The Quality of Your Oral Practitioner

 A Compilation of Issues From Experiences

It is unfortunate that a page like this is included. One or even a few oral practitioners are not representative of the entire population. This information is provided to you with the intent that you avoid sharing in the unfortunate experiences of others.

Can They Really Tell If You Brush?

Make sure that your oral practitioner can actually tell the difference between someone that does and does not brush. Some seem to be unable to. Highly discolored teeth is not evidence of poor oral hygiene. It could be evidence of a health problem. If you know people with periodontal disease then you also may have noticed that despite their best efforts at proper oral hygiene, many of them seem to have highly discolored teeth. Included are people that don’t have habits that discolor teeth. There was nothing found in the literature that explains this phenomena. This might be a good litmus test for selecting an oral practitioner if you choose to work with one. You know if you brush or not and all the accusations in the world do not change that. You may accumulate tartar very quickly on your teeth despite your best efforts to prevent that from happening. Some people accumulate tartar more quickly than others. See the abstract section for more information on calculus or tartar and tooth discoloration.

Misunderstandings and Miscommunications

Make sure when they explain things there is not some creative misunderstanding included. Ask questions, verify your assumptions and set your expectations. Then convey back those expectations to make sure that you completely understand and ask if you have omitted anything. For example, your periodontist may be explaining scaling treatment and mentioning that you might see an oral surgeon as well and include the statement that your teeth will look longer as the result of treatment. It seems clear from that discussion that it is the visit to the oral surgeon that makes your teeth look longer, not from the periodontist. When the periodontist is done and there are large pieces of gum that have been removed, they then may make it clear that you misunderstood. They say that gum tissue that they cut off during the scaling process never grows back.

Proof of Tartar

Before any practitioner convinces you to do this treatment, they should prove to you that you actually have tartar build up under your gums and that this treatment is justified. Just because you have been diagnosed with periodontal disease does not automatically mean that you have tartar built up under your gums. If your are in the habit of cleaning your own teeth with a drug store issue tartar scraper your may have neither plaque nor tartar. For example, your periodontist may write and say that you have high tartar to be insured that they will do the treatment and justify the treatment. Since the typical individual with severe periodontitits has tartar below the gum line, they may just automatically assume that you do too, without even looking. They may go as far as to fabricate this on the written record after the scaling to justify the treatment that they did. Acknowledging that you do not have tartar is not worth the same dollars. You should be supsicious if you have consistent previous records that indicate your plaque and tartar have always been low, or, if you clean your own teeth, you know that you do a great job from your dental checkups, and you have been keeping them clean. If you suspect this to be the case, get a second written opinion. Talk to your dentist about it and ask for their opinion.

The difference between scaling, planing and cleaning

Cost and time. Search the web and ask your dentist and periodontist for a clear distinction. We were unable to find anything that indicated there is a distinction between scaling and planing and just a cleaning. Scaling and planing are done with pain killers because they do tissue damage. When this procedure is complete, it can result in several days to a week of pain that causes the individual to not be able to eat or sleep. When your body is in pain, it is trying to tell you there is something wrong. Cleanings can be done without pain killers. Both of these procedures remove not only what is on your teeth, they remove natural material as well. You should be informed of this consequence and any other consequences. When the information is not volunteered ask a lot of questions about the procedure and all of its side effects.

Do they acknowledge the healing?

If your gums and teeth appear to be healing, but your oral health practitioner is not acknowledging your healing, it is in your best interest to excuse yourself from the appointment. An oral practitioner that displays an inability to correctly assess what is sitting right in front of them has openly displayed their capabilities in their field. If they are missing important evidence sitting right in front of them, then you should be wondering what else they have missed. If they are openly refusing to acknowledge it, they are of no use to you. If you are not in front of the highest quality practitioner you can find, you are not going to receive the treatment that you need and may receive treatment that you don’t need. Let the referring dentist know that the periodontist cannot seem to render an accurate assessment and ask the dentist for an opinion, a new referral or get a second objective opinion elsewhere.

If you know you are healing, at each visit with the periodontist that are far apart in time, you should specifically request a new probing examination and a tissue assessment, before you allow them to treat you. Your periodontist may refuse to acknowledge your healing because that is not worth the same dollars as the treatment. When they are done with the treatment, they may state that the treatment was entirely successful, because of the scaling and now you are healed. Needless to say if your problem is caused by an allergic reaction, then this makes no sense. It does make the written medical records a source of amusement for others, but that should not make it worth it to you.

How Dumb do They think You Are?

Don’t be the victim of an oral practitioner that seems to think the average patient is incompetent enough to believe anything. Some operate on that premise. Listen carefully to your assessments and make sure that you feel they match to your actual condition. Listen to their suggested treatments and always consider if you really believe it is necessary and what the potential alternatives might be. Consider the permanent and long term consequences of any treatment path.

Probing and Root Damage

The signs of root damage are: pain while chewing both in the up and the down motion, sensitivity to hot, cold, sweets and acid foods. The effects of root damage do not show up immediately after treatment and may show up weeks later. The periodontist that uses an ultrasound device and presses hard, too long, or holds it at a bad angle to your teeth, can do root damage, as one possible method. Once root damage is done, and your gums are inflamed also, you can start resorbing your roots. In the abstracts section there are a few citations on this topic. In addition to the pain manifestations, root damage may show up in your next probing. Your pocket depths should be fairly consistent at the four corners of your teeth and around your teeth. If your periodontist managed to crack your roots, this will show up as secluded areas with very deep pocket depths. Some practitioners seem to be a little quick and careless with probing and can actually miss this at your follow up examination. If you are suspicious ask your dentist for an examination or get an objective second opinion.

Probing is when your dentist or your periodontist use a sharp pointed thin metal instrument with measurements on it to measure how deep the gum pocket is all around your tooth. 

Wipe off the instruments

If you decide to have the scaling treatment done, ask the periodontist to wipe off the instruments right in front of you. Some sharpen them and then don’t wipe them off afterward before beginning to work on your teeth. The result is that they are leaving little metal filings embedded into your gums. Many people are allergic to metals. Metal filings should not be embedded in your gums, allergic or not.

Keep Your Teeth

Pulling your teeth out can be an act of maiming and permanent, irreversible damage. You should be completely certain there is no alternative before you allow them to do something like this. You will be stuck with what they did for the rest of your life. Your roots will no longer be stimulating your mandibular bone for normal bone turnover. This will result in further bone loss. Eventually, you will have nothing left to stick your dentures to and will be surviving on a liquid diet. If it turns out that you are also allergic to products like denture grip or the material that these dentures are made out of, you will have a very serious problem. The fact that you have to live with what they did every day of your life is not their problem and some seem very quick to suggest pulling many teeth out because it is their opinion that you are going to lose them anyway. Keep your teeth. If you problem is an allergic reaction or a sensitivity and you remove the allergen or irritant, it will heal.

Keep Your Teeth Healthy

It is possible that your dentist will decide not fix a tooth with a cavity or repair some dental work because they feel that you are going to loose that tooth anyway. There is no guarantee that you are going to lose the tooth anyway. Leaving a problem in your mouth that is causing constant irritation is not your objective. Allowing a cavity to continue to rot your teeth because they don’t want to fix it is possibly doing a lot of damage to that tooth it is a continuous process of decay and infection trapped beneath dental work that you cannot get at to clean. If you cannot get them to fix the problem, get someone else to fix it.

Alternatives?

Whenever they suggest doing something, you should ask what the alternatives are. If they cannot answer your questions or give you explanations to your satisfaction, go elsewhere for information. Depending on the circumstances, perhaps you need to go out of their field for opinions and information. You can also do research on the internet and use the NIH database.

The Full Story

Make sure that you have the full story on anything they do. You do not want to be in a position where you set your expectations only to find out that these expectations were wrong. You do not want to find out there are more risks and consequences you were never informed of when you agreed to any treatment or any process. This includes any restorative dental work. Make sure you are informed of the health risks that are associated with any dental material and the risks of any procedure. The scaling process and regular cleanings not only remove what is on your teeth, they also remove some of your natural material. Cutting up your gums is apparently permanent damage.

Intentions and Goals of Each Appointment

You should make sure there is both agreement and commitment for each appointment For example, if you make an appointment for scaling and want a really quick re-examination before the scaling is actually done, make that clear. If they agree to do this, make sure they do instead of jumping right into scaling. Excuse yourself from the appointment if they don’t and get your examination done elsewhere. If you have healed sufficiently, you may not need this scaling treatment. If they do the examination and you feel that you disagree with the results, make sure it is clear up front that you may in fact refuse the scaling treatment and will be leaving the appointment. Get a second objective opinion.

Objective Second Opinions

If you have any doubt about accurate assessments, get recommendations from others on who has a good reputation and who does not. You should not need to convey anything about your oral medical history to get an honest and objective assessment of your current state. Always get a written report and specifically ask that any relevant information is also included in the report. You can tell an oral practitioner up front that you would like an objective opinion and a written detailed assessment.

Are They Keeping Up?

Some of these practitioners do not keep up in their fields at all. They could be conveying information to you that is several years old and not be at all familiar with the most recent breakthroughs or even knowledge that is common to most others. A couple of years is a long time and in most of the sciences there is significant technical progression in that period of time. If you are suspicious you can check the answers to questions that they gave you in the NIH database or get second opinions. Alternatively, try someone that is almost right out of school. You can look up the licenses to practice medicine for every health practitioner right on line in your state. They are likely listed under civil service. You can find out how long they have been in practice. Longer is not always better or more experienced and there is almost no relationship between how much experience someone has and how much skill they have in their own field. This is especially important if you are not comfortable with treatment options and would like to know what the alternatives are.

Amount of Anesthetic

There are two things that you want to avoid at your oral practitioner visits, an overdose and a severe allergic reaction.

The anesthetic that they give you should not be staying with you for hours on end. If it is, then perhaps you should find out how much they are using and what it is. Some of these practitioners apparently do not know how to adjust for body weight. Others seem to think that you really want to be as numb as they can possibly make you.

You have a right to decide just how numb you want to be and how long you are willing to tolerate it after the appointment. The anesthetic is not for them, it is for you. Some of these practitioners never considered that you would like to eat within the next 10 hours and you really do not have any appreciation for the painkiller keeping you numb for 20. If you have had any problems in the past, or you have never been for a scaling appointment, it is in your best interest to do your homework so that you can tell them how much to use and what. You are the one that has to metabolize it afterward and put up with all the discomfort while you are waiting for that to happen completely.

The anesthetics that they use are not harmless substances. Every molecule of it has to be processed by your liver and eliminated by your body with several systems all working together. Too much of the substances over taxes your liver and those systems. If those substances were perfectly safe, you would be able to buy it over the counter and there wouldn’t be any precautions on the label.

If you react to these substances and don’t realize it yet the amount that you are administered makes a huge difference and can make the difference between a tolerable and a very severe reaction. Every time there is a reaction, local anaphylaxis occurs on a tissue or organ and does tissue damage. Its bad enough that your body has to eliminate all of the substance, its probably better not to set yourself up for damage so that you can do the elimination.

Anesthetics are measured in standard units called a carpule. That means that one carpule of 1 substance may be equivalent in effect to 2 carpules of another.

Start with your dental work. If a dentist has used an anesthetic on you, find out how much and what it was. If you need to, find out for every time they did an injection. You already know from those appointments how numb you were and how long it lasted. You also know whether or not you reacted to the substance at all. Amount matters and if you periodontist is inclined to give you 10 carpules of something when your experience so far is with only 1 carpule for a filling, you can have a very serious reaction if you are allergic to it. If 1 carpule gets you numb enough, you should be questioning why they intend to use 10 (hypothetically). You will be able to figure out how much anesthetic keeps you numb for how long. This may vary from person to person.

Send your dentist a letter requesting the information on how many carpules each visit and what was used. Include a self addressed stamped envelope. This way you will not be bugging your dentist with a phone call while they are trying to see patients. Refuse your periodontal treatment until you have this information.

Once you know what they used and how much was used, you can then start discussions with any oral practitioner that you intend to us, with what they intend to use and how much. You should discuss what you feel comfortable with. You need to take care of this before your appointment. If they argue with you, then don’t do the appointment Tell them to do it without the painkiller. You will have to sit still for ½ hour and they will have to be a lot gentler. You have to decide if you really think it is that necessary to get it done or if you really want it and are willing to sit still. Enduring pain for a ½ hour is a lot different than suffering the consequences of substances for hours on end, plus dealing with and any potential damage they may have done to your organs by not adjusting properly. Talk to your MD if you need to, perhaps they can help you out. If your oral practitioner agrees to a certain amount before the appointment, make sure at the appointment they have not forgotten what you agreed to before they inject you.

An Allergic Reaction to the Anesthetics

If the side of your face begins to get red and hot after their work, you might be allergic to the pain killers. That redness and burning sensation is due to a histamine release. See your MD right away or go to the ER. Maybe they will take a blood sample and find out how much you were given. Always check your throat after your appointment to make sure you do not have hives. If you are allergic and you do not keep the amount under control up front, you can have a very severe reaction. Any reaction, no matter how minor, is doing tissue damage to you. If you have any sort of a rash or skin eruptions on your face on the same side you were injected in your gums, that too can be evidence of an allergic reaction.


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