid gets you less soda AND diet to boot. And I have at most two cans of soda a day. I'm a water girl.

Gym: I chew LOTS, after almost every meal or snack. Again, it's all Extra sugar free. Not sure that it has xylitol in it, but Orbits is pretty darn expensive for as much gum as I chew. Any less expensive brands with xylitol or is Extra just as good?

Tounge: I've had a tounge scraper for a couple of years. And a second in my on-call bag. I've recommended them to friends and family. Wouldn't travel without it and I don't find anywhere near the same results if I brush my tounge.

Dental School: Nope, not one here, but the reactions seem mixed at best.

Brushing: I currently have a Crest Spin brush. I had something much more expensive a couple of years ago (mother-in-law bought it, I don't remember what it was), but I hated it. So, I think it's better to have a lesser toothbrush that I will actually use than invest in a fancy one that I hate. (I practice medicine this way, too.....pts are real people!) I always (13/14 days) brush before bed. I also brush AFTER breakfast everyday, but I agree brushing beforehand is dumb AND it makes breakfast taste funny. I also make sure I brush when I'm on call. I've even been known to make a trip to my call room just to brush my teeth, not because I'm getting any sleep any time soon. I use Crest total. I'm a Crest kid, firm and strong. I'm willing to try a new toothpaste, but again, if I don't like it, I'm not likely to brush.....

Flossing: Okay, I can do better. 'Nuff said.

Plaque score: From the description, I had that done all the time as a kid, but haven't done it in years. (It's the pink stuff, right?)

Filling life: Okay, if 15 years is good, then I can't expect much more. However, I'm not thrilled since I'm only 26.

Second opinions: Given that it takes at least 4 months to get a new patient cleaning and exam at every dentist in town, I can't get an appt without stating I'd like a second opinion. However, I would think that I can atleast not reveal any more details until this dentist has made his/her recommendation. (That's the way it works in medicine.) I think the point about needing to be comfortable with my dentist is a good point. I'm less comfortable with her than I've been with any dentist. But she's given me much worse news than anyone else.

Amalgam vs composite vs whatever else: None of the fillings are in my front teeth and almost all of my current restorations are amalgum. I have no problem with the way my teeth look. Although, I guess it would be interesting to have my teeth be all white again. I'll continue to think about it, but given my past experience, I'm tending toward amalgam.

Sealent: I don't think I have any molars or premolars left without fillings. I have had them sealed in the past, however. I'll check and be sure to get them sealed if any are unfilled.

Okay, new question:
They advise work by quadrant. Given my schedule and the almost impossiblity to have time for 4 dental visits (sorry, no respect for the "I have a dentist appt" excuse in medical school), is it unrealistic to try to do it in two days, splitting the work by the side of my mouth?

Thanks for all the input! I'm quite amazed at the prompt replies -- I can tell you are (or will be) all good, caring dentists. DrSpongeBob, my pediatric dentist was Dr. Bob, but he was a strange man.....

 

[DcS]

As far as getting the work done by half at a time, I'll give you my opinion but I am only a 2nd year student, tom or rob will give you a more accurate answer. If the dds can block that much time in his schedule, I assume he will be willing to do it. We were taught that you shouldn't anesthesize the max and mand on the same side, so here at UNC they would recomment doing it cross-arch...ie like max right and mand left. Scary things can happen when a pt is completely numb on one whole side!

 

[UBTom]

Heya Keraven,

Chewing gum: I always have a 25-piece bulk pack of Trident in my scrub pocket. Costs $1 per pack at my local supermarket.

Tongue scraper vs. tongue brushing: I don't know how many directions you can scrape your tongue with a scraper... For that reason I like brushing my tongue instead with a toothbrush. However, there is no reason why you can't do both and cover all bases!

Brushing: A regular soft-bristle toothbrush is fine, especially for people who have no dexterity impairments. Crest is fine too. My personal kit is an Oral-B soft brush and Crest Multicare paste. The secret to brushing right is to use the proper brush strokes!

With proper maintenance, some amalgam fillings can indeed last quite a long time... Mine has lasted me 20+ years no problems. Too bad I grew up during a time when sealants weren't popular, otherwise I probably would have no fillings at all.

On working by quadrants: It's preferred like Dcs said so we don't have to numb up a patient in too many places and risk them injuring themselves by accidentally biting a lip or cheek or tongue without feeling it... Also, for most people the toxicity ceiling for Lidocaine is about 9 carpules. But in tough circumstances you might be able to get a dentist to do more stuff done per visit, yes.

Luck.

 

[c132]

I agree with Tom!! I gotta give him a hard time though!! What good is a fellow denty if they can't touch a nerve every now and again!!!!!

So serious, Tom does your school teeth away from composite cores? Mine so does!!!! I have about 7 dentists in my family and all of them use comp. cores 90+% of the time. Also what is your schools proto on temps? That is the worst part of ours. They want a temp that is perfect. A lot of times, my temps look better than the crowns that come back from the lab!!! None the less though, we spend hours on them.

Just think, a few more weeks and you will be makin the big $$$$$$$$

 

[UBTom]

I would tend to stay away from the dental school. I hope the people recommending it here don't think they are currently at the peak of their skills. Do you think you're not going to be better at this after doing 8 hours a day for 5 years? Having been there myself I can promise you, you will get better and look back at stuff you did and wonder what you were thinking. If you're broke and have no other option go for it but if you don't feel like going through 4 appointments before you get to see the student and then only have one of your nine fillings done in a 2 hour appointment pay for the experience. I AM NOT SAYING STUDENTS PROVIDE BAD DENTISTRY, just that I think it's reasonable to think a seasoned dentist could probably do it better and certainly faster.

Heya Rob,

Yep, a private dentist can definitely do things lots faster that's very true. But if nothing else, a dental school I think is an AWESOME place for a second/third/fourth opinion.

Shoot, the department chairs at my school teach in the clinics and I ask them for consults all the time when doing the comp exam and trying to formulate a tx plan, and they are THE experts in their disciplines.

Even if one does not want the actual tx done at a dental school by a dental student, I think one should at least take advantage of the comprehensive consultation services available at one.

Though that will probably disappoint the dental student though..

So serious, Tom does your school teeth away from composite cores? Mine so does!!!! I have about 7 dentists in my family and all of them use comp. cores 90+% of the time. Also what is your schools proto on temps? That is the worst part of ours. They want a temp that is perfect. A lot of times, my temps look better than the crowns that come back from the lab!!! None the less though, we spend hours on them.

Hey c132,

You betcha I'm excited! I am SOOOO looking forward to working without having to wait 15 minutes for an instructor to come and check my work.

My school has a pretty good mix of younger and older instructors.. The younger ones seem to like Fluorocore, another couple likes Tetric Ceram (!), and the older guys swear by amalgam. I've done a fair share of all of those but I think I like Amalgam cores because they are so fast! Just condense them in and that's that... Whereas with the composites I had to cure them by increments. I'm sure I'll probably do more composite cores though as my speed improves.

These past couple of weeks I think I've been improving my speed on making provisional crowns/bridges... We are preparing for our NERB exam in two weeks so I'm burning through a lot of ivorine teeth and making provisionals for them on a manniquin and typodont-- Makes me feel like a green freshman all over again. (shudder)

 

[Vincristine]

I just had this thought, and I'm somewhat ashamed I don't know the answer. I'm presuming there is "good" bacterial flora in the mouth the same way there is in the gut and the vagina. Does long-term antibiotic use have any effect on this good mouth bacteria the way it can in the gut or the vagina? In the past year, I was on Bactrim DS 1 qd x 6 months for recurrent UTI prophylaxis. I obviously had numerous other full courses of abx (usually Cipro) in the past two years -- much more than in the past 8 years before this. Any known effects?

 

[no2thdk999]

Heya Rob,

Yep, a private dentist can definitely do things lots faster that's very true. But if nothing else, a dental school I think is an AWESOME place for a second/third/fourth opinion.

Shoot, the department chairs at my school teach in the clinics and I ask them for consults all the time when doing the comp exam and trying to formulate a tx plan, and they are THE experts in their disciplines.

Even if one does not want the actual tx done at a dental school by a dental student, I think one should at least take advantage of the comprehensive consultation services available at one.

Though that will probably disappoint the dental student though..

Tom,

I agree, you will not get a less biased opinion of what NEEDS to be fixed than by a dental student trying to get it right for the professor since there's no $$ influence. Just don't want y'all thinking the truth is never given once you get paid for your diagnosis. You don't automatically lose your scruples when you get the diploma. One of my favorite things to tell people getting a second opinion is you can ask 7 dentists a question and get 8 answers. There are some who want to fill every piece of stained enamel or crown every craze line. There are others who won't recommend any treatment until it hurts or is oozing pus. Hopefull we find a happy medium that's best for the specific patient but it's hard to say who's right and who's wrong. It has a lot to do with the practicioner's and patient's risk tolerance, previous dental history, etc... Good luck on the NERB's!

Keraven,

First you are not allowed to use the word vagina on this forum!!! Second diet soda is better but it's still pretty acidic and can lead to decay. When it comes to cavities it's not so much the amount of sugar/carbs you have a day but the amount of time it sits in your mouth. It's not like a diet where if you eat 2 pieces of chocolate it's twice as many calories. It's much better for your teeth to have an entire chocolate bar eaten in one minute than half a chocolate bar that you let slowly dissolve in your mouth over the course of an hour. Third I consider myself a reasonably smart fellow (not MD material but...) and I thought I knew how to brush my teeth before dental school. It really takes someone 5-10 minutes of hands on showing you how to get to every spot. Those 10 minutes could save you $1000's over your life. It will all be for naught if you don't floss regularly though.

Bacteria do come in good and bad varieties but the mouth is a fairly consistent place and tends to repopulate with the same critters shortly after Ab therapy. The downside is that bacteria in the mouth form a nice sticky biofilm that is hard for Ab to kill off entirely.

Do a search for xylitol gum on google. Extra gum isn't bad for you, but if it's not 100% xylitol (extra isn't) you won't get the total protective effect. It actually works by selecting good bacteria over bad so if the gum is only 50% that's still alot of bad bugs floating around.

I would not feel bad doing everything in 2 appointments or even one if you had to. It's might be uncomfortable to have your whole mouth numb but as long as your over 5 years old you probably won't eat your lip off. Oral surgeons routinely anesthetize the entire mouth for wisdom teeth ext's. And if you get close to the MRD for lidocaine either your dentist is a bad shot or you need to be sedated. The downside is 9 fillings is a long time to both sit with your mouth open and hold a handpiece. I'd recommend two visits.


JMHO
Rob

 

[DcS]

As far as xylitol content, I believe Carefree Koolerz has one of the highest xylitol concentrations of OTC gums. I've recommended it to patients and they have seemed to like that type.

 

[totony]

Hi, this might be anecdotal, but several years ago I chewed lots of gums, and during that time my amalgam fillings got loose and had to be replaced (two fillings on the molar teeth, same side). My fillings are around 10 years so it was time to be replaced. But isn't chewing gum a trigger for this? I wonder if the pulling and pushing motion could destablize the filling. I don't know the answer and need input here. Thanks

 

[DcS]

Hi, this might be anecdotal, but several years ago I chewed lots of gums, and during that time my amalgam fillings got loose and had to be replaced (two fillings on the molar teeth, same side). My fillings are around 10 years so it was time to be replaced. But isn't chewing gum a trigger for this? I wonder if the pulling and pushing motion could destablize the filling. I don't know the answer and need input here. Thanks

I read an article a while ago stating that certain gums are very sticky and can, if chewed enough, loosen/weaken fillings. This can be avoided by chewing sugar-free or xylitol based gums.

 

[gpg]

have you considered checking out an outsourced dentist..... since the US is sending out all work to countries like India,you might find a dentist who will do an equally good job......and the total cost including the travel and stay will be lesser than what u will have to pay there.....

getting down to serious stuff,
1)if u have not been to a 2thdoc for 2 years....pls don't do that....
2)Use a mouth wash at least once a day....and massage ur gums when u brush ur teeth...
3)remember its not how much but how often u eat the forbidden stuff that matters....so if u eat 1 huge candy bar....thats better than 10 small toffees....
4)get all the work done asap.......remember....fillings are much easier and cheaper than root canals....
5)I am sure u don't have the time to get ur work done from a dental school....
6)Composites,done the right way,are the best solution today.....they bond to the tooth look good and conserve toth structure....I will put it this way....with amalgam you are "filling" your tooth.....but with composites you are "restoring" your teeth.

all the best!

 

[Kung Foo]

Keraven,

Your mum is probably right about the chemo when you were 3. Your ameloblasts (the cells that make the tooth enamel) are extremely sensitive to environmental influences including chemo. They make tooth enamel from the time you are 4 months old until around 15 y/o. So, they were certainly at work when you were being treated for the tumor. Unfortunaly, teeth don't remodel like other hard tissues (aka bone) so you're stuck with what you got.

The important thing (unless you want to end up with full dentures or a mouth-full of expensive implants) is to control the caries in your teeth and around your restorations, etc. If you get a second opinion on the work that needs done, ask when you call for an appointment if the practice is PREVENTION-based, meaning that they focus on measures to help you avoid getting mroe cavities. Another doctor (or the one you saw) may also be able to develop a priority list to enable you to tx the most urgent problems first and the rest as you have time.

Good luck!

jw

 

[no2thdk999]

Your mum is probably right about the chemo when you were 3. Your ameloblasts (the cells that make the tooth enamel) are extremely sensitive to environmental influences including chemo. They make tooth enamel from the time you are 4 months old until around 15 y/o. So, they were certainly at work when you were being treated for the tumor. Unfortunaly, teeth don't remodel like other hard tissues (aka bone) so you're stuck with what you got.

If her decay was due to chemo at age 3 we would expect to see all of Keraven's teeth affected since the crown of every permanent tooth is normally still developing at this age. She reports her decay is limited to the posterior.

Also long term chemo/radiation in kids can cause abnormalities such as root agenesis, malformed roots, discolored enamel, etc... but most studies show no increased rate of caries.


JMHO
Rob

 

[Vincristine]

I got my second opinion on Friday by a dentist I trust (had done work on my mouth previously, highly recommend by many, many other people, etc). I explained the whole situation. I wasn't too thrilled that he asked to see the treatment plan from the first dentist before he took a look because I was hoping for a completely unbiased opinion. But I was trying not to be difficult, so I gave it to him. Even though I brought copies of my full set of recent x-rays, dentist #2 took his own set of bite wings because the copies were difficult to read (he said). (I was a tad annoyed because I had to deal with dentist #1, their lack of customer service, and paid $25 for copying, and then dentist #2 didn't want them.)

His recommendations were to replace one filling which has decay beneath it and replace a second filling because it is needs to be replaced. That's it. He said he wouldn't completely disagree with all of the other work dentist #1 said I needed, but his philosophy is different. First, he does not feel comfortable replacing all my silver fillings with resin (as dentist #1 suggested) given the fact that I am obviously not the perfect patient and filling my mouth with something requiring more maintain is NOT the way to go. Most of my fillings will need to be replaced over time, sure, but only one has to be done now. Why not get another couple of years out of my current fillings rathern than replace them expectantly?! As for the crown dentist #1 ordered, dentist #2 said I'm most likley looking at a crown some point down the line, but again he sees no reason to do it now. I have a couple areas of decay between teeth, but given that I have room to improve with flossing and flouride rinse, we can watch them since they haven't penetrated the enamal yet.

Over all I was quite pleased, and not just because he told me I didn't need a ton of dental work. It was the fact that he asked about my lifestyle, and took my proposed surgical residency into account when making decisions and recommendations. The next 4 months should be a good test of my ability to keep up with my dental care and we'll reevaluate things then. He hopes I've kept my end of the bargin and won't make him look like an idiot. This is a VERY important point -- if you don't work WITH your patients and have reasonable expectations, you're likely harming both of you!

Today I got my flouride rinse (something I've used on and off since I was like 5), new floss (he recommended Oral B Complete over Glide), and both Trident and Orbits (in hopes that I can like one of the them over my X-tra). I'm trying to get excited about this.

Thanks again for all the advice and input!

 

[UBTom]

Bravo!

Patients who are compliant with home care and maintenance instructions, have a high "dental IQ", and are willing to stick with the recall schedule are the best patients! It makes life a lot easier for us dentists.

Good luck, and hopefully your next checkup will yield good results!