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Archives for April 2018

Pediatric Dentist Missed Massive Cavity

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I’m not sure how this could have happened. My son was just into the dentist’s office a couple of months ago. They did x-rays, a cleaning, and a checkup then gave him the all clear. I thought everything was fine, but a few days ago he woke up crying about a tooth hurting. I called his pediatric office, but they only work four day weeks. I wasn’t sure what to do. He was in so much pain. I ended up calling my dentist and asking if they would be willing to have a look at him. They were, thankfully. I brought him in. When they did an x-ray, they noticed he had a massive infection. My dentist said there is no way that wasn’t there at his last appointment. It was so bad they had to take his tooth. It was a molar, which worries me. I think I heard they’re important for children to keep. I was grateful my dentist was good with my son, so the appointment wasn’t too horrible for him. They gave him some medicine to make him sleepy and relaxed before the removed the tooth. I don’t know what I’d have done without them. Is it normal for a dentist to miss something this big? Should I say something?

Patsy

Dear Patsy,

A little girl smiling in a pediatric dental chair

No, your pediatric dentist shouldn’t have missed that. While some infections can blow up quickly, it sounds like that one was there for a while. I’m glad you were proactive in calling your office. Something else which bothers me is the lack of emergency protocols at your pediatric dentist’s office. It’s fine if they want a four day work week, but they should have something in place in the case of patient emergencies. The fact that they don’t, makes me wonder how much they truly care about their patients.

I would certainly bring it up with them. Not only did their negligence cost your son a tooth, it could have been much worse if the infection spread to his brain or heart, both of which are quite close to his jaw.

Your intuition about his molar is right. While some baby teeth can fall out early with no consequences, the same is not true about molars. They need to stay until your son is about twelve years old. The simple solution is to have a space maintainer placed where his molar was. That will keep his teeth from shifting, causing crowding later. If your office hasn’t done so already, ask them to place one.

You Don’t Have to Go to a Pediatric Clinic

It doesn’t sound like you’re being well-served by your current pediatric. In your place, I’d look for another one. If you live in an area where there is only one pediatric clinic, it’s perfectly acceptable to go to a general dentist who enjoys treating children and do a fantastic job in relating to them. I suppose you’ve seen that with your dental clinic when they stepped in to help you.

You may even want to just let your son start visiting your clinic, if it’s okay with them. Your son seemed to respond well to them and they seem quite attentive. The important things are your son gets the care he needs and he has positive experiences with his dentist. This way he gets a lifetime of care without anxiety.

This blog is brought to you by Dr. Raymond Bolt.

Affordable Way to Fix Neglected Mouth?

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I’ve been out of the country for ten years. My brother had been taking care of my mother who has Alzheimers. I plan on staying here for a year and then moving her to Europe with me. I’ve come back because my brother’s wife is ill so I’m taking over my mother’s care. I was appalled at the state of her mouth. One of the first things I did was schedule her a dental appointment. She needs so much work (three teeth pulled, a handful of crowns, several fillings, etc), the dentist suggested I just extract her teeth and give her dentures and be done with her teeth. Is that an affordable way to deal with a neglected mouth?

Sandy

Dear Sandy,

Image of dentures

It’s great that you’re stepping up and taking care of your mother during your brother’s difficulties with his wife’s health. Alzheimers makes being a caregiver quite challenging so I’m sure he’s grateful for your help.

Every dentist’s philosophy is a little different (along with their prices). In general, full dentures can cost anywhere from $1300 to $3500 per arch. Tooth extractions can cost between $75-$400 per tooth. If cost alone is your only deciding factor, I’d simply ask the dentist you prefer for prices on dentures versus the sum of all the individual procedures needed without dentures. However, I’m going to suggest there are other factors to consider. then suggest affordable dental alternatives.

Dentures Have Problems

  • Her chewing capacity will go down significantly
  • They move and will get food under them
  • They’re not as comfortable as other options
  • They”ll cause her to lose jaw bone

Alzheimers is a Factor

Alzheimer patients are forgetful. Because this solution is a removable one, it may be hard for her to keep up with their maintenance as well as just where she puts them for the evening. It’s very likely she’ll remove them.

Some Alzheimer patients can grow angry and violent. It’s not a judgment on your mother (or any other person affected by this horrible disease). It’s more a matter of this is how many of them respond because they’re frightened, not hostile by nature. You’ll need to consider whether she’ll cooperate with keeping them in or not.

Preserving Tooth Structure is Better for Her Health

Given the downside of dentures, many patients grow to dread mealtime. It’s important she receives good nutrition as part of her treatment. If eating becomes painful, she may refuse, not realizing she’s actually harming herself.

However, the biggest problem is facial collapse. I mentioned earlier that her jawbone will begin to shrink. Eventually, she’ll lose enough bone structure that her jaw will no longer be able to retain her dentures, making her a dental cripple. Then, she’ll have no way to eat and will essentially be relegated to a liquid diet.

Instead, you might want to consider getting dental implants for her teeth which can’t be saved. This preserves her jawbone and makes it much easier for her to eat.

Affordable Ways to get a Lot of Dental Work Done.

In your place, I’d ask the dentist to list out all the work she needs done in order of most urgent to least. Phased treatment is a great way to save money. It allows you to do the work a little at a time as finances allow.

Be careful to distinguish between affordable versus cheap dentistry. Let’s say one dentist charges $600 for a dental crown and the other $1000. You might think saving $400 is a really good deal. Now let’s say the $600 dentist uses subpar materials in order to make up his profit margin and you end up replacing it three times before the $1000 crown ever needs replacing. Are you still saving money? You want affordable quality, not cheap.

Almost every dentist I know is willing to work with Care Credit, a medical credit card. They only fund medical procedures and have very workable terms, including some with zero interest. Also, there’s no penalty for paying it off early. This may allow you to get a little extra work done.

This blog is brought to you by Dr. Raymond Bolt.